The Big Question with Stanislav Otstavnov: The moral questions underpinning the COVID-19 pandemic.

Stanislav Otstavnov, PhD, is the acting head of the Laboratory of Public Health Indicators Analysis and Health Digitalization at the Moscow Institute of Physics and Technology (MIPT), and the chairman of the Committee for the Comprehensive Assessment of Medical Devices and Information Technology of the Health Technology Assessment Association. Dr. Otstavnov is an associate professor at MIPT and HSE, an expert on grant initiatives of the Russian Federal Agency for Youth Affairs, and a participant in several citizen science projects. His lab focuses on health statistics analysis and unites researchers from across Russia who are experts in the field of public health and biostatistics and have extensive experience in international scientific and educational projects.

What is the biggest ethical or philosophical question that has arisen as a result of the coronavirus pandemic?

The epidemic has exposed many important moral and ethical issues. Where is the line between a normal paid job (or hobby) and heroism? Not only doctors and nurses, but also ambulance drivers and medical engineers help patients. Not only biologists, virologists, and immunologists are searching for potential treatments but citizen science activists, too. That includes even those who do not understand biology and simply use computers or mobile devices in scientific research. They are all heroes the world needs right now.

What is the measure of the responsibility for decisions, correct and incorrect, made or not made in time? In January even CDC and WHO were mistaken about the scale of the disaster, which is not to say their competence is in doubt.

Should we humanize the legislation? After several months under “house arrest,” are we to change our views and reconsider the practice of imposing and applying punishments, especially for nonviolent crimes?

Who is willing to neglect personal gain for the common good? How to break the castes of society? Who should be considered a victim of the coronavirus? To earn or to donate? One for all and all for one, or everyone for themselves? There are a lot of questions with moral implications.

At first I was going to focus on questions that have to do with the value of information: “To keep silent or to share information with the world?” or “How much knowledge, or ignorance, can we safely afford?” But the circumstances especially emphasize the relevance of the fundamental question: “What is the value of life?”

Why is it significant?

Lives matter.

The events of recent months highlight the relevance of that question, which is extremely important outside the coronavirus agenda, and incredibly important today, in the context of the pandemic and its consequences, direct and indirect.

On the one hand, it is impossible to measure the value of human life, and it is true that if we put a single human life on one side of the balance scale and the lives of the rest of humanity on the other side, the scales would remain in equilibrium.

But the resources of health care in particular and the economy as a whole are limited, there won’t be enough resources for everyone. So the assessment of human life has to be carried out regularly, explicitly or implicitly. Should that highway have Jersey barriers? Should we clean up a nuclear legacy site? Should the money be spent on universal health coverage or missiles and radars? Should we invest in vaccine development or dubious ventures such as homeopathy? Should we allocate money for political events or deploy new hospital beds? Declare a lockdown or prevent the economy from collapsing and spare small businesses? All these decisions are about the assessment of human life, and the answers are not always obvious — after all, by saving some lives through quarantine, we pose a threat to others due to job loss, hunger, potential increase in crime, etc. But you still have to make a choice.

There is another side to this coin. We are all tired. We’re scared. We can do rash things. We are tired of being frightened. A single spark can start a flame. Police violence and civil unrest in the United States. The aggravation in Karabakh. The brutal suppression of the protests of the Belarusian people. Hundreds of millions are economically vulnerable, and it almost seems they have nothing to lose but their chains. And those who do, try to save it in a world of unequal opportunities. Sometimes in a brutal manner, forgetting that lives matter.

How can it be addressed?

On the one hand, adequate priorities are necessary.

Today making effective evidence-based decisions is an imperative. There is a lot we still do not know, in particular about the COVID-19, but there is something that we do know for sure. Clinical trials of homeopathic preparations against COVID-19 are a waste of time and other resources. So are the trials of medical devices based on the torsion field effects and the like. Evidence-based medicine is one of the fundamental achievements of civilization, along with the habeas corpus and human rights.

Universal health coverage for poor countries requires financial resources and a strong political will. This may sound like a slogan, but the less unnecessary stuff we do, the more accessible medical care will become, and its quality will be better. But that depends on us implementing health technology assessment and systematically transferring scientific developments into clinical practice. It is necessary to reduce the burden of disease and the cost of illness and to increase life expectancy and health-adjusted life expectancy (recognizing that the situation around the world is not homogeneous).

On the one other hand, sometimes it’s helpful to learn how to compromise. Love thy neighbor. Have respect. Be patient and tolerant.

We cannot save all lives. And we will not invent physical immortality any time soon. There are pain, disease, war in the world, and they can hardly be eradicated. What’s actually within our power is to eradicate bullshit and do less evil, and the world will start changing for the better. The medicine will save the patients. The vaccine will save you from the infection. Love and beauty will save the world.

It seemed that the planet was huge, and the distance from Wuhan to the U.S., South Africa, Brazil is more than thousands of kilometers, but as you can see, we are all in the same boat.

After all, fighting to save lives (working in hospitals, modernizing the health care system, creating health care innovations) may seem like fighting windmills. People die anyway. However, it is this seemingly hopeless struggle that makes the existence of civilization meaningful. In the end, blood has always been shed for pieces of land, but conquered land can always be reconquered by someone else. And the moments with our family and friends — alive, healthy — aren’t they priceless?

IMAGE SOURCE: Creative Commons

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