Saturday, April 04, 2020

Bioethics blog as plague journal

I have not been active on this blog for quite some time. The causes are multiple, but one comes to my mind first: do people still read blogs, anyway? The doubt is de-motivational. Over the last years, it seems that more and more bloggers have switched over to Twitter, which is to say that they have stopped posting longer pieces beyond 'threads' on that platform. You can see Twitter's attraction: less of an investment in time and greater likelihood of immediate feedback or impact. It fits better in our life-work imbalence. This blog too has been associated with a Twitter account since 2012 (@BioethicsGlobal), but over the years I have found that the elements that make Twitter attractive can also make it repulsive. I think Twitter ought to be renamed 'Oversharing', or more to the point, 'Hostility'. I am there for the retweeted news items and pet videos, mostly.

So why back to the blog, if blogging has been culturally sidelined? The answer, like the (unhappy) answer to a lot of questions these days, is COVID-19. It is not a matter of getting likes or being retweeted, anymore than it was for Daniel Defoe when he wrote A Journal of a Plague Year in 1722. It is more a matter of trying to bear witness, in a medium somewhat more accommodating than Twitter, though without the detachment and hindsight that the coming tsunami of bioethics books on COVID-19 are likely to have. Right now, we really don't know where all this is going.

In the last two months, bioethics has been reacting to the COVID-19 epidemic in all sorts of different ways. One way to look at the bioethics response is by categorizing it (very roughly) in terms of medicine, science, politics and art.

Medicine: the speed at which recommendations have been formulated to guide the allocation of scarce medical resources has been amazing. It is almost an epidemic in itself. True, questions about fair allocation has always been in the American bioethics wheelhouse, even if talk of rationing health care there is also somehow taboo. It makes sense that bioethicists would want to be useful in this particular area, though you can wonder how much the schemes will really come into play in the terrible rough and tumble of ICU units.

Science: when a pandemic strikes the richer nations, there seems to be a rise in epidemiology talk in the general public. This could be a good thing, if it means entrenching a public health mindset. But sometimes it also means that a lot of people are talking out of their their hats. The more epistemological bioethicists find themselves combatting rumor and questioning the assumptions of mathematical models. And in addition, there is the question of what kinds of scientific studies should be conducted (and how) in pandemic circumstances, something much closer to home for European and American bioethicists this time around, when the mayhem is happening in Los Angeles and not just Liberia.

Politics: the virus is apolitical, but the responses to it by countries, communities and individuals are political through and through. As has been remarked before many times, and forgotten many times, an epidemic magnifies whatever problems were pre-existing in the body politic. And apparently we have a lot of problems, worldwide. Politicians may put re-election interests before scientific facts and public health imperatives. Instead of social distancing out of social solidarity, people may go out shopping for guns. In a horrible calculus, the value of the economy is weighed against massive numbers of the dead. Not to mention the geopolitics.

Art: there are a number of websites devoted to the COVID-19 pandemic from a statistical perspective. Deaths and confirmed infections per country are continuously updated. Like obscene things in general, the numbers are hard to look at and hard to look away from. But every death is terrible, for the person concerned and the fabric of relations from which they were torn. The human face of the pandemic, from the perspective of the infected, their families, health care workers, and others -- in this case to some extent literally everyone, even the billionaires -- also should inform how people in bioethics respond. This is a world of suffering and human drama, not a trolly problem, and bioethicists need to bring out their ethnologist, novelist, poet.

In the weeks (months?) that come, this blog will focus on the COVID-19 response in low- and middle-income countries, especially in sub-Saharan Africa. The pandemic is only just starting to pick up there. Different countries face different challenges, and context matters, but there are some overarching issues. The health care infrastructure in many places is weak. In most if not all countries, there is severe poverty. Social distancing or 'stay in place' may be unrealistic where people have challenges accessing running water, live in crowded townships, or rely on face-to-face contacts to survive. Unlike elsewhere, only a small minority have the luxury of continuing their livelihoods online. What ethical issues will this confluence of circumstances engender and expose? There is already concern that the global supply chain of medical resources is being diverted towards richer and more powerful northern countries, from whom Africa can seemingly expect little humanitarian aid this time around. What will 'allocation of scarce medical resources' look like when (as is feared) fragile health care systems are rapidly overwhelmed?


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