The core ethical conflict consists of the need to sustainably safeguard a high-quality and effective healthcare system, while at the same time minimising serious side effects for people and society. This requires the fair balancing of competing moral goods, including basic principles of solidarity and responsibility, and carefully examining to what extent and for how long a society can cope with severe restrictions on everyday life.
The Chairman of the German Ethics Council, Peter Dabrock, said: "In this crisis of unprecedented proportions, we can consider ourselves lucky to have such great resources of solidarity in our society. But we must be honest: These resources, too, must be handled with care and conflicts between demands of different groups of people in need must be fairly negotiated."
The Ethics Council would like to encourage both policymakers and the general public to understand the various conflict scenarios as normative problems. Their resolution is a task for society as a whole. It would be contrary to the basic idea of democratic legitimacy to delegate political decisions to the scientific community and demand from it clear instructions for the political system. More than any others, painful decisions must be taken by the bodies which are mandated to do so by the people and are therefore vested with political responsibility for these matters. The coronavirus crisis is the hour of democratically legitimised politics.
An important focus for the near future is to avoid triage situations in which doctors would be forced to decide who should get priority access to intensive care and who should be treated as a lower priority. The state must not rate human life, and therefore must not prescribe which lives should be saved as a priority in situations of conflict. However, the responsibility to decide between life and death in such dilemmas where there is a catastrophic shortage of medical resources should also by no means be placed solely on individual doctors. For reasons of equal treatment alone, but also for the sake of general acceptance, uniform rules for clinical emergencies are needed that should be based on well-considered, justified and transparent criteria. First recommendations have already been published by medical associations.
At the same time, the current restrictions of liberty by infection control measures must be critically evaluated on an ongoing basis. The German Ethics Council agrees that the goal of considerably slowing down the spread of the coronavirus currently requires the greatest attention. However, the question of the conditions and ways in which an orderly return to a reasonably "normal" life can take place must also be considered now, due to its importance for minimising economic, cultural, political and psychosocial damage in the medium and long term.
The German Ethics Council recommends the following individual measures, among others, for the near future:
- further increase and stabilisation of the capacities of the healthcare system
- establishment of a nationwide system for recording and optimising the use of intensive care capacities
- reduction of bureaucratic hurdles and better networking within the healthcare system and between it and other relevant sectors of society
- further expansion of test capacities
- further continuous data collection on individual and community immunity and typical courses of Covid-19
- broad promotion and support of research on vaccines and therapeutics and preparation for their mass production and introduction
- support for interdisciplinary research into the social, psychological and other effects of the measures taken in the context of the Covid-19 pandemic
- development of effective and tolerable protection and isolation strategies for high-risk groups
- a sound strategy for transparent and regular communication on actions taken and policy-making in relation to Covid-19
- concrete calculations of the expected costs of measures taken and alternative scenarios
The English translation of the Ad hoc Recommendation is available at https://www.ethikrat.org/fileadmin/Publikationen/Ad-hoc-Empfehlungen/englisch/recommendation-coronavirus-crisis.pdf.