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Coronavirus And Bioethics

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Bioethics is life ethics or the ethics of human life from its beginning to its end. As a normative science, bioethics is concerned with the ethical problems connected with life, health, illness, and death. It is the ethical dimension of the life sciences.

In our globalized world, bioethical problems and dilemmas are to be addressed today – and the new coronavirus is making it totally clear – globally and grounded on ethical universal principles and values. We address the bioethical problems related to the Covid-19 pandemic from a global perspective.  

We reflect first on the bioethical dimension of the novel coronavirus in general and second on the dramatic dilemma posed by the scarcity of resources - of ICUs (Intensive Care Units), of ventilators, or assisted respiration.


Every human person is an individual and a social being. He/she possesses a precious unique dignity and inviolable rights, which are not given by others – by civil or religious authorities – but are inherent in the nature of the human person. The human person is the center of all ethical and bioethical concerns. Every human being, an ethical being, has unique and excellent dignity, which may be described as the possession of human rights that are inviolate: the right to life, to freedom, to the pursuit of happiness, etc.  

Certain universal ethical principles guide decisions concerning human life, in particular the principles of respect for every human being, for his/her dignity and rights. Essential values that help us practice respect for every human being:  life, freedom, justice and solidarity, truth, and the common good. At times, there may be a conflict among principles, for instance in the case of the coronavirus and other pandemics there is the tension between the principles of personal human rights and rights and the common good.


The main ethical dilemma here, particularly for healthcare professionals, is selecting among patients who should use the insufficient intensive care units (ICUs), including ventilators. The dramatic decisions to be taken ought to be according to basic and universal bioethical principles grounded on human dignity and rights and the common good.

            The main principles to guide us are justice, solidarity, and fraternity. Justice speaks of equality: to give to each person what is due to him or her, radically his/her rights. Solidarity leads us to work for the common good. Fraternity takes all humans as brothers and sisters, in a particular way the wounded on the roads of life, the affected by Covid-19.

All human beings are equal in dignity and rights and therefore “equal cases deserve equal treatment.” Unfortunately, as it happens in this pandemic and others, there are not enough ventilators needed by patients in serious condition: the demand of needed treatment is much greater than the supply of available means; there are too many patients for the use of an insufficient number of ICUs needed. In this case, experts speak of the painful application of the principle of catastrophic justice to decide who should be incubated and who cannot be.

Before applying the proper principles for a fair selection of patients, all other possible options should have been taken, so that rationing becomes the last and only option. What are the other possible options? Our experts mention the following: caring for patients in serious condition cannot be provided by other means; the patient cannot wait until a ventilator is available; a ventilator cannot be used by two or more patients at the same time; the patient to be discarded cannot be taken to another hospital with the required ICUs and ventilators; the relocation of other medical means destined to other patients who are not fighting for life is not possible, etc. We repeat: it is understood that the ICU is used in emergency situations and for patients that really need it and cannot be treated otherwise.

So the number of ventilators is not sufficient to cover the greater number of patients who need them. Among them, whom to give priority? This is not a new question. It was also the question in other pandemics and catastrophes from nature, and in wars. In wars: to choose among the many wounded whom to save, considering that not all could be treated by the few available doctors and nurses and facilities. It is also a problem regarding organ transplants: the demand is much higher than the supply. To whom may the kidney be given? PAV states: “The search for treatments that are equivalent to the extent possible, the sharing of resources, and the transfer of patients, are alternatives that must be carefully considered, within a framework of justice” (Pontifical Academy for Life, Global Pandemic and Universal Brotherhood. Note on the Covid-19 emergency, March 2020).


What are the criteria for selecting some patients over others? The general ethical principle applied in these rationing situations is the so-called triage selection. Triage is usually defined as “the process of deciding which patients should be treated first based on the degree of sickness or severity of the injury.” Selecting some patients entails excluding others. The Pontifical Academy for Life writes: “In such cases, after having done at an organization level everything possible to avoid rationing, it should always be borne in mind that decisions cannot be based on differences in the value of human life and the dignity of every person, which are always equal and priceless.  The decision concerns rather the use of treatments in the best possible way on the basis of the needs of the patient, that is, the severity of his or her disease and need for care, and the evaluation of the clinical benefits that treatment can produce, based on his or her prognosis.” 

Writes an expert on bioethics: “An initial criterion for making this selection would be the possibility of obtaining a significant benefit and reversibility of the severity of the condition in the treatment of recipients, in whom invasive mechanical ventilation, for example, would be indicated. Careful assessment of the chances of survival of these patients and the magnitude of the sequelae they may suffer as a result of the progress of their disease is needed. Accordingly, those with the best prognosis for recovery and survival with the minimum of sequelae would be selected” (Julio Tudela, Instituto Ciencias de la Vida. Observatorio de Bioética, April 11, 2020).

The application of the principle of utility (utilitarianism), of social usefulness, may be discriminatory. One unethical possibility – unfortunately a reality in some places – is discrimination against some groups of affected patients such as the elderly and the disabled. Let us listen to the answer of experts on the matter. First the Pontifical Academy for Life: “Technical and clinical means of containment must be integrated into a broad and deep search for the common good, which will have to resist a tendency to direct benefits toward privileged persons and neglect of vulnerable persons according to citizenship, income, politics or age… Age cannot be considered the only, and automatic, criterion governing choice.  Doing so could lead to a discriminatory attitude toward the elderly and the very weak.” Tudela puts it briefly: “The application of other criteria in a discriminatory manner, such as the age of the patient or other circumstances such as psychiatric disorders, dementia or any other forms of disability or dependency, would not be bio-ethically acceptable, because it would mean acting against respect for the dignity that every human being possesses.”


The medical/ethical decision to exclude some coronavirus infected patients from using the ICUs they need is not a form of euthanasia, but usually a painful decision, part of the only possible medical/ethical option. The infected patients excluded from the use of mechanical ventilators should continue hospitalized, when possible: a hospital offers much better care than a nursing home, especially the needed palliative or comfort care.

Palliative care includes medical, social and spiritual care: doctors and nurses address mainly the health problems and pain; close relatives and significant others, provide “a warm heart” that fights the possible loneliness of patients, and priests and pastors care for the spiritual wellbeing and peace of the patients. In the context of the new coronavirus, the Spanish Bioethics Committee (April 2020) suggests that at least a close relative of the dying patient should accompany him or her.  “This accompaniment and the spiritual and religious support constitute part of the rights of the patient.” Our Christian faith favors and practices as much as allowed, those suggestions based not only on our humanity but in the praxis of the Church throughout the ages. They are expressions of the merciful love lived and taught by Jesus Christ who had a special love for the vulnerable, in the case of Covid-19 the elderly and disables.

Before ending our reflection, let us underline the importance of two ethical principles: solidarity and subsidiarity. The principle of solidarity (justice and love of neighbor) is witnesses with al, principally with the most vulnerable in our societies and communities. Subsidiarity comes from subsidium, which means “assistance,” “help.” Both principles are usually together: “Solidarity without subsidiarity, in fact, can easily degenerate into a ‘Welfare State’, while subsidiarity without solidarity runs the risk of encouraging forms of self-centered localism.” Hence the State’s role in society must neither be invasive nor absent” (Pontifical Council for Justice and Peace, CSDC, 351). Situations of emergency, states of alarm, or exception ought not to be prolonged more than necessary.

May this tragic tsunami of the coronavirus Covid-19 help us all to be more open to others, to help the needy and most vulnerable, and to practice solidarity and fraternity! As one family, we can get out of this pandemic more co-responsible, more humble and wiser. We hope and pray!