Dr Francis Chittuparambil, OCD
World is reeling under the awesome effects of the covid pandemic. Almost 18 months after the eruption of the pandemic, we can now partially evaluate on how we handled this emergency and take strategic precautionary measures to confront a possible third wave. I consider it as a duty coming out of the Christian calling. The corona virus is raising questions and challenges the humanity particularly in the areas of healing, religion and faith. The fundamental moral truths of human dignity, justice, equality etc. come into forefront in the efficient and effective handling of this pandemic. The main points that we wish to discuss in this issue are: the role of moral principles in this unprecedented emergency situation, the handling of the covid pandemic by the governments, the vaccination policy followed in the country, the allocation of the scarce medical resources, moral responsibility of the individuals to get vaccinated and the morality of getting a vaccination that might have been developed from the aborted foetuses etc.
THE MORAL PRINCIPLES
Moral principles and norms are guide to human living. In a conflictual situation they are like the star which guided the magi to the manger. They help one who finds in a dilemma as to which course of action is to be undertaken and to avoid unethical decisions. In the context of an unprecedented emergency like the Covid pandemic they assume greater importance. The traditional and habitual means and ways of dealing with a contagious sickness seem to be ineffective now. Hence, the need to rethink the ways and find new means to put into practice the ethical principles in our daily living. The medical personnel, government authorities and even the ordinary citizen, all are required to strictly follow the principles to avoid risking the human lives and to give a safer, quicker and effective healing for covid patients. In this difficult moment of health emergency, we need moral wisdom to execute the right moral action. Which are the principles that are to be immediately considered in the present situation?
1. Sacredness and inviolability of human life: The human person is created in the image of God (Gen. 1: 27) and so is sacred and absolutely inviolable. The human life is not simply an organic process or a living entity, but is the life of a person who bears a dignity in himself/herself distinct from other living beings because of having been created in the image of God; he can never be made use of as an instrument and should never be the object of scientific experiments.
2. Civil laws protect the good of the person: The civil laws are meant to protect the good of the persons especially the weak and the vulnerable. Law that goes against this primary principle is not morally legitimate. It may not be obeyed even if it is the result of the opinion of the majority. In a democracy, the majority decides the legality, but not necessarily the morality. Pope John Paul II’s Evangelium Vitae 72 and CDF’s Donum Vitae III speak about these principles.
3. The principle of lesser evil: This principle says that one has to choose the lesser evil when only two evils are in front of him and is obliged to act. In some extreme cases of covid the principle would help the medical personnel to make some unavoidable choices.
THE HANDLING OF THE COVID PANDEMIC
As the covid pandemic spread extensively in other countries, the different government agencies in India gloried in having controlled its wide spread. The negligence of the governments in foreseeing the possible outbreak and taking preventive measures in time made us to pay dearly. In less than a year, India’s situation became much worse than many of the European countries. Lack of efficiency and professionalism, favouritism, lack of know-how were clearly visible in handling the covid cases. Even when the second wave was predicted by WHO in advance, our authorities failed to take preventive measures. This is clearly a violation of the democratic policies since elected representatives are obliged to take measures to protect the lives of the citizens. In the humanitarian services taken over by the different countries and government agencies a clear lack of collaboration was evident. Pope Francis in his Encyclical Fratelli Tutti exposed the effects of the pandemic. He wrote: “… the pandemic brought to light not only our false securities but also the inability of the world’s countries to work together” (Fratelli Tutti no. 7).
THE VACCINATION POLICY
Does the Government of India follow any precise vaccination policy? Answer is often negative. Prominent questions in this area: Who should be preferred in giving vaccination? Are vaccines safe? The consequences of vaccination? Should it not be given freely? Surely, the health care workers who are more exposed and other more vulnerable members like the elderly are to be given priority. Buying vaccine, obligation to register in the on line portal instead of the spot registration etc. make the vaccination system defective. The government should have made clear policies before the vaccination process begins. Being one of the highly populated nation, the decision to sell the vaccine to others without considering the need of the people of the country is clearly unjust. The state governments were supposed to buy the vaccine for those below 45 years of age, until 07 June 2021, when the Prime Minister announced the supply of free vaccine.
Many are confused as whether to get vaccinated or not due to reported deaths after vaccinations and the allegation that it may lead to impotency and/or a slow death. Vaccination does not guarantee full immunity since even after vaccination we are obliged to wear masks and follow other covid protocols. The researches on the efficiency and consequences of the vaccine are not fully conclusive. However, the vaccination is necessary for safeguarding one’s own as well as the health of others. In this regard, the document of the Congregation for the Doctrine of Faith (21 December 2020) asserts that “the morality of vaccination depends not only on the duty to protect one’s own health, but also on the duty to pursue the common good. In the absence of other means to stop or even prevent the epidemic, the common good may recommend vaccination, especially to protect the weakest and most exposed”.
