Moral Decisions and Pandemic

04-05-2020Fr. John LettersFr. John Bonavitacola

Dear Friends,

You may not have given it too much thought but you should, namely moral decision making in the time of Pandemic. One of the moral principles that we see in action right now is the principle of Subsidiarity. That is, that the higher level should not do what the lower level is competent to do. In this case the Federal government should not do what the states can do and the states should not do what the municipalities can do. The most effective responses come from the local level since a community knows its needs and how to respond to them. That’s why the state Governors are taking the lead and only asking the Feds for assistance when needed. The state should assist or provide where the municipality cannot and so on. The fact is that Arizona has different circumstances and needs from New York and Phoenix has different circumstances than Yuma so operating on the Principal of Subsidiarity would offer the most effective way for localities to help themselves and to be helped where needed without creating a bloated and inefficient bureaucracy or a one-size fits all approach.

The issue of DNR’s (Do Not Resuscitate Orders) has obvious moral consequences. It was reported that some Hospitals were issuing blank DNR’s for all elderly patients. That turned out not to be true. But if they had been that would be a form of invidious discrimination. Any DNR that is based on a person’s age, race, gender or ethnicity would be immoral. In the case of age there might be a 70year old who is much healthier than a 50yr old and therefore the 70yr old would benefit from the treatment much more than the younger patient. Obviously, the goal is to save everyone but when there are large numbers of patients needing treatment and a limited amount of resources, decisions need to be made as to who to treat first. This is called medical triage.

It seems with the coronavirus that patients with diabetes are hit particularly hard with the virus and have a greater instance of dying once they contract the virus. Based on their underlying conditions a person without diabetes could be offered say a ventilator first since they have a greater chance of benefiting from the treatment. But if you were to say that since people with diabetes who contract the virus have a higher mortality rate and since a high percentage of Native Americans have diabetes, therefore we will not treat any Native Americans, well that would be obviously immoral discrimination based on race. The challenge medical personnel face is that many of these decisions need to be made quickly which is why they need to be guided by a set of moral principles and ethics so they can make the best decisions, often life and death decisions in moments of great stress and pressure.

Another issue that we should consider before making policy decisions generally goes like this: “if we do this, even if it saves one life, it is worth it”. Now every human life has intrinsic value and we believe in the eyes of God everyone has infinite worth as well. But do we really want to make large policy decisions based on the idea that if one life is saved it is worth it? So, for instance we know that every year tens of thousands of people die in vehicle crashes. So, would you say that we should ban all vehicles, cars, trucks, motorcycles so that if even one life is saved it would be worth it? Or since we know that drivers under the influence of alcohol kill many people each year and additionally alcoholism kills many people each year should we ban the production and consumption of alcohol since saving even one life is worth it? (You could probably get me to agree to that one!) Probably not. The same is true with the quarantine, if we continue as is until there is a vaccine, and one life is saved or even many, is that the best decision considering all the other consequences such as loss of livelihood, loss of housing, the ability to feed yourself or your family, mental health crisis’s that will come, societal unrest etc.

There is another step we have to consider first. And that is how much risk are we willing to live with? In the case of vehicles, we have decided that the level of vehicle caused death is a risk we are willing to live while at the same time finding ways to mitigate the deaths. This is why we use seatbelts, airbags, have speed limits, highly visible signage and traffic enforcement. Still even with all that we accept the risk that car crashes will still happen.

The same is true as we make decisions during this Pandemic. Our Public Health Officials tell us that none of us will be safe from the virus until there is a vaccine. Therefore, the best course, medically is to stay in place until then. I don't question that as their best-informed decision. But that decision has lots of other consequences and many of them are dire. If large amounts of people lose their income, their housing, their ability to feed their families, in the end the cure may be worse than the disease.

Medical triage is a decision generally made on a case by case basis. But there are decisions that are more universal in scope that have moral consequences that impact us all and which we need to consider carefully as a society. First, who exactly gets to make the decisions? Is it just one discipline or one sector that has all the say or is it more of a multi-disciplinary approach? In this time of Pandemic is it only the Public Health officials that makes decisions on how we move forward? Or should other concerns be brought to bear on policy decisions?

We as a society have to begin asking ourselves how much risk is acceptable? Can we go about returning to something approaching normal using practices that mitigate the risk but do not eliminate it? This is where the principle of Subsidiarity needs to be employed again. Different high-risk groups may need to take greater precaution and different locales may be able to relax restrictions sooner than others yet always keeping in mind that what one area does can affect another area.

We may be between the proverbial rock and a hard place, no good choices, we lose either way. So, then what is the least bad choice? Not so easy to answer but the question has to be asked. Or maybe, please God, we can find a way to turn this thing around quickly.

Love,

Fr. John

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