“Ethical challenges during the coronavirus epidemic”: dean of spiritual life reflects on morality in a time of global crisis

On Friday March 13th in my E&D course on biomedical ethics I shared some ominous data about the spread of the coronavirus pandemic and the worldwide healthcare concerns it has created.  We also examined the looming ethical dilemmas that we now face here in the United States. These include the following: 1) How can we ensure ethical integrity and justice as we develop and distribute screening tests, medicines and vaccines; 2) How will we protect healthcare professionals, distribute limited healthcare resources and still uphold those who are most vulnerable; and 3) What personal freedoms are we willing to give up and what other sacrifices are we willing to make in order to contain and control this pandemic? 

At one point I asked my students what we should do if hospitals could not keep up with treating those who became sick, and how we might decide what to do if there were not enough ICU beds and ventilators for the gravely ill and infected among us. As they pondered my question I reminded them about the committee of seven people we had learned about at the beginning of the semester.  With the development of new kidney dialysis machines in Seattle in the early 1960s, these people were given the responsibility to decide which patients would receive the life-saving dialysis. You see, there were simply not enough of the new machines to go around. This committee of seven people had an overwhelming responsibility. Whoever they chose received dialysis and lived. Those they rejected did not receive dialysis and died.  Could a similar kind of rationing scenario happen again with the coronavirus outbreak?  

The facts indicate that this is certainly possible. A recent assessment of hospital beds shows that Oregon has the lowest ratio of any state in our nation with 1.6 beds per 1,000 people.  Nationwide we average 2.8 hospital beds per 1,000. However, in order to understand the potential crisis we may face you need only compare our ratio with that of Italy which has 3.2 hospital beds per 1,000 or Hubei province in China where there are 4.3 per 1,000. Furthermore, a Johns Hopkins Center for Health Security Report from February 27, 2020 suggests that in a “severe” pandemic on the scale of the 1918 Spanish flu outbreak, the United States might need up to 2.9 million critical care beds. The same report estimates that we currently only have a total of about 100,000 critical care beds. The report points out the obvious by stating that, “Even spread out over several months, the mismatch between demand and resources is clear.”

By now most of us have learned about the importance of “flattening the curve” in order to reduce the impending demand on our health care system, and about how important it is for us to slow the spread of the virus through reducing person-to-person contact and by eliminating large events and occasions where groups of people gather.  We can only hope that we have been successful in slowing down the spread of the virus in order to flatten the curve. Only time will tell. 

As I consider all of this I find myself wondering if enough Americans are willing to sacrifice for the common good anymore. I wish I could answer with a resounding “yes,” but the recent run on toilet paper in stores and the hoarding of hand sanitizer around the country doesn’t inspire my confidence. I can only hope that we will come together in our communities, states and in our nation to change the course of this pandemic.  I can only hope it won’t be as bad as I fear, and that we will indeed rise to the occasion by rediscovering what really makes America great: e pluribus unum (out of many, one).

Mark Duntley

Dean of Spiritual Life

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