Ethical reflections about COVID-19

"Age is not the key, and security is not the only thing"

Here is a short extract from a document which brings together a series of reflections, the result of consultations and specific situations detected throughout this complex and unprecedented period in our lives.

2020 will go down in history as the year of the coronavirus pandemic, among other reasons because of the great impact of the measures applied at health, social and economic level... where on many occasions decision making has faced considerations of values and rights with the consequent ethical conflicts.

We must contribute an ethical vision to the current and main problems of society and of people's daily lives, because it is necessary to make people aware that in every act and choice we make, some values take precedence over others. It is, in this sense, the responsibility of politicians and responsible institutions that are taking the lead in this crisis to be aware of the values that project the decisions and actions developed.

We believe it is important to reflect on some of them, to consolidate the positive ones and to amend those that require, in our opinion, corrective measures. In line with the above, firstly we would like to express our support for the reflections made by other organisations and professionals, against the inequalities that are sometimes occurring as a result of the measures adopted in the management of the current COVID-19 pandemic.

These days we have often asked ourselves what our concept of health is. Is it global? Does it include physical, psycho-affective, social and spiritual health? Are we respecting or considering all the dimensions of this crisis? On whom does it depend to look after community health? Does it depend only on the health authorities? The community response is shaped by the behaviour of each individual.

We have also questioned the line between individual responsibility and responsibility to the group. Do I have to do things that I don't want to do or that don't suit me? In this very individualistic society, can't I take my own risks? 

The close relationship and influence of the individual on the collective and of the collective on the individual has been repeatedly stressed. A relationship in which we must consider both others, society as a whole, and each individual.

It is the responsibility of each one of us, of social entities, institutions, etc., to defend, value and actively promote the values that we consider most important in our daily behaviour, so that they take root in our society, nourish and support decision-making, and generate policies and structures that will result in a society that is better prepared to face possible future crises, with maximum respect for the dignity, equity, justice and autonomy of people.

Distributive justice

Age, functional ability or cognitive level cannot be exclusive criteria in the provision of services or access to health care, as we have seen reflected in some protocols in recent months.

The only admissible criterion for the allocation of available health resources is the expected benefit, according to scientific evidence, to each person.

We consider the containment measures imposed to be appropriate in an emergency context, and therefore limited and temporary in nature. Any protocol of action outside this space of temporary urgency consideration, should contemplate, after the analysis of each case, specific characteristics and resources, as well as options/alternatives that may lead to a greater achievement of other principles and values, and to the benefit of the integral health and well-being of the people.

In this situation of crisis we maintain the right to express our wishes in advance, and to have them taken into account when making decisions about our person, to be able to give informed consent, to be able to renounce treatment and also to be able to assume certain personal risks.

Attending to diversity

Residential centres are not, nor do we want them to be, hospitals. They are people's homes. Many of them need support. And although it seems obvious to remember this, these people have the same rights as other citizens. 

We are talking about very diverse spaces that allow, according to their different structures, profiles, available support..., to modulate the application of the measures, so that they adjust better to these characteristics and to the profile of the people who live there.

For all these reasons, it seems necessary to rethink the social and health model that we have.

To work for a model of care that serves everyone, including the vulnerable, the excluded, the disabled, the dependent, etc. A model that provides a comprehensive, coordinated and flexible response to social and public health needs.

A model that focuses on the person, and not only on risk and safety. 

Decision-making

The most prudent decisions in ethics are those that maximize the achievement of the greatest number of values. For this it is essential to count on others, to share.

We have shown a certain paternalism, considering that we know what is good for everyone. This lack of deliberation has tipped the balance towards one of the extremes, physical health, without allowing for alternatives that would embrace other values at stake. 

In any case, positive aspects can certainly be drawn from this situation. It seems necessary to identify, define and implement the good professional, managerial and social practices that we are experiencing, in order to learn lessons and make use of them. As well as from the personal resources we have demonstrated.

The resilience, acceptance, support in situations of suffering that many people have shown in the process is a reflection, which we must keep in mind, of the dignity of each person.

Face to face

We must not relax, but adapt and prepare for the future, for the new scenario. Plan services taking into account the lessons learned from this pandemic.

Taking into account the number of individual rooms, developing training and protocols designed for this new reality, strengthening the network of community support, volunteering, etc., can be an example of this.

As a society, we must take advantage of these milestones to move forward. Let us hope that this pandemic, beyond the terrible effects it is producing, will also have as a consequence an advance, a leap forward in the development of this global consciousness, which will help us to unite and lead us to share, in consensus, some universal objectives of love for all that we are and of which we form a part.