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Health Secretary Matt Hancock
Decisions about who to put at risk and what is an acceptable risk are ethical and policy decisions, not scientific decisions.

On the 25th April the Nuffield Council on Bioethics, put out a statement on Covid19, and the basics of democratic governance. This statement was drafted by Dave Archard (Chair) and Hugh Whittal (Director) and signed by every member of the Council. The statement called out the lack of transparency and accountability in the UK Governments handling of the pandemic, and the need for transparency and accountability if trust is to be maintained. It asked the UK Government to:  

  • “Show us (the public) what it is doing and thinking across the range of issues of concern
  • Set out the ethical considerations that inform(ed) its judgements
  • Explain how it has arrived at decisions (including taking advice from e.g. SAGE, MEAG), and not that it is just ‘following the science’
  • Invite a broad range of perspectives into the room, including wider public representation
  • Think ahead – consult and engage other civic interests”

Putting out public statements, especially on twitter on a Saturday evening, is not the kind of thing the Nuffield Council on Bioethics does. The Council is a deliberative body, we usually work to long deadlines with extensive consultation and research. During my six years service on the Council we have never done anything remotely like this. We work slowly and carefully, and often behind the scenes in the policy world. That we took this route, and went public, shows just how important we think this is. Good ethics and governance are always important, but in times of crisis, they are far more important. We are not the only ethical voice worrying about transparency in decision-making and the need for ethical input. There are many others, and these voices are growing louder, but the Council is the nearest thing the UK has to a national ethics committee. When a body as eminent as this goes public with a call for the government to do things differently and with some urgency, we should pay attention.

We have all heard it said, that now is not the time for criticism or dissenting voices, that this should wait till ‘after’, whenever that may be, and for an inquiry. For some things this may be true, but some things must be called out now. Not so individuals can be blamed, blaming and shaming are almost always wholly unhelpful, but so that we can do better now and going forward. Trust is not something we can address later, we talk about trust being broken, because that is how trust works. It breaks. Yes, it can be rebuilt or regained, but this is a very slow process and even when repaired it is more fragile than before. Another reason we cannot and should not wait is that the decisions taken now will have better and worse consequences. Very real consequences which will help or benefit different individuals and groups and in different ways. Decisions about who suffers and how and why those decisions were made has to be transparent and justifiable. The government has to explain, to be transparent and to be accountable. This doesn’t mean it has to be certain, or ‘right’, all decisions may be ‘wrong’, but they need to reasonable and we need to see the reasons. To be uncertain is not to fail, to change in light of new information is not to fail, to explore alternatives and think through the consequences is not to fail. But not to think, debate and discuss, and to be seen to do so, is to fail.

The death toll from Covid 19 in the UK is set to be the worst in Europe. Given we had our near neighbours, Spain and Italy ahead of us as well as China, it didn’t need to be. While it is the case that the situation is unprecedented, it is not the case that we didn’t know it was coming. We’ve been talking about global pandemics, and other global health emergencies, in science, ethics and policy communities for very many years. That ‘disease is not respecter of borders’ is a truism, precisely because we know it is true!

Decisions about how and when to exit lock down must be informed by good science but ‘following the science’ is not enough. Decisions about who to put at risk and what is an acceptable risk are ethical and policy decisions, not scientific decisions. The Covid crisis shows how much we need experts and professors have never been more in the public eye. I have been exceptionally proud and humbled as I’ve watched, and supported where I can, my scientific and medical colleagues mobilise with speed, throw themselves into redeployment to the NHS, into leading the research, the trials and the testing. They are amazing! We need other experts too.

While lockdown is finally beginning to bring down the death rate, the costs are high. The choice we face is not a simple binary of economic recession or saving lives. Lives are lost as health resources are focused on Covid 19, and as we avoid A&E, lives are damaged as domestic violence rates rise. Other costs are harder to quantify, how should we factor the trauma which health workers are subject to or the costs which attach to not being able to say goodbye to your loved ones in person? And the costs fall harder on some than others. There are opportunities too, we can move quickly, the public can be trusted, we can step into roles we didn’t do before, work collectively and deliver in situations which previously we couldn’t imagine. To survive this well, we cannot wait. We must think and speak about what is better and worse, and for who. We need to know how these decisions are being made, and we need the reasons to justify and support them. To ask for this is not unhelpful criticism when we should all be pulling together, it is making sure that we can continue to pull together, and live with ourselves when we reach the ‘after’.