Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation—that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option—fails to adequately accommodate the complexity (...) of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options. (shrink)

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework (...) distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. (shrink)

In many countries and regions across the world, the initial response to the massive health risks posed by COVID-19 has been the institution of lockdown measures. Although they vary from place to place, these measures all involve trade-offs between ethical goods and imperatives, imposing significant restrictions on central human capabilities—including citizens’ ability to work, socialize, exercise democratic rights, and access education—in the name of protecting population health. As such, it seems imperative for philosophers to ask whether lockdown measures are ethical.This (...) is a difficult question. We are deeply uncertain about the possible effects of COVID-19 and of lockdown policies, raising questions about... (shrink)

In their recent paper ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’ Savulescu and Cameron attempt to argue the case for subjecting the ‘elderly’ to limits not imposed on other generations. We argue that selective lockdown of the elderly is unnecessary and cruel, as well as discriminatory, and that this group may suffer more than others in similar circumstances. Further, it constitutes an unjustifiable deprivation of liberty.

With increasing inoculations and emerging coronavirus variants, governments worldwide are challenged to adopt proper liberty-restricting measures to reduce the spread of COVID-19 and minimise grave consequences for liberty and well-being caused by over a year-long pandemic. Cameron et al ’s proposal of a selective strategy addresses this pressing issue.1 Following Savulescu and Cameron, they argue for limiting the liberty of the elderly. But, instead of claiming not doing so is an instance of wrongful levelling down equality, they argue this discriminative (...) strategy is morally acceptable.2 I argue against the selective liberty-restrictive measures after proposing a revision of the five-limb proportionality test that plays a pivotal role in supporting their argument. The following is a reconstruction of Cameron et al ’s central argument: It is ethically acceptable to promote the best outcome. One way to promote the best outcome is to maximise utility at the population level without imposing unreasonable costs on the most vulnerable individuals. All else being equal, adopting selective liberty-restricting measures in the COVID-19 pandemic is the best way to maximise utility at the population level without imposing unreasonable costs on the most vulnerable individuals. If it is ethically acceptable to …. (shrink)