In general, the COVID-19 pandemic qualifies as one of the most impactful disasters of the 21st century, posing difficult and unparalleled challenges to healthcare professionals as well as health systems worldwide. Health systems faced with the overwhelming demand for health capacity have created numerous guidelines showing how patients should access healthcare services. From a philosophical standpoint, utilitarianism has emerged as the key ethical theory in references to public debate in regards to response to the pandemic. According to Beauchamps & Childress (2019) utilitarianism stipulates “the right act in any circumstance is the act that produces the best overall result as determined by the theory’s account of value” (p. 354).
The concept is based on the premise that the right action in a given circumstance is typically the act that maximizes utility, that is, the value that guides actions, policies, and programs. In a healthcare setting, the moral obligation of a healthcare professional is to maximize utility as it is termed as the right thing that should be done. In this regard, it is quite essential to examine how utilitarianism applies to the COVID-pandemic from a healthcare perspective by examining its numerous principles.
To begin with, one key rule of the utilitarian approach is to save the greatest number of patients other factors considered constant in a healthcare setting. This principle is particularly applicable to the lockdown situation by evaluating the number of lives that would be lost in the event of a lockdown. Given a specific scenario where one patient has a 90% chance of recovering whereas another patient has a 10% chance of recovering, medical attention should be provided to the patient whose recovery probability is high. In a situation of scarcity, the treatment duration should always be optimized to save most lives.
On this notion, Beauchamps & Childress (2019) point out that “probabilistic judgments would likewise play a role in the physician’s utilitarian calculation of the right action in response…” (p.357). Regarding the availability of resources, the more resources or treatment used by a patient, the more likelihood other patients will die since they cannot access treatment.
The second crucial aspect of utilitarianism is a patient’s length of life. According to a utilitarian standpoint, it is important to consider how long a patient enjoys life in that it affects the amount of good produced. Therefore, in a pandemic situation, lifesaving treatment should be preferred to save patient’s lives for longer than those regarded for shorter periods. As a result, a consequentialist approach for this basis is the preference to save young people over the old population. Length of life is also pertinent to the lockdown situation as it has had significant implications for the assessment of policies in various countries. For instance, in the case of Italy, the average age of dead COVID-19 patients in Italy was 78.
This is an implication that the majority of those saved through the implementation of lockdown would have reduced life expectancy. Based on a consequentialist perspective, the value of quality life remains the same irrespective of a patient’s age. Nonetheless, if the COVID-19 pandemic generally affects patients with low life expectancy, the advantages of a lockdown would be minimal compared to illnesses that have an impact on young patients.
The third aspect of utilitarianism concerns the patient’s quality of life. Utilitarianists do not only consider the length of a patient’s life after treatment, rather recognize their quality of life as it is termed as crucial. In another context, there emerges a dilemma regarding the involvement of lesser degrees of cognitive disabilities. According to utilitarianism, cognitive disabilities and impairments should not be left out in determining decisions of allocation in the event if they compromise the patient’s welfare.
This is a concern highlighted by Beauchamps & Childress (2019), “Because of the benefits to society of the general observance of moral rules, the rule utilitarian does not abandon rules, even in such difficult situations” (p.358). Nonetheless, the comparisons of general welfare between patients are not straightforward. It is not certain that a person with a disability has lower welfare compared to a person without impairment. As a result, the most profound ethical question concerns what makes life happy or worthwhile. The quality of life is also pertinent to lockdown as the life saved by the implementation of curfew and lockdown were bound to reduce the quality that would affect the overall benefit.
Responsibility is another important element of utilitarianism in healthcare. This theory stipulates that people are morally responsible to the degree that the impact of their acts is foreseeable and can control them. Thus, failing to take a certain course of action that would lead to maximizing utility is equal to the intention of causing that harm. In several ways, utilitarianism presents itself as a demanding theory in healthcare in that people are morally responsible whenever they foreseeably and avoidably consider a lesser good. In collaboration to this notion, Beauchamps & Childress (2019) states “it demands that people strip themselves of many goals and relationships they value in life to maximize good outcomes for others” (p. 360).
For healthcare professionals, if utilizing an optimal policy necessitates research, then they are should be culpable for the occurrence of deaths as a result of the pandemic. Another pertinent challenge in the allocation of resources is the responsibility for illness as majority of healthcare professionals have the awareness that such responsibility should be considered in the account of resource scarcity (Beauchamps & Childress, 2019) Responsibility remains relevant for consequentialists provided it affects probability, quality, and length of survival.
More importantly, the social benefit is a core objective for utilitarians. According to Beauchamps & Childress (2019), “The goal is to realize the greatest good by balancing the interests of all affected persons” (p.356).
A key premise of this ethical theory is that the consequences of actions, whether long-term or short-term, remain significant to decision-making. In the event of a pandemic, maximizing utility would take the form of providing priority to healthcare professionals and those offering key services to others in a healthcare setting. This has been evident in countries such as the United Kingdom in COVID-19 testing as it was conducted out of the reason that healthcare workers could return to work earlier. Subsequently, this brings about the concern about the social worth of other groups of people. The development of rules to evaluate social worth is complex from an ethical viewpoint, and they are difficult to fairly enforce as well.
In conclusion, utilitarianism is a counterintuitive and demand theory in its application in healthcare. Its consideration during the pandemic is based on the notion that to discard it would mean the suffering and dying of people avoidably. As discussed, there are several good reasons to sacrifice the welfare and lives of others such as preservation of liberty. Nevertheless, the choice of decisions should be considered in full awareness of ethical cost and transparency.
A utilitarian approach is fundamentally neither easy nor simple as it requires healthcare professionals to choose the course of action that is likely to benefit most patients to the greatest extent, irrespective of how counterintuitive or challenging they may be. During a pandemic situation, a healthcare professional and worker should consider the number of patients to be saved, a patient’s length of life, quality of life, responsibility, and social benefit.
References
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics. Oxford University Press.