“My father was to be admitted into the ICU today; however, he’s not going to be treated or allowed in.”
A woman explains after her father, affected by the coronavirus and with serious respiratory problems, was scheduled to enter the Intensive Care Unit (ICU) that day for treating his condition. That same morning a 44-year-old, seriously affected man came to hospital and the doctors decided that the bed in the ICU should be occupied by that person, and her father would have to wait. The doctors were applying a decision strategy like the White scale which defines reasonable criteria for situations like this, but it is a difficult resolution for someone who must remain outside the ICU.
ETHICAL DILEMMAS AT STAKE
These kinds of situations, dramatic indeed, will be repeated in the upcoming weeks. We must understand that these criteria for the discriminative use of limited health resources are to be defined not only by doctors, but by society. In fact, that is what the White scale advocates and how ethical values necessarily come into play. In any case, any scale of priorities of this type must be solidly founded, with humanizing, scientific and politically rational criteria; moreover, it must be clearly explained, without any reservations involving the population in the decisions.
At the same time, the pandemic presents us with another ethical crossroads: we decided in the past to provide universal and free access to health care. That meant establishing a hierarchy of values in which the equality of all and the very value of human life prevails. But it has not been enough. The pandemic shows us that we have not invested enough, such as in ICU beds. Economic resources are limited, and if we decide now to recover the ratio of ICU beds/100,000 inhabitants, we will have to take money from elsewhere in the state’s general budget or increase taxes. Are we willing to pay that price? In our perspective as Evangelicals, we should, but everything depends again on the value we concede to human life, both young and old.
On the other hand, Evangelicals are alarmed by the economistic worldview of life that several global policy makers are demonstrating in their public statements, in which they quantify the possible death toll only in terms of economic balance between the cost of resources for medical treatment of people, and the rollback effects on the sacrosanct deity of GDP and its growth. People have an immense, non-quantifiable, intrinsic value that must be above those calculations.
This disease is challenging in many ways. It brings back questions that we thought had been solved and will force us to rethink priorities and behaviours. And it’s not going to be easy.
SECURITY AND FREEDOM
The Korean philosopher Byung-Chul Han poses another challenge. It seems that some Asian countries are dealing more effectively with the spread of the pandemic by using computing and big data tools which involve extensive government control over citizens, to an extent that we Western people find unacceptable. This control is now being effective in tracking potentially infected persons, for example, their mobility and traceability, but it can also be used –as it has been for decades in the P. R. China– for the control of what each citizen does, reads, communicates, etc., which supposes a serious liquidation of personal liberties.
The dilemma that arose in the 1930’s, which was reopened with the threat of Islamic terrorism, is once again being reawakened with the fight against the pandemic. Will we hand over more control of our lives to the State if in return the State guarantees us greater effectiveness against collective threats such as the present one? Is it worth giving up some personal freedom in exchange for greater security?
Part of the answer lies in the fact that it is not always a question of all or nothing. So, the solution may be to replicate “how far, until when, and under what circumstances?” We must be very clear, because political power tends to monopolise more and more control and never returns willingly any domain sphere even if it had been handed over conditionally and temporarily.
It is possible that the Asian example will lead many to think that the Chinese model, which combines capitalist development with an Orwellian police state, has had results in handling this general emergency, and that it will effectively overcome the health and economic crisis. It is possible that many understand that the price paid for personal liberties is not slight, and they may be inclined to think that efficiency is most important. Consequently, we must change the foundations of our Western democratic system and convert to the State’s permanent control over the activities of the individual. This tendency to surrender more competencies to the State is becoming palpable here among us in other areas of public life. The Spanish Evangelical Alliance has made statements in the area of, for example, the family’s responsibility is more important than that of the state. This idea goes beyond the left/right axis and threatens the healthy limitations on the exercise of power, limitations that are characteristic of a democratic State. From our Protestant perspective, political power must always be restricted and controlled by counter-powers and must rigorously respect inalienable individual liberties. It is a fallacy to sell us security in exchange for renouncing to freedom.
But we cannot stop there! In a biblical perspective, individual freedom is inseparable from personal responsibility, and the latter includes a clear commitment to others, a serious awareness and exercise of our own personal social responsibility for others. The Bible is full of requirements of care and dedication to one another. Therefore, State control becomes less necessary if each citizen exercises his social responsibility. This is relevant in the present pandemic.
This pandemic shakes up our health system, our security, and our economy. But it may also shake up our shared worldview; the consensus on democratic principles; the balance of powers; and the sovereignty of each sphere of competence and personal freedoms. Spanish Evangelical Alliance calls on demanding effectiveness from the State as much as the development of each one’s social responsibility and the defence of personal liberties.
THE RESPONSIBILITY OF THOSE IN GOVERNMENT
It is our civic duty to support the measures taken by the authorities, both the current ones and those that will come later, but it is also our duty to demand from the rulers the corresponding responsibility and foresight. Some will say that this is not the time to look for fault, but it is certainly the time to evaluate what is being done because the epidemic does not leave us any margin. If something must be corrected, it has to be immediately corrected.
We can no longer have the feeling that decisions are being made “as we go along.” Undoubtedly, the measures must be proportionate, but as far as possible they must not be improvised. We have examples from the P. R. China and Italy, and from them we must learn and be able to appropriately react in time. In view of this, the Government has failed and must correct the strategy. There was no responsible anticipation when at the beginning of March it was already known what was coming to us and the Government irresponsibly allowed –and promoted– in many towns the massive demonstrations on International Women’s Day; it was neither responsible during the celebration of the Vox event in Vista Alegre on those dates. It is not acceptable that ideology prevails over caring for citizens. The same thing happened with mass sport competitions and other events, the judgment of which was based on the economic and populist criteria, rather than about responsible and transparent management of the general interest.
