From triaging to quarantines, ethics underpin difficult public health choices during a pandemic, according to GVSU expert

In the scramble to enact the best public health and medical measures for responding to the COVID-19 threat, ethical considerations are always part of the fabric for public health decisions, a Grand Valley ethics expert said.

What the pandemic is laying bare, however, is how stark some of those ethical considerations are, particularly when it comes to scarcity of medical resources, said Jeffrey Byrnes, assistant professor of philosophy, who is an expert on clinical and public health ethics.

"I think people are doing their very best, from public health officials to governmental officials like governors, who at times like this become important public health officials," Byrnes said. "Even hospitals, which are existent to care for specific individuals, at this level of a pandemic become arbiters of public health in the way they treat and care for patients. They’re making decisions that impact the entire community."

The specter of possibly foregoing treatment for some patients in the event of scarcity — of ventilators, beds or even healthy medical personnel — has caught the public's attention and is at the heart of the "flatten the curve" rallying cry to prevent an overwhelming of medical resources.

The philosophy of triaging, where medical personnel prioritize which patients receive the allocation of scarce resources, is a longstanding approach on the battlefield, Byrnes said, but has now come to the forefront globally during this crisis.

Byrnes is quick to point out the standard used in triaging: survivability.

"The ethics literature is very concerned about this," Byrnes said. "What’s really important is that we keep in mind the nature of triaging involves a focus on the greatest possibility of survivability and not on any judgment of social utility. It's not a judgment about usefulness or longevity, it is a judgment about the ability to recover."

In a pandemic that has shown to be particularly deadly for senior citizens, there has been a global sensitivity that this population segment would bear the brunt of such decisions. Byrnes noted that while younger patients are more likely to bounce back from this illness, in a triage circumstance, survivability has to be medically determined case by case.

That emphasis on individual circumstances is key to an ethical evaluation of a patient's treatment at a time like this, Byrnes said. Doctors will advocate for their present patient's needs and triage decisions are left at a higher decision-making level.

"You want the person caring for you to be concerned about no one but you," Byrnes said.

Byrnes also emphasized the importance of medical facilities being as transparent as possible about their pandemic triage criteria and protocols to help bolster trust in the system.

These potential circumstances help underscore the urgency to limit the spread of the pathogen, particularly since other medical emergencies such as heart attacks, falls and flu complications will continue and put further strain on resources limited by treating the virus, Byrnes said.

Still, Byrnes warns against "overcorrection" in the push to protect those who are vulnerable by enacting social distancing measures such as quarantines or curfews. Ethical considerations include the economic hardship on people affected by closures and the effect of a top-down action on individual liberties in the U.S.

"What we need are very clear recommendations and concrete explanations of the incentives to follow those," Byrnes said. "Decisive action is needed at times of crisis, but officials also need to be clear about their criteria for determining when the danger is over so that this particular crisis would not become an open-ended rationale for extended top-down control."