Why did healthcare professionals disregard ethical guidance during the covid event?

Technocracy and human values are incompatible

This article was originally published on the HART platform

Photo by Markus Spiske on Unsplash

An earlier article described how, throughout the covid event, health care professionals (doctors, nurses, psychologists, behavioural scientists) habitually behaved in ways that were at odds with their ethical codes. The moral imperatives of delivering effective interventions, doing no harm, ensuring informed consent, avoiding perceived conflicts of interest, and whistle blowing upon witnessing unacceptable behaviour of colleagues, were all widely disregarded during the ‘pandemic’. What were the key reasons for this mass abandonment of ethical principles?

One thing is for sure: this neglect was NOT due to a lack of specialist ethical resource. On the contrary, there was no shortage of accessible experts (and written guidance) that could have steered practitioners towards doing the ‘right’ thing by operating within the bounds of moral acceptability:

Ethical codes of each profession: Doctors should have been conversant with the ‘Professional Standards’ set by the General Medical Council, nurses with the guidance provided by the Nursing and Midwifery Council, and psychologists with the output of the British Psychological Society.

Moral & Ethical Advisory Group (MEAG): With a membership comprising ethical experts, social scientists, and representatives from UK religious and secular communities, the central purpose of MEAG was to offer advice to the Government on health and social care issues. The group was active for a three-year period (October 2019 to October 2022).

National organisations offering ethical guidance: Four national organisations – albeit with overlapping membership, aims, and sources of funding - operated outside of the government infrastructure, publishing evaluative comments on ethical issues throughout the covid event. These were:

- Nuffield Council on Bioethics: The ‘leading independent policy and research centre, and the foremost bioethics body in the UK’. In its annual report of 2020 it states: ‘The Council played a leading role in identifying and responding to pressing ethical issues, and was able to quickly produce high-quality work to support national and international responses to the pandemic.’

- Oxford Uehiro Centre for Practical Ethics: Founded in 2002 and located in the Philosophy Faculty at the University of Oxford, the organisation comprises a group of academic researchers who aim to promote philosophical methods in ‘practical ethics’; Their specialists offer ‘ethics advice and consultancy for a wide variety of research projects and areas’.

- Wellcome Centre for Ethics and Humanities: Based at Oxford University, established in 2017, the centre aims to ‘lead debate on the ethical requirements for scientific research & technological innovation’ and it investigates ‘the ethical aspects of advances in neuroscience, big data, genomics & global connectedness’.

- UK Pandemic Ethics Accelerator. Formed in May 2021, it describes its central function as being to bring ‘UK ethics research expertise to bear on the multiple, ongoing ethical challenges arising during pandemics’ by providing ‘rapid evidence, guidance and critical analysis to decision-makers across science, medicine, government and public health’.

Michael Parker (Professor of Bio-ethics at Oxford University, and a MEAG member) recognised the abundance of ethical expertise on offer during the covid event when, in a May 2022 lecture, he described the period 2020 to 2022 as, ‘one of the most sustained and intensive periods over which a government has had access to timely ethics advice on policy evolving in real time’.

In addition to these ‘live’ sources of ongoing ethical guidance, there were also several policy documents (issued prior to the covid event) that could have potentially aided healthcare professionals in their day-to-day decision making. One prominent example was the 2007 publication, ‘Responding to pandemic influenza: the ethical framework for policy and planning’, that emphasised the importance of minimising harm, respecting people’s personal choices, keeping things in proportion, and transparency in decision making – salutary principles that were abandoned in the covid years.

Why was this profusion of available ethical guidance largely ignored? While surrounded by multiple sources of advice, highlighting principles and values to steer practitioners towards morally responsible behaviour, why did our health care professionals disregard this body of guidance and habitually act in ethically unacceptable ways?

Two often-cited reasons for this neglect of ethical principles during the covid event can be instantly dismissed as baseless and unjustifiable. First, the claim that ‘we were in a crisis’, and therefore did not have the time to consider moral doctrines, does not hold water; adherence to ethical imperatives becomes even more important during perceived emergencies as these are the times abuse and atrocities are most likely to occur. Second, the common mantra ‘we were just following the science’ is even more disingenuous. The inadequacy of this excuse is conveyed in a 2022 statement by Professor John Coggan (a member of the Nuffield Council on Bioethics):

‘There has remained a tendency … to frame difficult decisions as ones that are simply led by ‘the science’ … But there are values at play when a Minister decides which science to follow. And there are value judgements in weighing up the costs and benefits of doing so, and in understanding whether and how this acceptably bears on people’s basic rights’.

