The ethics of emergencies must not become policy for peacetime

The ethics of emergencies must not become policy for peacetime

Back in October I started a new part-time job, as Associate Head of Public Policy for the Christian Medical Fellowship (CMF). It is exactly the sort of job I came to London hoping to get…in 2007!

In the intervening years I got a Masters Degree in Philosophy, and had a lot of different jobs and experiences, all of which have come together to prepare me for this job.

So now the sorts of posts I used to write on this blog have a proper home – they’re not just my independent musings, but things that might actually reach the types of audience they are relevant to (and not just you kind, interested people!).

I’ve written a few posts for CMF now, but here’s one you might find interesting and helpful as we hear stories of limited resources and doctors having to make extremely difficult – often life and death – decisions. Please do be praying for our medical teams and the emotional toll this disease is taking on them, as well as the physical one. Thank you.

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The ethics of emergencies must not become policy for peacetime

One of the questions proponents of abortion like to pose to their opponents runs like this: If you were in a hospital that was burning down, would you save a tray full of frozen embryos or a single child?

This is supposed to prove that we pro-lifers don’t really believe that an embryo is human, because if we did, surely we would want to save the many, not the few? To choose the child, they say, would be to deny the value of those embryos.

The answer, of course, is two-fold. Firstly, humans are not rational creatures. Although a level-headed utilitarian calculation might show that those frozen embryos had the potential to bring more happiness to more people for more years than the one sick child, our emotions should, one would hope, be drawn by the cries of the one, terrified child. The second part of the answer is related; the choices we make in a time of crisis are not the same as those we make in times of ‘peace’. The calculations we make when resources are limited when only a few can be saved are not, and should never be taken to be, a blueprint for how we should distribute care when the crisis has passed.

Our hospitals are not burning down (please, God), but healthcare professionals throughout the UK and across the world are having to make incredibly difficult life-or-death decisions in this current crisis. Who to put on a ventilator? Which surgeries are urgent and which can wait? Which patients to see in person and which to care for by phone or video link? Who to take heroic measures with, and who to palliate until the end.

These decisions are heart-wrenchingly hard. We may strongly disagree with the decisions our superiors are making. We may feel the pressure from our juniors and other colleagues. We will get it wrong, sometimes. But these are clinical decisions, based on the expected efficacy of care. They are not moral decisions based on the value of the patient’s life.

Unlike John Humphrys, writing in the Daily Mail last week, we do believe that all lives are equal in the sight of God. Every person was specifically, individually, carefully and deliberately created by him. He knows every hair on their head, every cell in their body. He knows when they sit, when they rise, and when they fall. He knows their every thought, hope and dream. Before a word is on their tongue, he knows it completely. And he loves each one with the same passionate, compassionate, self-pouring-out love. And he has numbered each of their days. Those who are given ten days are no less precious than those who are given 10,000 or 30,000. Length of life does not equate to value of life. Neither does the presence or absence of disease or the capacity or otherwise to fight infection.

Where we do agree with Humphrys, though, is that we can’t ‘dump nine million individual human beings into a box labelled “the elderly” with all that implies’. Nor do we treat all disabled people the same, or all those with underlying health conditions. To extrapolate from our individual decisions in these highly pressured days and draw broad generalities from them would be a serious mistake. And it is one we must be alert to.

Extraordinary measures

These extraordinary measures are just that – extraordinary. They are not lasting judgements on the value of individual patients or segments of the population. Neither should they be monetised and used as a basis to argue for the legalisation of assisted suicide in order to ease the financial burden on an NHS which was stretched to breaking point even before this crisis.

Because it’s true; in coldly utilitarian terms, allowing those who request it assistance to end their lives would save the NHS money, and could even increase the availability of organs for transplant. Such are the findings of a recent report published in the journal Clinical Ethics. Its writers used QALYs (quality-adjusted life-years) to calculate the cost-benefit to the NHS of legalising assisted suicide and euthanasia. At their most conservative estimate (based on the Oregon model), they state that legalising assisted suicide would produce a net gain of 1,907 QALYs per year (and ten times that many using the Netherlands model, which includes euthanasia). The Times reported this with the headline, ‘Assisted dying will save NHS cash and provide organs’.

The report has been criticised by groups on both sides of the assisted dying debate, not least because campaigners for assisted suicide prefer to present their position as arguing on compassionate grounds, not the ‘money-grabbing’ ones The Times identified. The report’s authors also repeatedly state that they do not intend financial considerations to be ‘primary arguments’ for assisted dying. They are merely trying ‘to get a sense of the order of magnitude of the population-level health benefits that could flow from legalising assisted dying’.

And indeed they have shown that life could be better for a lot of people if those who felt that their ongoing care was a ‘waste of resources’ were allowed assistance to die. It would also save money to end the lives of the elderly, the long-term sick, and those who clog up our surgeries with minor complaints, simply because they’re starving for human contact. But this is no reason to do it. No matter how clearly and lucidly they request it. The value of human life is not measurable in pounds and pence.

One ‘thoughtful Tory’ may have told The Times that during the coronavirus crisis, ‘It is unsustainable to have people in their youth put their whole life on hold for months while the economy tanks to save a 91-year-old who would have died six months later anyway’.

Yet thankfully, that is what we have committed – have been commanded, even – to do. Because that ‘91-year-old’ is not a figure on a balance sheet. She is one of our parents, our grandparents or our vulnerable friends. She is a person, and people matter. Relationships matter. No-one is disposable.

And because she, and the 53-year-old asthmatic, and the 14-year-old cancer patient and yes, even the BBC’s former ‘rottweiler in ­residence’, John Humphrys, are persons, that means that the life-and-death decisions being made in hospitals and surgeries around the country will be painfully personal. Just as those who we choose to palliate instead of intubate are not QALYs on a spreadsheet, neither are those who have to make the decisions, or carry them out. When we come out of this, when at last we emerge, blinking, into the light, we will need to provide emotional, mental and spiritual care for those who are deeply traumatised by what they have seen, done, and been tragically unable to do. And we must not turn these emergency measures into peacetime policy.

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This post first appeared on the CMF blog, where you can find other informative and helpful posts on a variety of angles for this extraordinary time.

2 Comments On This Topic
  1. Ann
    on Apr 4th at 9:59 am

    This is brilliant, Jennie. (For such a time as this, comes to mind)! A succinct reminder not only of the dreadful decisions we expect medical staff to make – and always with our friends and family at the top of their priority list – but together with the much wider issues that could do easily creep on unawares when this is all over. They certainly do need our prayers.

    Reply
  2. Katy Walton
    on Apr 4th at 9:24 pm

    This is such an interesting post. My father has autism and has seen some disturbing posts about treatment of chronically ill patients during this time. This fills me with more encouragement for what is to come.

    Reply

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