Posted on April 10, 2020 at 9:00 AM
by Charles E. Binkley, MD
COVID-19 presents a moral crisis of epic proportion. One ethical quagmire after another has emerged. Clinicians are asking how to decide which of two or more equally deserving patients gets the only available ventilator. They are also raising well founded concerns about the lack of available personal protective equipment (PPE) necessary for them to do their jobs safely. The captain of a U.S. Navy aircraft carrier sacrificed his position by publicizing the threat on his ship in an attempt to save the men and women on board. People all over the world are asking for transparency and seeking necessary information about SARS-CoV-2 and COVID-19, particularly how to keep themselves and their families safe. Hospital administrators, militaries and governments around the world are mounting an increasingly authoritarian response, essentially stripping away any veneer of transparency, democracy, and proportionality. This authoritarian response risks causing greater and more enduring moral harm than the virus itself.
One of the most authoritarian responses, which has had global repercussions, was that of the Chinese government early in the crisis. After warning colleagues of a cluster of patients with SARS (severe acute respiratory syndrome) like symptoms, Dr. Li Wenliang was detained by China’s Public Security Bureau and told to stop illegal activities or he would face punishment. In an interview prior to Dr. Li’s death from COVID-19, he emphasized the necessity of transparency early in a pandemic so as to minimize the number of lives lost. The authoritarian personalities of other leaders around the world have clearly emerged in response to the COVID-19 pandemic. In democratic Hungary, Prime Minister Viktor Orbán used the pandemic as an opportunity to effectively silence government criticism and rule by decree, bypassing the parliament and existing laws. In Turkmenistan, leader Gurbanguly Berdymukhamedov reportedly banned the word “coronavirus” and threatened to arrest those who utter it. On March 25, the Philippine Congress passed the Bayanihan to Heal as One Act, granting President Rodrigo Duterte temporary, sweeping authority over many facilities and services, stopping just short of giving him power to take over private companies. Section 6 of the Act penalizes information that is subjectively deemed to have “no valid or beneficial effect on the population.”
Additionally, Philippine authorities are employing inhumane tactics, such as locking violators in coffins or dog cages, to punish those who break curfew laws related to COVID-19. Even in the United Kingdom, reports have emerged of authoritarian tactics by the police related to COVID-19 social distancing policies, leading one former supreme court justice to express concern that such behavior risks setting Britain up as a “police state.”
Emergence of authoritarian tendencies is also evident in the response that physicians, healthcare workers, and even the commander of an aircraft carrier have received when they raised valid concerns. In almost every interview with doctors and nurses working on the front lines and lacking the equipment necessary to adequately care for patients and protect themselves and the community from contagion, the interviewee has asked to remain anonymous for fear of retaliation by their hospitals or medical groups. Physicians have been fired for publicly raising concerns about the adequacy of protective equipment and COVID-19 testing at their hospitals. Other clinicians, some with underlying medical conditions that place them at higher risk for serious outcomes if infected with COVID-19, have been reprimanded and threatened with termination for wearing masks in public, based on concern for the hospital’s image. Well before the Centers for Disease Control and Prevention (CDC) changed its official policy about face covering, the medical community knew about the risk of infection from asymptomatic carriers of COVID-19 and clinicians sought to protect themselves, as well as their patients and families.
U.S. Navy Captain Brett Crozier, frustrated with the inadequate response to what he believed to be dire risk to the lives of his crew from COVID-19, alerted his Naval superiors. In a clearly authoritarian response, acting Secretary of the Navy Thomas Modly relieved Captain Crozier of his duties. The justification for dismissal followed a somewhat predictable pattern; acting Secretary Modly implied that the well respected captain had become emotionally “overwhelm[ed].” Similarly, senior officials of the U.S. Department of Health and Human Services allegedly questionedthe “mental health and emotional stability” of a whistleblower who raised concerns about the lack of adequate training and protection given to the team dispatched to help process Americans evacuated from China and other areas with high rates of COVID-19 infection. Calling into question the emotional stability of whistleblowers is a predictable authoritarian response that seeks to discredit the source and therefore discount valid concerns raised.
COVID-19 has unmasked latent authoritarianism in some sectors and placed a spotlight on its raw expression in other arenas, most notably governmental. Several ethical foundations have been violated or ignored.
Veracity, or truth telling, is an essential ethical principle, not just because it is the right thing to do, but because it is the basis of public trust and ultimately saves lives. During a pandemic, suppressing and punishing physicians, nurses, and healthcare workers for speaking the truth about inadequate training and lack of necessary medical equipment erodes public trust and leads to unnecessary suffering and death. Similarly, governmental suppression of data, discrediting whistleblowers, and punishing those who speak up is detrimental to the common good and deters others from expressing potentially life-saving concerns. Ambiguous medical claims based on insufficient or at best incomplete scientific data undermine the credibility of the individual and the information. The more inherent authority possessed by those making such claims, the greater the risk to public trust and safety.
Bioethicists often cite the harm principle to justify externally imposed isolation or quarantine. Recognizing the fundamental right to autonomous decisions, the harm principle can also be applied to the restriction of other individual freedoms when done for the greater benefit of society. These restrictions must be instituted in a finite and proportionate manner. The measure implemented should be the least restrictive and of the shortest duration to meet the stated goal. Authoritarian systems are capitalizing on the COVID-19 tragedy to impose limitations on freedom and liberty that are disproportionate to the stated need and scientifically baseless. These limitations do not seek to promote society’s common good or to minimize harm and suffering. Instead, these policies are opportunistic and immoral.
Most of us recognize these authoritarian responses to the pandemic for what they are. However, the authoritarian personality seems to attract followers who are highly dogmatic, severely limit their sources of information, and have highly compartmentalized minds. In their view, the authoritarian leader is always right, regardless of any contrary information with which followers are presented. Thus, although they are a minority, these followers are likely to worsen the pandemic by discounting scientific recommendations for prevention and treatment, suppressing legitimate concerns, and fostering a culture of fear.
In the context of a global contagion that is highly infectious and can be spread by asymptomatic individuals, authoritarian leaders and their followers pose serious moral and public health concerns. Alarmingly, when ensconced in positions of power, authoritarian types will cause unnecessary suffering and preventable deaths on a grand scale. The world will one day recover from COVID-19, but it may never recover from this moral lapse.