The same document answers the question on the feasibility of getting vaccines that have used cell lines from aborted foetuses in their research and production process. In paragraph no. 2 it says: “When ethically irreproachable Covid-19 vaccines are not available … it is morally acceptable to receive Covid-19 vaccines that have used cell lines from aborted foetuses in their research and production process”.
DISTRIBUTION OF SCARCE RESOURCES
The pandemic Covid 19 has made us to reflect seriously on several health care issues like the just allocation of the scarce medical resources. The daily newspapers in this time of second wave of the covid pandemic bring in almost continually the news about the long line of ambulances waiting for admission of patients depending on the availability of oxygen support machines. We noted the death of many patients due to lack of sufficient life supporting instruments or medical personnel to care for them. Pope Francis in Fratelli Tutti no. 19 cautions us on this frightening reality: “In this way what is thrown away are not food and dispensable objects, but often human beings themselves. We have seen what happened with the elderly in certain places in our world as a result of the corona virus. They did not have to die that way”. This duty to care for the sick is constantly impelling us to be human and Christian in a qualitative manner.
A very pertinent question is regarding the allocation of the scarce resources. We need to follow certain principles in allocating the resources and even rationing of them. The medical personnel have to choose whom to attend to and often makes the most painful choice of removing oxygen cylinders from those who have less hope of survival.
The resources can be classified into primary, secondary and tertiary: The primary resources are the body organs, the secondary are the life supporting machines like ventilators, hospital beds, essential drugs etc.; the tertiary resources are other essential health care commodities such as masks & sanitizers which are very essential during covid pandemic. The time and care given by the medical personnel are also important resources. Here comes the delicate duty of fairly prioritizing the beneficiaries in the light of different principles and forming the various ethical approaches to this urgent task.
A first principle to be safeguarded is the value and inviolability of human life and persons. The Congregation for the Doctrine of Faith in the Declaration on Euthanasia (1980) writes: “Human life is the basis of all goods, and is the necessary source and condition of every human activity and of all society”. Pope Francis writes in Fratelli Tutti no. 8 (2020) these words: “… by acknowledging the dignity of each human person, we can contribute to the rebirth of a universal aspiration to fraternity.”
The principle of justice means fairness in the allocation of medical care in an interpersonal (patient and the health worker) and top to bottom level (Government or health department to patients). Any care to patients should be free of any bias based on gender, social status, relationships etc. To each one according to his/her medical need.
A third principle is the principle of beneficence, which says that whatever activities in the medical or experimental field should be for the good of the patient, and should never do any harm to the patients. The different vaccines and medicines should be tried on human beings only after having proved its efficacy in subhuman creatures.
A fourth principle is the principle of equity which states that the medical services, quarantine facilities etc. are to be delivered equitably. This principle is based on the ideals of justice and fairness. Different from the principle of equality which states that everyone should get the same thing in the same quantity and quality, the principle of equity considers and gives people what they need to enjoy a healthy, happy, contented and serene life. The principle of equity can be considered as the means whereby equality is guaranteed. The Holy See’s Covid 19 Commission and the Pontifical Academy of Life in their joint document published on December 29, 2020 remind the world leaders that vaccines must be provided to all fairly and equitably, prioritizing those most in need.
Fifthly, the principle of autonomy of the patient says that every individual has the right to make choices that deal with his or her own health, though in extreme cases it may be the doctors who decide what is good for the patient. Covid treatment centres should give priority to this factor.
The system of triage of the covid patients (determining the priority on who should be immediately attended to in an emergency situation) must keep in mind above-mentioned principles as the criteria. The triage must always follow the fair process and the personalist approach.
GOOD SAMARITAN MODEL
In conclusion, let me present Lk 10: 30-37 as a guiding example in this time of pandemic to become another Good Samaritan, as we spent our energy and scarce resources to take care of the sick. Jesus himself comes with the divine healing through him/her and spends time and energy in taking care of the sick. The Good Samaritan who goes out of his way to aid an injured man (cf. Lk 10:30-37) shows Jesus Christ who with “the oil of consolation and the wine of hope” takes care of the needy. The serving health care personnel in full anonymity with the PPE kit is the actual Good Samaritan of the covid times.