Monday Memo 04/27/2020

The Monday Memo

April 27th, 2020                                                                       PITT DPT STUDENTS

The Bioethics of a Pandemic: Navigating the Moral Challenges of a Global Health Crisis

This public health crisis we’re all facing right now has forced everyone to ask impossibly difficult questions of themselves and others. COVID-19 has impacted nearly life in our nation and worldwide. Undeniably, a lot has been lost: physical connection, employment, a shared sense of health security, and most devastatingly, human lives. In this time, I’ve learned (with help from others) that very few good things come from comparing someone else’s suffering to your own. Sharing the burden of suffering… now that’s a different story. We are ALL going through things that are incredibly taxing right now. Consider it like this: we are all in the same boat, but not in the same storm.

If you couldn’t already tell how much self-reflection this quarantine has sparked, it’s a new level over here – and I have been thinking a lot about ethics. To begin the conversation on bioethics, I want to make the distinction between the two terms, ethics and morality. Although exact definitions are disputed, ethics is generally thought to be the practical, guiding principles of “right and wrong” conduct that is distinguished by certain communities, while morality is the principles of “right and wrong” based on a more subjective, individual code of beliefs. That said, “bioethics” or “healthcare ethics” is a branch of applied ethics studying the implications of the philosophical, social and legal issues arising in medicine and life sciences.

             As if these concepts and practices weren’t difficult enough in “normal times”, add a pandemic to the mix?! I have been mulling over all the different topics of concern in bioethics right now, and I won’t lie, it is a bit overwhelming. Here are a few pressing ones on my mind (certainly not all-inclusive):

  • Allocation of scarce resources – most pressingly: ventilators/medical equipment, PPE, food, and monetary support.
  • End of life decisions, especially for those without a pre-determined preference. (shout out to Atul Gawande’s wonderful book, Being Mortal.)
  • Balancing individual (patient-centered care) and community health (patient care guided by public health emergencies). This includes clinicians following triage protocols that may cause them moral distress, since they have had to change their usual practice.
  • Ethical issues surrounding human vaccine trials and expedited research.
  • Wellness vulnerability of undocumented or low-wage immigrants, as well as people that are impoverished or homeless.
  • Damaging impact of spreading misinformation, which can lead some to respond in a way that puts themselves/others at an increased health risk.

I don’t mean for this to stir up fears (or even more anxiety) on top of what we are all already feeling. These conversations are difficult, but necessary. I often find myself exhausted from the 24/7 pandemic coverage and have to ration my intake of news. Taking inventory of my emotional capacity is one aspect of self-respect that I’ve engrained into my own moral code. Something I’m constantly struggling to follow. And not for everyone. But whether or not we watch ALL the news or only some, we should acknowledge that there is definitely an obligation to stay informed for the sake of our collective health. This leaves us with a tricky balancing act – watching for safety and not watching for sanity. Some tips: pick a few reputable sources, check in with them in a way that honors your emotional capacity, and then step back.

PT school has given me the tools to begin these conversations around bioethics, but I certainly can’t do it alone. By having these exchanges with others (as you’re able), we can build up our own moral toolkit. Taking a piece here and there from the people we admire. Take lessons now from the brave work of our PT colleagues in hospitals across the nation, who are acting out the highest form of APTA’s “altruism” value. Now it’s our turn to practice APTA’s “social responsibility” value by staying home! There is no easy answer for these modern bioethical questions, (a lot of them answered by the classic “it depends” PT school answer). But as I like to think…. In the words of Pittsburgh’s dear Mr. Rogers: “Anything that is human is mentionable, and anything that is mentionable can be more manageable.”

-Hannah Davis, SPT