Responsibility versus choice

January 16, 2022

Most important ethical questions that have arisen in the context of the pandemic concern moral responsibility

Responsibility  versus choice

I tested positive for Covid-19 almost 10 days ago. The only symptom I had was a runny nose. No high-grade fever, no breathlessness, no body ache and above all, no fear.

Things were very different a year ago. People were dying or spending weeks in hospital only for “long Covid” to haunt them months later. So, what has changed? Well, a few things – we have better diagnostics that allow for prompt identification and isolation of cases, we know how to prevent spread, we understand more about how the virus causes disease and hence, have developed better treatments and we have vaccines. Oh, and the virus has also changed.

The moment I got my result, I immediately informed everyone who I had been in contact with so that they could look out for symptoms and also get tested. I then shut myself off for 10 days. I am always masked at work and when I go out to the market. I am still avoiding large indoor gatherings. I am fully vaccinated and also have had a booster. I am extremely conscious of the fact that I need to protect my family, my colleagues and my community. However, not everyone has adopted this stance.

Vaccines are working

My decision to get the vaccine was primarily based on the need to protect myself. I felt it was safe and would do the job well. I based my choice on data I looked at from the clinical trials that were taking place, whether it was made at warp speed or fast tracked, it was something. I trust the science; I have done so for decades. Despite reports of adverse events of one of the vaccines, when you think about the millions of doses administered, it’s a drop in the ocean. Even Panadol carries a safety warning of adverse reactions.

Currently, the highly transmissible Omicron variant is driving a sharp increase in Covid-19 cases, primarily among people who are unvaccinated — and this latest variant is infecting some people who are vaccinated as well. But the good news is that vaccines have proven to be effective against severe disease, hospitalisation and death.

Recently published data shows that it’s the antibody level that is key in protecting against symptomatic infections. Scientists measured how effectively each vaccine induces production of protective immunity in the form of antibodies against an Omicron pseudo-virus (a synthetic version), as well as the Delta and wild type viruses. The results were striking. Neutralisation of the Omicron variant pseudo-virus was low when they used samples taken from people who were recently vaccinated with two doses of an mRNA vaccine or one dose of Johnson & Johnson. But individuals who received three doses of an mRNA vaccine had a very significant neutralisation against the Omicron variant.

This explains the rapid roll out of booster doses and the house-to-house vaccination drive by the government last week. The government has accomplished the remarkable task of providing free vaccines to over 75 million Pakistanis. The vaccine has been made mandatory for public officials and many private institutions also have policies requiring employees to be vaccinated. We have seen the government start off with a gentle nudge to pushing people into getting vaccinated.

Balancing responsibility and rights for collective good

Some of the most important ethical questions that have arisen in the context of the coronavirus pandemic concern moral responsibility. The primary responsibility of governments is to create a balance between individual values and rights, on one hand, and the health of the population, on the other. We can think of individual responsibility as a virtue; it develops from crucial character traits and habits. The responsibility of governments is connected to individual responsibility through the values of trust and solidarity.

However, a society as a whole has to decide how to respond to scientific findings, instead of delegating policy decisions to scientists and other “officials”. The core ethical issue requires taking the right measures to “sustainably safeguard a high-quality and effective healthcare system whilst, at the same time, averting or mitigating the serious adverse consequences of these measures for people and society”.

Individual rights relate to the value of autonomy and autonomy is considered closely related to freedom of choice. In her paper, Jessica Fahlquist takes up the example of people having to wear seat belts. She argues that “seat-belt requirements and stop signs would be considered infringements on autonomy if it is understood merely as the freedom to act (i.e., ‘shallow autonomy’). In contrast, the value of ‘deep autonomy’ could be conceptualised as the value of making one’s own important life choices, assessed over a longer period of time, involving ‘reflection on the values by which one’s life will be structured’. It entails respect for an individual’s choices, but also for their capacity for conscious reflection upon these values. From this perspective, seat-belt laws are not infringements of autonomy because individuals can choose not to abide by the law”.

Decreasing the spread of the pandemic also requires that individuals take personal responsibility. Similar to individuals contributing to climate change and antibiotic resistance, they are unlikely to be solved or managed unless both states and individuals take actions. State action is crucial, but unless there are also behavioural changes among the individuals making up the population at large, long-term change is unlikely to occur. It is crucial for the current pandemic, but it will be even more important to prevent similar challenges in the future

However, the expectation that individuals will take responsibility for collective problems must be connected to individual contexts. Social, cultural and religious factors also play a role and determine the ease or difficulty with which individuals adopt responsibility. For people to be willing to take responsibility to develop the habits necessary for managing a pandemic, they need to trust their governments. Trust is relational and requires that the trusted party be worthy of trust. Trust in public-health officials has decreased in the past few years. This has led to parents refusing to have their children vaccinated.

Vaccination can be seen as taking responsibility for protecting others as well as oneself. Forcing people to protect others is unlikely to encourage virtuous behaviour. As Dawson et al put it, “You can compel action, but not trust”. Trustworthiness in those given responsibility requires action, and if authorities are open and honest with their information, trust is more likely to be maintained.

To overcome the pandemic, both governments and individuals need to take responsibility: will the twain ever meet?

The social pact, far from destroying natural equality, substitutes, on the contrary, a moral and lawful equality for whatever physical inequality that nature may have imposed on mankind; so that however unequal in strength and intelligence, men become equal by covenant and by right.”

Jean-Jacques Rousseau, The Social Contract

The writer is a consultant molecular biologist at the Aga Khan University Hospital regional laboratory in Lahore. The institution may not necessarily subscribe to the views expressed by   the author

Responsibility versus choice