National Public Radio gave a clear example of how medical ethics works in an interview with Dr. Douglas B. White, a critical care doctor at the University of Pittsburgh Medical Center. Over the past decade, Dr. White helped develop an ethics framework for a pandemic, and is consulting with hospitals about their choices as the coronavirus pandemic unfolds.
Note the word “choices.” Ethicists don’t tell people what to do. Typically, they discuss the benefits and harms of a course of action, helping people to arrive at a conclusion that is as satisfactory as possible when dealing with highly complicated, multi-level issues. The Ethics AdviceLine for Journalists also operates on such a framework, based on a discussion of the issues involved.
In the NPR interview, Dr. White explained how that works in this time of a viral pandemic, otherwise known as COVID-19. In the United States, he points out, states regulate the practice of medicine. No national bioethics commission exists.
At the core of the medical ethics framework devised by Dr. White is the advice that each hospital create its own ethics frameworks providing clear guidance in the chaotic time of a pandemic emergency. This includes putting in place a triage team, a team of technicians who are not personally caring for patients. They would sort patients depending upon level of needed medical care.
“Imagine clinicians in the heat of things with barely time to think,” said Dr. White. They should not be called upon for planning efforts while making maximum efforts to save the lives of patients.
Tonya Mosley, the NPR interviewer, asked the doctor about bias in deciding who gets care, and “mental short-cuts” that might exclude considering aged patients for scarce resources.
“Long-term life expectancy should not be a consideration to make allocation decisions,” he said. More important is near-term life expectancy. He compared a 90-year-old cancer patient expected to live one year with a 20-year-old without underlying health problems. Both need a ventilator, but there is only one available. Who gets it?
“The priority should go to the individual most likely to survive,” Dr. White explains.
It is the most ethical thing to do.
Medical staff welfare
Equally important is the welfare of medical staff that administers cardiopulmonary resuscitation, or CPR, on patients whose very breath is laden with the deadly virus, placing medical staffs at huge risks of infection. They, too, must be considered in a hospital ethics framework.
In the CPR method, a medical worker places overlapping hands on a patient’s chest and pushes hard and fast, at least 100 compressions a minute, forcing air in and out the patient’s lungs and mouth. In an earlier time, medical workers also were instructed in mouth-to-mouth resuscitation.
These methods obviously must be reconsidered in a time of the coronavirus. A breath of moist air forced from a patient’s mouth can contain millions of COVID-19 viruses. It’s the reason for six-feet of social distancing, and why every person among us these days is seen as a potential death-dealing carrier.
Add that to the medical ethics of health care, both human engagement and resources like ventilators.
Along the same lines, Jenny Jarvie of the Los Angeles Times reports that there is no consensus on how health care in the United States would be rationed in a pandemic. Although the U.S. Centers for Disease Control and Prevention outlines general principles, she writes, individual hospitals, health systems and states decide policy.
“The result is a patchwork system,” Jarvie explains. “States including New York and Minnesota have drawn up detailed guidelines for allocating resources. Others have not talked about it much at all.”
Medical ethics roulette
The discovery of a vaccine against covid-19, expected a year or more away, is likely to touch off another round of medical ethics roulette. Doctors and hospitals will have to decide who gets the vaccine at the outset, when supplies of the vaccine are limited.
Though it might not seem that way, states that shunned enforcing isolating or are presently taking steps to reopen after weeks of having their residents shelter in place are exercising their own ideas of ethics, the proper way to behave for the benefit of everyone. More than 97 % of the U.S. population was under stay-at-home or shelter-in-place orders.
By the end of April, only Iowa, North Dakota, South Dakota and Wyoming had not issued stay-at-home orders. The rest of the states were extending such orders or gradually easing them, called “reopening.”
Reopening sounds like such a nice, reassuring word. But reopening after the coronavirus plague is harder than most Americans realize, according to a study by Harvard University’s Edmond J. Safra Center for Ethics.
“We need to massively scale-up testing, contact tracing, isolation and quarantine – together with providing the resources to make these possible for all individuals,” said the study.
The plan proposed by the researchers relies on proven methods of halting the spread of an infectious disease, a three pronged strategy of testing, contact tracing and social isolation aimed at fully restarting the economy by August.
But it is daunting, considering what has been accomplished so far. Five million tests a day would be needed by early June, and increase over time to 20 million tests a day to fully remobilize the economy, according to the study. Between February and the end of April, the U.S. had administered 4.2 million covid-19 tests.
Journalists will be called upon to explain these developments, decisions and their impacts on human beings and on society. Alexandria Neason, in The Columbia Journalism Review, observes that journalism fancies itself well-suited to crisis, but a “back-to-basics approach only works when the challenge is familiar.”
There’s nothing familiar about the COVID-19 outbreak. An industry that relies on in-person reporting is blocked by social isolation mandates to protect the public’s well-being. Dozens of stories a day repeat the advice of doctors and scientists, producing a deluge of information that is called an “infodemic.”
