Putting ethics into the ‘stuff like this’

Responding to suggestions that the UK Government might introduce immunity or vaccine passports, the Prime Minister in an interview on the 24th February first recognised that doing ‘stuff like this’ was a ‘novelty’.

He then promised a review, led by Michael Gove, which would tackle what the Prime Minister acknowledged were ‘deep and complex issues’. He added that a ‘proper review’ would involve the ‘best scientific, moral, philosophical, ethical viewpoints’. This is extremely welcome, but it is also striking that only now should the Prime Minister publicly state the need for ethical oversight of a new policy. Up to now, everything that has been done to tackle the pandemic and our recovery from it has been ‘led by science’ and it would seem only by science.

The Nuffield Council on Bioethics has repeatedly emphasised the importance of openly stating, and defending, whatever values and principles might underpin Government policy, whether it be measures of social isolation, trace, test and track, support for those most affected by the virus, prioritisation in health care, and, of course, the roll out of the vaccine. All of these matters must be justified not only by the best science, but also by the most robust and defensible moral arguments and considerations.

One reason the Prime Minister might think immunity certificates need ethical review is suggested by his use of the term ‘novelty’. What he probably means is that the use of the state’s coercive powers to enforce compliance with a public health measure is somehow a new kind of ‘stuff’. His later comments in the interview about mandatory measures not being liked by libertarians rather gives the game away. The Prime Minister is a conservative for whom the use of laws and enforcement policies to achieve certain ends is deeply uncongenial. For libertarians in his party it is almost unthinkable. That is why so much in this pandemic has often been simply left to trusting people to behave responsibly.

Yet everything a government does needs ethical justification, and not only measures of compulsion. And one of the most important ethical values in play should be that of fairness or justice. It is fascinating to note that this year is the fiftieth anniversary of the publication of one of the most important books of English-speaking political philosophy, John Rawls’ A Theory of Justice, one whose influence is more than ever relevant. Rawls thought that a liberal democratic society should not only guarantee and protect the equal liberties of every citizen, but also ensure that the distribution of social goods is fair. Here is not the place to discuss Rawls’ view of what fairness means. What is important is his idea that a good society should be a fair one.

Consider then how the pandemic has undoubtedly adversely affected individuals in different ways, and has arguably reinforced existing inequalities, for instance between BAME communities and the rest of society. Consider how measures of social isolation have disproportionately affected children, those living alone, and those unable to access services. Consider how the shutdown of various sectors of the economy has disproportionately affected some, those who cannot work at home for instance. Is all of this fair? What should we say about the way in which different social groups have been queued for vaccination? The recent change in official advice to give adults with learning disability priority in receiving the vaccine or the demand by many that teachers get the vaccine early is evidence enough of how people think about what is fair and proper.

Now some might say that we are in an emergency, that we must in consequence simply be pragmatic and respond to the urgent demands of the crisis. But whilst emergencies may necessitate a different balance of moral considerations, it does not mean that ethics has no place at all. Much of the thinking behind policies seems to have been a rather crude balancing of benefits and harms – save as many lives as possible, reduce the pressures on the NHS, get as many people back to work as we can. As a previous blog has argued we can, and should, consider the different moral values that might be relevant to guidance on vaccine prioritisation, finding a place as the German Ethics Council does for justice and solidarity, and not merely think in terms of overall numbers.

The Nuffield Council wrote to the Government in December 2020 noting the forthcoming roll-out of the vaccine, asking for clarity on the ethical values that might underpin any advice it followed. In February of this year, it convened a roundtable of experts to consider once again what considerations should inform the next stage of that roll out. All present agreed that fairness is a core value and that special attention should be paid to the recognition of those social groups who had a claim of justice to be prioritised in the roll out.

In respect of the possible use of vaccine passports fairness is absolutely relevant. The Prime Minister promised not to be ‘discriminatory’ against those who for good reason cannot have the vaccine. But fairness is relevant not just to who can get the vaccine, but to when they get it, and whether they can access whatever might be the form any passport might take. Most importantly it is an issue of fairness if a passport system creates a two-tier society, one in which – to use the worrying words of the Israeli Health Minister whose Government has effectively used the passport system to mandate vaccination – those who are not vaccinated ‘will be left behind’ .

Ethics is relevant to all the ‘stuff’ that Governments do, and is especially relevant now as we begin to see a way out from the pandemic. The Prime Minister promises a review of vaccine passports that will take account of all viewpoints. We don’t yet know what the review process will be, nor who will be involved or consulted. The Nuffield Council has for 30 years been the independent voice of informed bioethical opinion and advice in the United Kingdom. We are ready and willing to contribute to that review.