• cafebioethics

Self-inflicted COVID & Access to Care

By: Alyssa Izatt, University of Toronto

I am entering my fourth year of my undergraduate degree as a philosophy major at the University of Toronto, with minors in Practical French and Italian. Throughout my degree, I have been interested in the fields of ethics and applied ethics. In the fall, I look forward to participating in the Socrates Project, an undergraduate TA program. 

COVID-19 represents a global threat and requires collective action, however, as individuals, we only have control over ourselves. As a small business owner, I have foregone opening this summer, because of the risks for my clients, as well as for myself and my family. It’s difficult to make sacrifices contributing to the common good, only for others to disregard lockdown regulations. However, I think we must be careful to avoid moralization when it comes to making decisions about public health. I wrote this paper to explore this idea, in the context of the current pandemic.

The COVID-19 pandemic has put a strain on medical systems worldwide, as the global population struggles to “flatten the curve”. In some cases, doctors must make difficult decisions about what care they can provide because of the scarcity of medical resources. Given that crowds have gathered to protest the lockdown restrictions, endangering themselves and others, it may seem fair to give treatment priority to those who contract the virus accidentally, or through their work in an essential field.

There are several reasons why one might feel as though lockdown protestors should receive less priority in the allocation of scarce resources. Firstly, they are risking their own health by protesting, and though they may reject the reality of the risks, they have been warned and should be aware of the importance of physical distancing. Therefore, if they do contract COVID-19, it is self-inflicted, due to their own lack of regard for safety precautions. Secondly, by protesting, they are risking the health of their fellow citizens by knowingly increasing the potential exposure of the virus, thereby putting everyone they encounter at further risk. When we compare this to those who contract the virus despite their best efforts to remain physically distant, or because they are an essential worker, it seems justified to prioritize the care of individuals who are attempting to reduce the spread of the virus, particularly in cases where an equal allocation of resources is impossible. In this case, our feelings influence the allocation of resources. Essentially, those who we feel are more deserving would receive higher priority than those who we feel are less deserving. Though our intuitions suggest this may be fair, an equitable healthcare system responds to need, rather than assessing the moral worthiness of a patient.

First, let’s examine the point that people who inflict harm on themselves are less worthy of care than those who are harmed through no fault of their own. Just because an ailment is self-inflicted, does not mean that it should receive less care or priority than one that was acquired unwillingly. For instance, if two people walk into the emergency room, one with a wound from self-harm, and the other with a burn from cooking dinner, the cooking injury would and should not receive prioritized care. The care they receive should be based on the severity of the injury itself, rather than the nature of how the injury was acquired. While in the case of self-inflicted harm, the cause of injury is relevant to treatment and future care, it does not infringe on a person’s right to treatment. By using the cause of an injury to determine a person's priority, we begin a moral evaluation in order to justify the care they receive. Such an evaluation would have negative implications for the operation of the healthcare system.

Firstly, it could mean that any person who is partially responsible for their ailment would be given less priority than a person who is not. It is difficult to establish the degree to which a person can cause their own illness, as there are many factors impacting health and it is unclear which factors are the most important to consider. Additionally, it means that instead of examining medical factors, such as which patient has the greatest need or the best chance at recovery, doctors would need to make decisions with ambiguous criteria about which patient deserves prioritized care. In contrast, by making decisions based on a comparison of individual need, doctors eliminate factors which are not relevant to a patient’s best outcome. Essentially, to receive equal care, a person would need to meet a moral standard of blamelessness in their condition. This infringes on healthcare as a right, something everyone should be able to access equally, and necessitates patients possessing a level of virtue to receive adequate care. Many people will fail to meet this standard, which would result in diminished or withheld care. Just as recipients of food donations do not need to meet a moral threshold in order to eat, recipients of medical care should not need to be good people in order to receive care.

However, protesting puts other people, such as law enforcement, medical staff, and essential workers at a greater risk of contracting the virus. This is not just a self-inflicted risk, but also endangerment of the broader public. Is it fair to prioritize an innocent person over someone who has harmed or is likely to harm other people? Here, the answer is still no. For instance, dangerous criminals have the right to receive healthcare, even if providing it puts others at risk in the future. Additionally, the punishment for harm to others is separate from a person’s access to healthcare. Denying someone healthcare during a pandemic because of their immoral or illegal actions would be like denying a prisoner food during a shortage, or water during a drought. By treating the prioritization of care as a consequence for an undesirable action, we would establish a dangerous precedent. Not only would doing so eliminate an individual’s chance to defend themselves, this would remove the deliberation from their punishment, as decisions about care, particularly during a pandemic, can occur in stressful, life or death instances. This means that the consequence for protesting would not be fairly decided, with each party having a chance to represent their position, and that those who are supposed to be providing care would also be tasked with making judicial decisions. Even though some protestors are endangering the people around them, diminishing their quality or access of care as a punishment is inhumane.

Furthermore, each protest is different. Though I have primarily addressed the narrower scope of protests against lockdown measures, there have been protests for different reasons since the lockdowns began in March, most notably the Black Lives Matter protests. These protests aim to defend the human and civil rights of people of colour, and while there may be increased exposure because of the protests, they are motivated by an urgent need. This further illustrates the danger of using the restriction of access to healthcare as a punishment, or requiring patients to meet a subjective moral standard. A person defending their right to life may be penalized for committing the same action as a person with a different motivation. Ultimately, protesting can pose a risk to public health, by increasing the spread of COVID 19. Despite this risk, a person's access to healthcare should not be diminished because of their participation in a protest.

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