Neither was there a responsible anticipation when the necessary health material was not imported in advance and no measures were taken to promote their domestic manufacturing. It had to be the private initiative or that of the autonomous governments that came into action. It must also be pointed out that in this the autonomous governments had competencies in public healthcare, and they did not exercise them with full responsibility.
In short, we support the necessary governmental decisions, but not as a blank cheque: we, as responsible citizens, demand a review of these decisions to improve them and correct them if necessary.
We will have to re-evaluate public health policy and change what is needed. Because the health care professionals are currently on the front lines, they have the authority to be heard. Public health policy must be liberated to some degree of ideology and it must pay more attention to professional knowledge and criteria.
And in foreign policy, the government cannot be so naïve: it allowed the Chinese Government to carry off all our stocks of protective masks at the beginning of the crisis, and now we must buy them back from China at a higher cost.
GETTING AHEAD OF THE CURVE
Dramatic situations like the one described at the beginning of this document –which will multiply in the coming weeks– were foreseeable, since we had the first news from China. We are not going to present forecasts of numbers of infected people and ICU admissions that will occur, because this could generate alarm. However, we can make our own decisions based on reviewing the natural history of the infection and observing what is happening in various countries. We can clearly foresee that the number of diagnoses will increase because of the evolution of the curve, and because with the rapid PCR tests we will detect more undiagnosed cases with mild symptoms. The more relevant question is how many people will need admission in hospitals and, above all, how many will require intensive care. And then we will discover that we have a real risk of being overwhelmed.
Currently Germany has a lower mortality rate. Although there are many reasons for this, one of the most important is that it has 24.6 ICU beds per 100,000 inhabitants. Spain has 8.2. And the reason is not that Germany has more economic resources: if we compare the GDP with ICU beds, we see that the budgetary effort is almost 50% higher in Germany. It is no longer a question of having more money, but the priorities in spending everyone’s money. We knew this before the pandemic. It was in line with a specific set of budgetary priorities that we have been maintaining for decades, with both rightist and leftist governments, and that has led us to where we are today. And what now? The incidences of severe respiratory complications from the coronavirus will exceed our healthcare resources. We will now have to implement war medicine measures, such as that of IFEMA, which is a good and necessary initiative, but it should have been preceded by more robust stable healthcare policies.
We cannot reverse all this immediately, but at least, we are now in a position to anticipate what will come after the pandemic, especially in two areas: healthcare and economy.
In relation to healthcare, we know that in the upcoming months and years, cases of chronic respiratory diseases and even lung transplants will increase, and we must start to prepare for this. Above all, however, we must learn from the pandemic in order to anticipate similar situations in the future and make budgetary decisions. Health is more than an expense: it is an investment and a basic right. On the other hand, the correct and coordinated articulation with the autonomous governments will be essential, avoiding the bargaining of resources from the central government with the autonomies.
As for the economy, we will have to pay special attention to the re-floating of companies and the rescue of families’ economy. The post-pandemic period will not be a time for ideological dogmas, but for effective measures. At the level of the European Union, the mutualisation of debt (the “corona bonds”) is a measure of solidarity, but it should not lead to the promotion of irresponsibility and relaxation of the countries that most benefit, such as Spain.
But as Evangelicals, we have additional responsibilities: some of our brothers and sisters will come out of the crisis with serious economic difficulties and we have a responsibility towards them that goes beyond that of the government. We must not leave everything in the hands of public initiatives. We foresee a situation of hardship and we must anticipate it, making use of the solidarity that has always been present in the Evangelical churches as mutual aid communities. The church of Antioch is an example to follow: “And there stood up one of them named Agabus and signified by the Spirit that there should be great dearth throughout all the world: which came to pass in the days of Claudius Caesar. Then the disciples, every man according to his ability, determined to send relief unto the brethren which dwelt in Judea.”
OTHER LESSONS FROM THE PANDEMIC
Lying and concealment kill. A Chinese doctor, Dr Li Wenliang, announced on December 30th that a SARS-like pandemic was coming; the police threatened him and actively suppressed his voice, in an unacceptable interference of political power over medical-scientific activity, so characteristic of dictatorships. The doctor died from his patients’ illness and his government has not acknowledged its own mistake and the doctor’s heroism. Had they not concealed his voice, the pandemic would have been smaller and more controllable. Concealment kills.
We will come out of this crisis with another lesson: what I do inevitably impacts others. We are each other’s caretakers and it is unrealistic to get rid of this responsibility by saying “Am I my brother’s keeper?”
This disease, like all diseases, overcomes social and economic differences, and strips away all false securities. All of us, no matter our position in life: poor or rich; powerful or ordinary; need to become more aware of our vulnerability. Suddenly, the words of Deuteronomy become clear: “And thy life shall hang in doubt before thee; and thou shalt fear day and night, and shalt have no assurance of thy life”. It forces us to re-think what and who is worth our trust and security.
It is an adequate moment to value what we really believe, in which person we affirm ourselves with confidence, so that we will not fall even if everything is being shaken: “We will not fear, though the earth be removed.” We Evangelicals are not immune to the coronavirus, we are very clear about this, but when we see all the things that are happening, we are sure that not one of them escapes the care of our Father God.