HEAL Montgomery Annual Lecture: ‘One year into the COVID-19 pandemic: Reflections on Health, Ethics and Law’ Event

Panel of Speakers

Professor Hazel Biggs (University of Southampton), Professor John Coggon (University of Bristol), Dr Natasha Hammond-Browning (Cardiff University), Dr Caroline Jones (Swansea University), Professor Sir Jonathan Montgomery (University College London), Dr Adrian Viens (York University)

 

Abstracts

A Pandemic is not Personal!

Professor Hazel Biggs - Emeritus Professor of Healthcare Law and Bioethics, University of Southampton, Southampton Law School

Since the Covid-19 crisis was declared a pandemic in March 2020 UK Government advice has urged and directed the population to act in particular ways for the protection of others. In an apparently communitarian approach we have been required to stay home to save lives and protect the NHS, and to make space and wear masks in an effort to reduce the spread of disease. Personal responsibility has been invoked in order to limit infections and ensure that resources are available to treat those who need medical assistance.  

Intuitively this seems an appropriate, indeed almost inevitable, response in relation to a publicly funded healthcare system. We are all part of the community and should all act responsibly to ensure the safety of ourselves and our neighbours. Underpinning it however is the stark reality that demand for treatment may outstrip the supply of resources available to provide the care needed. Hence the repeated reminder that the NHS may be ‘overwhelmed’.

Limited resources tend to mean that choices must be made concerning who has access to them, and who takes priority, even in end-of-life care. This is when the needs and interests of the individual may seem to conflict with the needs and interests of the many and responses to the pandemic may seem to become personal. This paper reflects on some of the tensions that arise.

 

Public Health and Health Inequalities Before and After COVID-19

Professor John Coggon - Professor of Law, University of Bristol, Law School

In this paper, I reflect on the light that the coronavirus pandemic has shone on systematised health inequalities in the UK. Health inequalities are a longstanding concern within public health. Furthermore, the mutual influences of social epidemiology and theories of justice, each on the other, have been seminal in the development of public health ethics as a field over the past two decades, and have led to significant advances in philosophical attention to health inequalities. Given the different impacts—direct and indirect—of the coronavirus pandemic on different groups and communities in the UK, there is now heightened awareness of, and concern about, health inequalities. This talk asks about current and ongoing public health strategy, and raises questions about the place of health inequalities in developing policy and practice.

 

Uterus transplantation during Covid-19

Dr Natasha Hammond-Browning - Lecturer in Law, Cardiff University, School of Law and Politics

Uterus transplantation is a novel transplant that combines organ transplantation and assisted reproduction medicine and regulation. Uterus transplantation procedures and resultant births are increasing worldwide. In this presentation I will briefly reflect upon whether the rate of uterus transplantation has been impacted by the Covid-19 pandemic, and whether the impact has differed between nations.

 

Testing times under COVID-19: The challenge of bringing terminations home

Dr Caroline Jones - Reader in Law, Swansea University, Hillary Rodham Clinton School of Law

The pandemic has necessitated changes in policy and practice in a plethora of settings. This paper focuses on the (temporary) approval in England and Wales for early medical terminations to be carried out at home. These amendments stand in stark contrast to the reluctance shown by a previous Secretary of State in BPAS v Sec. of State for Health [2011] EWHC 235 (Admin). The paper will reflect on the drivers for change and will also address the test case by Christian Concern which sought to challenge the approved availability of abortion ‘Pills by Post’.

 

Public Bioethics under COVID-19: logic and logistics

Professor Sir Jonathan Montgomery - Professor of Health Care Law, University College London, Faculty of Laws

COVID-19 has required us to develop public bioethics at an unprecedented pace. It has proved harder for groups to reach consensus when there are time pressures, especially when they meet virtually and do not know each other well. Requests for rapid policy advice often required conditional opinions, based on assumptions that were hard to test for reliability. This paper uses four examples to reflect on the challenges of connecting value considerations with ‘facts’ in these conditions of uncertainty. First, prioritization of critical care resources when there is limited data on capacity to benefit. Second, contact tracing apps; where abstract privacy concerns competed with concrete questions about public health impacts. Third, vaccine prioritization; where political and scientific issues rubbed shoulders with poor data recording. Fourth, immunity status certification where mundane logistical considerations vie with promissory rhetoric. Together these examples show how under COVID-19 public policy on bioethics has been driven by pragmatic challenges more than principled reflection.

 

COVID-19 Vaccine Policy: Changing Public Health Ethics Mid-Course?

Dr A.M. Viens - Associate Professor of Global Health Policy, York University, Faculty of Health

Recent controversy over delaying the second dose of some COVID-19 vaccines in some jurisdictions has focused predominantly on scientific or technical questions. Insufficient attention, however, has been paid towards the ethical implications of decisions to extend the schedule between vaccine doses. In particular, how such a decision marks a change from a maximizing conception of ethics that seeks the best option to a satisficing conception of ethics that seeks an option that is good enough. While a public health ethics that adopts a satisficing conception can be perfectly acceptable when established from the start, it is the move away from a maximizing conception mid-pandemic that can negatively impact the perceived legitimacy of vaccination policy in virtue of conveying the message that resultant options are in some way deficient, that our ethics changes between times of normalcy and emergency, and its potential to risk eroding public trust and compliance. This case speaks to the wider impact of events like COVID-19 on the field and practice of public health ethics.