Ethical ideals and the virus

Perhaps the most troubling ethical issue that has emerged from the current crisis is over the question of who is treated first. How can a medical professional choose which person deserves medical care over another if resources are limited? If these were once theoretical issues reserved for classroom discussions, today they are questions that are being put to a very practical test all over the world.

 

Recently I received a version of the question, which I had hoped I would never have to address, but the reality of our situation demands a response. The questioner wrote that he felt a great deal of anger toward the haredi public who have ignored the directives and continued to go to pray. In the questioner’s words: “And then they all end up in the hospital, and our society is collapsing as a result.” He then went on to ask whether, from the ethical perspective, if it comes to a situation of limited medical resources, should those who broke the law “go to the back of the line” in terms of who gets treated first?

 

Firstly, I would strongly urge all to avoid stigmas or generalizing against any one social group.  There is a basic ethical principle – that which we wouldn’t want done to us we should not do unto others.  We must all be fully aware that the haredi community is very far from being homogeneous, and, like every group, there are factions and individuals who act against the interests of the greater community. Furthermore, by speaking about the “haredim,” we run a serious risk of taking something from the legitimate ethical perspective and transferring it into a question about social bias or outright discrimination.

 

So the question must return to that exploration of medical priorities as a whole and independent of who the patient might be and with which community he or she might identify.

TO ANSWER this question, the traditionally accepted ethical perspective is that patients must always be measured based on their medical needs alone. Care must be provided without ever asking questions about religion, ethnicity, social status, gender or other factors that could lead medical providers to inject bias or favoritism into their approaches to treatment.

 

Ethical practice must also always work to avoid “collective punishment” of any sort.

 

The reality in the question is that even if one could argue that some “haredim” have failed in abiding by government regulations, many, if not most, are acting responsibly.

 

There is also a very practical challenge in trying to ever ask medical professionals to answer these questions. If we were to ask doctors and nurses to answer these questions, it would certainly come at the expense of their ability to best treat the patient.  Medical professionals are trained to focus on doing everything possible to improve and save the lives of their patients.  Anything else is a distraction from that goal, a distraction they cannot allow themselves at any time and certainly not in these days of incredible crisis. 

While I agree that in an ideal situation medicine deserves to be delivered equally, without taking into account who is the patient, the message that people’s actions should not be addressed in how we allocate care is also mistaken.

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If, in fact, a person brought his situation upon himself, like a suicide bomber, then he deserves to be judged based on that case. In the case of the corona patient whose fate was linked to failure to abide by the regulations, not only did he arguably bring the situation about himself, but, because of his personal ideological beliefs, he was likely harming others who would be affected by the continued spread of the virus.

 

I therefore contend that Jewish ethical perspective demands that we hold actors responsible in a way that the attacker and victim should not be expected to be treated equally.

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But I am forced to accept that this analysis is the ethical ideal – and not necessarily a practical one.  Practically, I return to the fact that we cannot risk collective punishment, and we cannot expect medical professionals to make these judgment calls. In a perfect scenario, these decisions could be made, taking into account all factors, medical, ethical and practical. In the real world, while someone who breaks the law should deserve lesser care than the law-abiding citizen, a doctor cannot make those decisions in the “heat of the moment.”

WHAT WE are left with is a critical educational lesson, which in many ways holds even greater weight than the theoretical one underlying this discussion.  

 

All who see themselves as moral human beings – and even more so, those who strive to abide by Halacha or any other legal system – should understand the weight of their actions.  Simply put, if you break the law, you should be sent to the back of the line. The fact that practicality and reality mean that this won’t be the case should be irrelevant. 

 

In these times of crisis and unprecedented challenge, our society needs to recognize that everyone’s actions directly impact on others, and that there is no place for such behavior. We should all firmly pray that this lesson is appreciated and internalized by all, and that, in so doing, people will choose the ethical and just path and allow our world to return to days defined by happiness, productivity and, most of all, good health.