COVID-19 may well be the greatest ethical challenge of our time, it asks of all of us – can we make sacrifices for the greater good? Can we make good decisions under pressure using ethical frameworks?
A tool that has long been used when teaching ethics is the ‘trolley problem 1.’ Students are confronted with the choice of allowing a trolley to continue on a track and kill five people or they can pull a lever and divert the trolley to kill just one. I’ve used this dilemma when teaching university students and business leaders – regardless, it always divides.
Even more so when the dilemma is layered with other factors. For example, what if the five are your family? What if the one is a Nobel Prize winner? What if they just discovered a vaccine – the vaccine? Individuals get uncomfortable trying to decide, and the underlying principles they use to justify a position can become confused.
The reality is that we are constantly making decisions that prioritise one thing over another, but often we’re not aware or honest about who are the winners and losers, and the trades that we make when balancing the harms and benefits of our actions.
Leading well in the time of COVID-19
COVID-19 brings the classic trolley problem to life as we decide who should get care when resources are scarce? Who should receive support?
In this challenging time, business leaders and directors would be wise to ask the question posed by the Classical Greek Philosopher Socrates - what ought one to do? It is a question for any situation where choice is being exercised.
Ethical frameworks to make tough choices
A framework can help answer the question of what it is you should do, rather than focussing on what you can do. Adopting an ethical framework assists in making good, considered decisions and puts leaders in a better position to justify and defend those decisions when they are explained to and questioned by others.
Often, we are faced with a tension between the needs and interests of different parties. For example, a firm needs to stay financially viable, but this may mean reducing their workforce. There is a tension between the financial interests of the firm and their duties to their people.
So, how can directors wade through such complexities to ensure management comes to good decisions that will stand the test of time?
Looking to the medical profession for guidance
The ethical frameworks used by the medical profession can provide good guidance. Many hospitals and medical colleges have well developed decision frameworks that cover the ethical considerations of their actions.
We can learn from these frameworks that are used by medical practitioners to make decisions that involve life and death.
Effective frameworks cover the following:
- Guiding Principles and Values: They identify guiding principles, such as to ‘treat people equally.’ 2
- Set Boundaries: They are clear in articulating the principles they don’t support, in setting the boundaries of what is acceptable. For example, ‘an individual person’s wealth should not determine who lives or dies.’
- Ensure Practical Application: Critically, they apply the values and principles to the practical situation, what they call ‘operationalising the values.’
- Recognise Complexities: A well-developed framework will consider a variety of factors and recognise that all values and factors can be compelling, and that no single value is sufficient alone to make a good decision. Instead, good decisions often require a multi-value ethical framework that can be adapted, depending on the particular details of the situation.
- Assess and Adapt: Medical colleges have produced updates to their frameworks based specifically on COVID-19 to ensure their frameworks are fit for purpose.
Decision frameworks provide guidance so that teams and organisations can make consistent and good decisions, even when under pressure. When it comes to decisions, it’s not perfection we should be aiming for, instead - good is good enough.
This slightly modified article first appeared on the CEDA blog in April 2020.
Clare Payne is the EY Fellow for Trust and Ethics, Honorary Fellow, The University of Melbourne and a former employment lawyer
References and Further Reading
Please see the following link to learn more about the decision frameworks being used by the Medical profession during COVID-19:
- The New England Journal of Medicine Framework: https://www.nejm.org/doi/full/10.1056/NEJMsb2005114
- Related Article: https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/
- The Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow as these already extraordinary circumstances worsen. The document begins by likening the moral choices Italian doctors may face to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, the authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”
- Reference to the Spanish approach: https://english.elpais.com/society/2020-03-20/spanish-doctors-prepare-to-make-difficult-decisions-if-intensive-care-units-reach-capacity.html
- Extract: The Spanish Society of Critical Intensive Care Medicine and Coronary Units (Semicyuc) has drafted an ethical guide to help doctors make those decisions. The text recommends that, given two patients, priority should be given to the one with the greatest life expectancy taking into account quality-of-life considerations. Neither this document nor the contingency plan drawn up by the heads of intensive care units (ICU) at Spain’s hospitals mention any criteria of age. Instead, the ethical guide says that “chronological age (in years) should not be the only element to consider in assignation strategies.”
- Article: Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629638/
- Article considering frailty: https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/age-is-just-a-number-and-so-is-frailty-strategies-to-inform-resource-allocation-during-the-covid19-pandemic/BAFAD41F10B8C93DF544C5F9F50F5289
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Footnotes
1 Philippa Foot, an English philosopher, first introduced this modern form of the problem in 1967. She was one of the founders of contemporary virtue ethics, inspired by the ethics of Aristotle.
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