In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine – including those over prioritising vaccinating the most vulnerable – as reflecting disagreements (...) over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input. (shrink)

A wide range of non-pharmaceutical interventions (NPIs) have been introduced to stop or slow down the COVID-19 pandemic. Examples include school closures, environmental cleaning and disinfection, mask mandates, restrictions on freedom of assembly and lockdowns. These NPIs depend on coercion for their effectiveness, either directly or indirectly. A widely held view is that coercive policies need to be publicly justified—justified to each citizen—to be legitimate. Standardly, this is thought to entail that there is a scientific consensus on the factual propositions (...) that are used to support the policies. In this paper, we argue that such a consensus has been lacking on the factual propositions justifying most NPIs. Consequently, they would on the standard view be illegitimate. This is regrettable since there are good reasons for granting the state the legitimate authority to enact NPIs under conditions of uncertainty. The upshot of our argument is that it is impossible to have both the standard interpretation of the permissibility of empirical claims in public justification and an effective pandemic response. We provide an alternative view that allows the state sufficient room for action while precluding the possibility of it acting without empirical support. (shrink)

How could the initial, drastic decisions to implement “lockdowns” to control the spread of COVID-19 infections be justifiable, when they were made on the basis of such uncertain evidence? We defend the imposition of lockdowns in some countries by first, and focusing on the UK, looking at the evidence that undergirded the decision, second, arguing that this provided us with sufficient grounds to restrict liberty given the circumstances, and third, defending the use of poorly-empirically-constrained epidemiological models as tools that can (...) legitimately guide public policy. (shrink)

How do social norms influence our choices? And does the presence of biased norms affect what we owe to each other? Looking at empirical research relating to PrEP rollout in HIV prevention policy, a...

John and Curran have convincingly shown that Scanlonian contractualism is a valuable resource for evaluating pandemic response policies, and that we should reject cost–benefit analysis in favour of a contractualist framework. However, they fail to consider the part of contractualism that Scanlon constructed precisely to deal with the question of when the state can restrict individuals from making choices that are harmful to themselves and others: the value of choice view. In doing so, they leave it open for opponents of (...) lockdowns to misuse contractualism to justify mistaken policies. This is because the most powerful contractualist objections to locking down are likely to be based on the VoC. When we apply the value of choice view, we see that a lockdown policy’s justifiability depends on the extent to which particular values of choice are found to be threatened by the policy in question, and what safeguards policy-makers have put in place to increase the value of choice and protect people from the harmful consequences of lockdown. Without the VoC, it is harder to explain why lockdowns, to be non-rejectable, must have certain features. With the VoC, the case for contractualism over cost benefit analysis can be made even stronger. (shrink)

Savulescu and Cameron supported selectively locking down the elderly during the COVID-19 pandemic on two grounds: first, that preserving total lockdown would entail levelling down and, second, that levelling down is wrong. Their first assumption has been thoroughly addressed, but more can be said about their wider antiegalitarian point that levelling down is simply wrong. Egalitarians are not defenceless against the levelling-down objection. Even though some consider it the most serious challenge to supporters of equality, egalitarianism possesses sound reasons to (...) assert, not only that something valuable is preserved when we level down, but also that preserving it may be, in certain circumstances, preferable to pursuing other fundamental moral goals. Although troublesome from a well-being maximising standpoint, levelling down ensures that healthcare policy reflects a commitment with the idea that people are equal in moral worth. That commitment is important enough to trump certain improvements in individual well-being. In the case of pandemic lockdowns, not all the interests protected by free movement are as fundamental as to pursue them at the cost of equality. Savulescu and Cameron’s framework is so reliant on the view that levelling down is wrong that it fails to account for the valuable loss that having the elderly suffer alone represents. (shrink)

[OPEN ACCESS] Commentaries on the ethics of Covid lockdowns nearly all focus on offering substantive guidance to policy‐makers. Lockdowns, however, raise many ethical questions that admit of a range of reasonable answers. In such cases, policy‐making in a liberal democracy ought to be sensitive to which reasonable views the public actually holds—a topic existing bioethical work on lockdowns has not explored in detail. In this essay, I identify several important questions connected to the kind of influence the public ought to (...) have on lockdown decision‐making, including how policy‐makers ought to handle misinformed or morally suspect viewpoints, and how policy‐makers ought to respond to minority viewpoints. I argue that questions like this, concerning the appropriate influence of the public on decision‐making, will be central to the field of bioethics as it increasingly focuses on policy and population‐level issues and therefore ought to be priorities for future work. (shrink)