Today’s crisis demands that journalists reconsider what news is essential, writes Neason. “This moment of self-isolation, of stillness, is an opportunity for us to take stock of our habits and behaviors,” she says.
The pandemic will undoubtedly leave the journalism industry changed, like the rest of society for the immediate future, maybe permanently. “My hope is that journalism, as an industry, will stop viewing itself as an external body meant to serve the public and instead begin to see itself as a member of the public,” Neason writes. “It’s an opportunity we can’t afford to miss.”
Such introspection can last just so long before the imperative of giving useful, even life-saving information, is needed.
Since the coronavirus is one of most covered topics in the world, AdviceLine ethicists were asked how this story should be covered responsibly and ethically.
David A. Craig, a professor and associate dean for academic affairs in the Gaylord College of Journalism and Mass Communication at the University of Oklahoma, says journalists need to separate fact from political discussion.
A science story
“I agree with the comment from the Poynter Institute that ‘it’s a science story, not a political one.’ Part of the duty of journalists to tell the truth about this virus is to focus on facts, facts about the virus itself, risks, patterns of spread and what public health experts (not politicians) are saying about it. They have a responsibility to frame things in a way that neither sensationalizes nor minimizes the reality as scientists and public health experts understand it. If journalists overplay risks, they may raise public anxiety needlessly. If they downplay them, they may be helping to create harm rather than minimize it.”
Joe Mathewson teaches ethics at Northwestern University’s Medill School of Journalism. Mathewson believes the significance of test kits has been poorly explained by the media.
“Does a hospital or doctor have to have a test kit to diagnose the disease? Why? If so, where do they come from? Does every hospital or clinic or infectious disease specialist have them? How do they obtain them? Should local residents suspecting the flu or worse go to certain places for diagnosis? We’re also hearing of variants of the coronavirus, not COVID-19. What’s the difference, and what should a person who contracts another strain do?”
Staking lives on information
These are pleas for credibility and reliable information, information the public can stake their lives on. Good luck with that.
The Becker Friedman Institute for Economics at the University of Chicago discovered that believing what you hear from television commentators can kill you.
A working paper titled “Misinformation During a Pandemic” studied the effects of news coverage of the novel coronavirus by the two most widely-viewed cable news shows in the United States, Hannity and Tucker Carlson Tonight, both on Fox News. Researchers tracked viewer behavior and the health outcomes.
“Carlson warned viewers about the threat posed by the coronavirus from early February, while Hannity originally dismissed the risks associated with the virus before gradually adjusting his position starting late February,” said the study.
It found “a correlation between higher numbers of deaths and viewers of Sean Hannity’s show on Fox News when compared with viewers of fellow Fox host Tucker Carlson. Hannity was much more skeptical of the pandemic than Carlson in its early days, saying regularly that it was no more dangerous than the flu and that social distancing was overkill.Greater exposure to Hannity relative to Tucker Carlson Tonight leads to a greater number of COVID-19 cases and deaths,” the study’s authors wrote.
The New York Times also linked a coronavirus death to Hannity, who demanded an apology and a retraction of articles appearing in March and April. The Times refused.
Protecting the public from news
Clearly, news consumers in some cases must be protected from the news. That’s what NewsGuard does. New York-based NewsGuard Technologies rates the credibility of online content sources. It launched a Coronavirus Misinformation Tracking Center to spotlight “websites that are willfully spreading false information about the covid-19 disease and the SARS-CoV-2 virus itself.”
NewsGuard listed 110 sites in the U.S., the U.K., France, Italy and Germany that it says are spreading misinformation.
But this is not a time for journalists to lose faith in themselves or in what they do.
Piers Morgan, a former CNN host and now a London journalist, in a “Reliable Sources” interview on CNN, put it this way:
“Do your jobs. Never has there been a more important time to be a journalist anywhere in the world. Hold your government to account. Nothing from before this matters. This is the big one. This will be the biggest story of every journalist’s life. We thought we’d never see 9/11 again, or the financial crash, but this is much bigger than all of that, in terms of the global impact of every single country in the world.
“This is it, this is what journalists are now supposed to be about, about getting to the truth, and holding government to account, and making sure they make the right decisions…. We’re all in this together, we’re all on the same side. It’s not about whether you’re a republican or a democrat or conservative or labor…none of that matters. It’s all about unity. And the way journalists can do their job is to stand tall, work together, dig deep and get to the truth and hold government accountable. In the end, if they do, governments will thank them, they will thank the media, for helping them save lives.”
The Ethics AdviceLine for Journalists was founded in 2001 by the Chicago Headline Club (Chicago professional chapter of the Society of Professional Journalists) and Loyola University Chicago Center for Ethics and Social Justice. It partnered with the Medill School of Journalism at Northwestern University in 2013. It is a free service.
Professional journalists are invited to contact the Ethics AdviceLine for Journalists for guidance on ethics. Call 866-DILEMMA or ethicsadvicelineforjournalists.org.