Fairness, Ethnicity, and COVID-19 Ethics

Alexis Paton

doi:10.1007/s11673-020-09999-2

Abstract

Recent weeks have seen an increased focus on the ethical response to the COVID-19 pandemic. Ethics guidance has proliferated across Britain, with ethicists and those with a keen interest in ethics in their professions working to produce advice and support for the National Health Service. The guiding principles of the pandemic have emerged, in one form or another, to favour fairness, especially with regard to allocating resources and prioritizing care. However, fairness is not equivalent to equity when it comes to healthcare, and the focus on fairness means that existing guidance inadvertently discriminates against people from ethnic minority backgrounds. Drawing on early criticisms of existing clinical guidance (for example, the frailty decision tool) and ethical guidance in Britain, this essay will discuss the importance of including sociology, specifically the relationship between ethnicity and health, in any ethical and clinical guidance for care during the pandemic in the United Kingdom. To do otherwise, I will argue, would be actively choosing to allow a proportion of the British population to die for no other reason than their ethnic background. Finally, I will end by arguing why sociology must be a key component in any guidance, outlining how sociology was incorporated into the cross-college guidance produced by the Royal College of Physicians.

Highlights

Recent weeks have seen an increased focus on the ethical response to the COVID-19 pandemic
Using social science analyses of ethical frameworks and clinical guidance used during the SARS pandemic (Thompson et al 2006) and the H1N1 pandemic (Daugherty Biddeson et al 2019), the Royal College of Physicians developed an ethical framework for decision-making based on social scientific work on ethics and pandemics
Existing ethical and clinical guidelines for care during the pandemic are largely unfair. They actively discriminate against people from ethnic minority backgrounds

Summary

Introduction

Recent weeks have seen an increased focus on the ethical response to the COVID-19 pandemic. 35 per cent of patients critically ill with confirmed COVID-19 are from the Black, Asian, and minority ethnic (BAME) population in Britain (Intensive Care National Audit and Research Centre [ICNARC] 2020), and an disproportionate number of the BAME population have died from the virus (Barr et al 2020). This is excessively high given that this same group comprises only 14 per cent of the U.K. population (ICNARC 2020). The focus has been generalizability in an attempt to be “fair.”

Is Existing Guidance Really Fair?

Building Ethical and Clinical Guidance on a Social Sciences Foundation

Findings

Conclusion