The Covid-19 pandemic has been analysed and discussed from many disciplinary perspectives. An aspect that still needs critical exploration is the role—that is, the modes and forms—of regulatory interventions during the pan- demic. It is interesting to note in this regard that, in many studies, regulatory measures are labelled “non-pharma- ceutical interventions”, as if they do not have any specificity on their own and only represent a theoretically residual category. The main aim of this article is instead to focus on (...) the distinctive features of normative measures as such. As regards the article’s focus, it centres on the normative interventions in the first period of the pandemic—that is, 2020—with particular reference to Italy. We have chosen to focus on this period because the most extensive and severe restrictions introduced to combat Covid-19 were established at that time. And we have chosen to con- sider Italy because it was the first country, after China, to be hard hit by the virus and to react in a draconian manner. As regards the methodology, the article is based, in general and primarily, on an extensive interdisciplinary literature review. With reference to the Italian case, the study is additionally based on: first-hand data collection and analysis (especially concerning Italian normative measures mainly issued at the national level: their type, frequency, target, hierarchical relationships); second-hand data and analysis (for instance as regards the effectiveness of Italy’s and other countries’ regulatory measures). In discussing the Italian response to the Covid-19 pandemic, certain weaknesses have been identified; and possible lessons have been highlighted, in terms of both “planning” (i.e. the necessity to better pre-define concrete and circumscribed sets of actions) and of “meta-planning” (i.e. the necessity of better planning the way in which public authorities could and should plan and act). Although this article is mainly based on the Italian situation, what we can learn from this case is largely generalizable. (shrink)

Lockdowns were a morally and medically appropriate anti-contagion policy to stop the spread of Covid. However, lockdowns came with considerable costs. Specifically, lockdowns imposed harms and losses upon the young in order to benefit the elderly, who were at the highest risk of severe illness and death from Covid. This represented a shifting of the (epidemiological) burden of Covid for the elderly to a systemic burden of lockdown upon the young. This article argues that even if lockdowns were a morally (...) permissible response to Covid, the harms and losses they imposed on the young ground a claim of compensation. I defend an intergenerational compensation argument that defends a claim for an egalitarian intergenerational transfer to compensate the young for the harms of lockdown. (shrink)

The editors of the JME are grateful to its authors, reviewers and readers for their efforts and attention to the important and novel ethical challenges of the COVID-19 pandemic. These efforts meant that the journal published a number of high quality articles analysing these issues and it has shaped subsequent discussions and debate in exactly the way that we strive for. Ultimately, outcomes such as impact, readership and contributing to knowledge are what matters most for a journal, but the imperfect (...) metrics that journal performance is measured against matter too. So, the editors of the JME would also like to thank our authors, reviewers and readers for helping the JME score 5.9 in the most recent Clarivate Impact Factor rating. While that is not the highest IF in bioethics, it is worth mentioning that the highest citing paper from the bioethics journal with the highest IF, would have rated as the seventh most cited paper in the JME during this period. So, this latest rating reveals that the JME has had a very significant impact, readership and contribution to knowledge during the pandemic and we want to thank those who made …. (shrink)

Cost-benefit analysis (CBA) is inappropriate as an aid to Covid policy-making because the plural, incommensurable values at stake are not all amenable to monetary measurement. CBA for Covid policy is also undermined by pervasive uncertainty and ignorance, and has some troubling distributional implications. However, non-consequentialist alternatives to CBA tend towards implausibly absolutist prohibitions on risk imposition. Arguments for setting aside consequentialism for special circumstances (the precautionary principle, or a medical rule of rescue) are also problematic when applied to Covid policy. (...) A broad consequentialist approach to policy guidance is defended, one which does not demand commensuration on a common monetary scale. Despite the absence of commensuration, policy guidance is still possible. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic response and preparedness (...) such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

The paper discusses non-pharmaceutical interventions (NPIs) as a collective form of protection that, in terms of health justice, benefits groups at risk, allowing them to engage in social life and activities during health crises. More specifically, the paper asserts that NPIs that realize social distancing are justifiable insofar as they are constitutive of a type of social protection that allows everyone, especially social disadvantaged agents, to access the public health sphere and other fundamental social spheres, such as the family and (...) civil society. (shrink)