Section IV


13. Allocation of Scarce Intensive Care Units and Ageism

Alcino Eduardo Bonella 

In the scenario of extreme scarcity of hospital resources for the high volume of patients in the Covid-19 pandemic, some protocols proposed or adopted, and some specialized papers, incorporated the cycle-of-life or age criteria as a relevant factor for the allocation of ICU beds and ventilators. In general, it is questioned which factors could be used, such as the severity of the patient’s situation, the order of arrival to the hospital, the greater or lesser chances of recovering from the disease, the age, a draw. It is a common observation that the age factor should never be used alone, but without totally condemning its use incorporated with other criteria. What can we think, from an ethical point of view, about the use of age? At first sight, our intuitions seem to conflict: one of the forms of discrimination, in the negative and condemnable sense of the expression, consists in arbitrarily disfavoring someone just because he is older; we have the intuition to condemn what can then be called ageism. However, with a little more information, and observing the most immediate attitude of medical teams at the beginning of the pandemic (as in the Italian or Spanish case, in which they even published initially guidelines indicating the use of age to prioritize the youngest, since they had a better chance of success with the intervention), we are left in doubt whether the use of the age factor, prioritizing for example in the case of Covid-19 the youngest, corresponds to something reprehensible or if the problem would not be exactly not using cycles-of-life or age. With further reflection there is however the ethical challenge that there is probably more harm in losing a younger life than an older one. When our intuitions conflict we need critical ethical thinking, which does not rely solely or even heavily on them, one’s own intuitions or past experience, however wise, but which appeals to practical-moral reasoning and the facts of the situation. I will try to present the outline of this in the issue of the use of age in the allocation of ICUs in the Covid-19 pandemic. Although an outline, there is apparently soundness in favor of using age and giving priority to younger people. The thesis to be defended is that this is the right thing to do. 

14. Rethinking Resiliency After Covid-19: Towards a Relational View.

Martina Orlandi

The Covid-19 pandemic has seen a striking increase in calls to be ‘resilient’. Universities released guidelines for “how to build resilience”, newspapers routinely ran stories of entrepreneurs reinventing their business after closing down. A quick Google search on ‘resilience’ and ‘Covid’ yields more than 300,000 results. Resilience, or the capacity to overcome setbacks, has traditionally enjoyed a positive reputation. Psychological studies have linked resilience to traits like the successful regulation of negative emotions, human growth, and subjective well-being (cf. Sisto et al. 2019; Chen et al. 2017; Kong et al. 2018). Philosophical research, on the other hand, has emphasized the value of committing to long-lasting goals and persevering through losses of confidence caused by setbacks (Morton & Paul 2020: 185, Calhoun. 2018, Calhoun 2009). But the Covid-19 pandemic has also exposed the limits of resilience. Particularly when calls for resilience target women and minorities, the pandemic has shown that resilience can often place an emotional burden on individuals to find ways to persist through difficult circumstances when what is most needed is instead government support and structural change. My aims in this paper are twofold. First, I show that calls for resilience are inadequate because we have an individualistic notion of resilience. The individualistic notion is flawed in two ways: i) it can foster ill-being because employing emotional and cognitive resources can be experienced as cognitively taxing and cause burnout, and ii) it discounts the role that structural injustices play in impacting the trajectory of women and vulnerable minorities because it transfers the responsibility of any achievement and failure onto the single individual without regard for conditions of oppression. In light of this, my second aim is to reconceptualize resilience as a relational notion that takes into account structural support as well as conditions of oppression and marginalization. According to this latter notion of resilience, oppression, lack of material conditions, or lack of structural support are elements that can impact the appropriateness of calls to be resilient. A relational notion of resilience fosters well-being because it puts the collective community at the center (instead of the individual) and it takes into consideration material conditions and structural injustices.

15. Community, Care, and Social Recognition in a Post-Covid World of Work.

Joshua Preiss

The Covid-19 pandemic triggered – or, perhaps more accurately, accelerated – a number of transformations in the nature of work and the relations between workers, managers, and capital owners. One particularly dramatic example is a rapid rise in remote work. While the share of work performed remotely grew steadily in the decade before the pandemic, in comprised only 5 percent of paid work hours in the United States in 2017-2018. That number reached over 60% at the height of the pandemic. Due to gigantic investments physical and human capital and changing worker and employer preferences, a large portion of this transformation is likely to stick post pandemic. This chapter considers the impact of a changing world of work on the enjoyment of important relational goods, including care, community, and social recognition. In addition, I argue that these transformations threaten a “good” or “capability” central to prominent theories of relational justice: our ability to relate to our fellow humans as free and equal. The feasibility of remote work varies dramatically along class lines, leading to even greater income, security, power, and health inequalities in an increasingly polarized labor force. The ongoing threat of infection and disruption to global supply chains, in turn, provide significant incentive for firms to automate and digitize manufacturing and service work. In short, while temporary government initiatives and rapid economic growth function to elevate the bargaining power of ordinary workers in some contexts during the so-called “great resignation,” absent significant reform, the longer-term impact of these transformations will likely be regressive. The moral import of these changes becomes clear when recognize that as technological change pushes employment from domestic life, then to factories, then to consumer-oriented service and “knowledge” work, work itself becomes increasingly public. This evolution does not only impact the majority of service workers for whom remote work is infeasible. The same technology that facilitates the expansion of remote work also brings with it the potential to demand that professional workers be available to work at all hours, and for employers to monitor that work, even when it is done in the “comfort of one’s own home.” When work becomes public and pervasive, it is inevitable that the content of that work plays a central role in a worker’s dignity and sense of self. To conclude, I consider reforms that can further our enjoyment of relational goods, and relational justice, in a post Covid world or work.

16. The emerging field of pandemic ethics.

Marcelo de Araújo

The covid pandemic has raised several moral issues related, for example, to the vulnerability of indigenous populations to the new disease, or to the behavior of richer states towards other states in the distribution of vaccines, or in relation to the elaboration of protocols for the allocation of scarce resources using the age of the patients as a criterion for the allocation. Considered in themselves, these questions concern different domains of investigation in moral philosophy, namely: social justice, international justice, and intergenerational justice. To date, little effort has been made in the attempt to show that these and many other morally relevant issues discussed during the covid pandemic should be examined as pertinent to a distinct field of investigation in moral philosophy, to which I refer in this article as pandemic ethics. In this article, I seek to establish a conceptual framework for pandemic ethics having especially mind some recent discussions on attributions of responsibility in the context of climate ethics.