Other factors contributing to the lack of ethical oversight during the covid event were identified in a critical analysis of the official thinking underpinning the development of the controversial ‘Look them in the eyes’ messaging campaign, reasons that also have relevance in explaining why the covid arena in general was an ethics-free zone. Specific instance included:

1. Advice being actively ignored by policymakers: One prominent example was the explicit rejection by Professor Chris Whitty (Chief Medical Officer), in April 2020, of MEAG’s offer to ‘produce a framework to assist policymakers take moral and ethical issues into account’; it appeared that Whitty preferred this advisory body to only offer guidance when asked, rather than being proactive.

2. Requests for ethical advise were often tokenistic: Any requests to MEAG for guidance only came once policy had been decided, evoking the Nuffield Council to comment that, ‘The Westminster Government does not seem to want to engage or take on board other views on any of these issues; nor is it evident that they are thinking about them, or taking advice on them from a social and ethical perspective … as far as we can see, neither the UK Government nor any of the devolved administrations have taken advice from their own Moral and Ethical Advisory Group’.

3. Lack of clarity around who were making the decisions: Without knowledge of where the power and influence lie, it is very difficult to introduce ethical values into the deliberation process. This barrier was highlighted by Professor Montgomery (co-chair of MEAG) who described how ‘It proved very difficult, at least early in the pandemic, to identify who was taking decisions. If you can’t identify who’s taking the decisions, it’s hard to offer advice in a timely manner.’

4. The ethical guidance offered was often fragmented: a 2020 academic paper referred to ethical approaches in the first months of the covid event as ‘piecemeal, confusing, and risks needless duplication’. Similarly, a 2022 review asserted that the provision of ethical guidance was unstructured, resulting in ‘decisions about values’ being ‘highly contingent … on opportunities and situations, with ambiguity and contestation’; these commentators plausibly suggest that a key reason for this fragmentation was ‘the ambiguity created by the perceived need to develop new ethical principles, guidance & frameworks rather than using well-established principles’ – this reflects the often repeated, but highly dubious assumption, that ‘covid’ required a completely different set of public health responses from what had gone before.

5. The constraints of being a member of a formal government advisory group: Prominent ethicists have claimed – rather unconvincingly – that they felt inhibited by the expectations associated with membership of a formal advisory group. Professor Jonathan Montgomery (a co-chair of MEAG) has claimed:

‘If you’re an advisory body within the Department of Health and Social Care, as the Moral and Ethical Advisory Group was, you are bound by the framework of your terms of reference and accountability’.

Likewise, Professor Michael Parker (a member of the MEAG and of various SAGE groups) has said that ‘the role of senior adviser comes with some responsibilities’ and goes on to discuss the ‘difficult balance’ between his individual perspective (and written outputs) and his collective responsibility as a member of a forum. It can, however, be argued that appeals to the constraints of formal membership of a government advisory body as a reason for lack of influence are somewhat lame; core attendance at an advisory group provides every opportunity – nay, an obligation – to proactively raise issues of ethical concern.

The incompatibility of technocracy and human values

While all the specific reasons - outlined above - for the lack of ethically-informed practice by health professionals throughout the covid event may have a degree of relevance, the central explanatory factor for the abandonment of ethics is likely to be a more fundamental one: the rise of technocracy.

Technocracy – a system where we are controlled by global experts – imposes a milieu in which higher human values have no relevance. We are no longer governed by democratically elected officials but by the products of algorithms and black box models, whose inputs and outputs are determined by remote bureaucrats. Under the guise of utilitarian mantras (‘the greater good’, ‘collective responsibility’), these invisible experts espouse instructions that they have defined as the ‘right’ things to do; ordinary mortals must obey or be smeared as being both anti-science and immoral. In this technocratic world, one is not perceived as a free human being, but as ‘a data point to be monitored, measured, and managed’.

Within this technocratic control system, the human-focused ethical principles that once guided the behaviour of healthcare professionals have little relevance. The inherent rights of each human being have now been trumped by algorithm-generated commands. Doctors, nurses, and psychologists increasingly follow protocols, robotically adhering to the directives of their invisible global masters. Critical thinking is a rarity, the inherent rights of each individual are deemed inconsequential, and practitioners can behave in ways that would once have been considered unacceptable: coercing patients into accepting medical products without informed consent; scaring and shaming people into compliance with ‘public health’ diktats; elevating personal gain (financial and vocational) above the needs of the service user; and failing to whistle blow when witnessing the cruel and abusive behaviour of colleagues – all these misdemeanours can be overlooked so long as you are adhering to the centralised missives.

Technocratic governance and the consideration of inherent human values are largely incompatible. The ever-strengthening stranglehold of top-down rule by global experts will – if not repelled – ensure that our healthcare system remains an ethics-free zone; in such a world, humane ethical principles that determine what is, intrinsically, right or wrong have no place. The sooner this central fact is more widely recognised, and visible opposition to the technocratic juggernaut escalates, the sooner hospitals and care homes can return to being hubs of ethically sound interventions.