Moral multi-tasking in the COVID-19 response

The word ‘jobs’ must be a moral mantra.

A French first aid worker drives an ambulance
A French first aid worker drives an ambulance in response to a home with a suspected COVID-19 case on 14 April in Paris. (Raphael Lafargue/ABACAPRESS.COM)

As the global aid community continues to scale up and adapt to the worldwide emergency around COVID-19, it is rightly engaging with different layers of moral decision-making to agree what is an ethically good response and not just a quick reaction.

In medical and social ethics, many aid workers are well informed from the earlier HIV/AIDS pandemic and the recent Ebola epidemics. But the COVID-19 crisis is only partly, and initially, a health crisis. It is now fundamentally a worldwide economic emergency as businesses of every shape and size stall and crash, and unemployment – both formal and informal – rises exponentially, much like the virus itself.

This makes the challenge more complicated still, and some predict it will be followed by political whiplash of many kinds. Nobody really knows what happens when you slam on the brakes of the world economy in an emergency stop and then try to restart it a few weeks later. Which letter of the alphabet will the recovery be on the graph: V, U, W, or a no-recovery L?

This means aid agencies must do some significant moral multi-tasking in their response as they try to act responsibly across a spectrum of ethical quandaries: from the way they work with individuals to the policy choices they make in the design of their programmes.  

Strategic ethics around COVID-19 involve a range of moral juggling familiar within humanitarian settings. Standard distributive decisions about which country, city, and district to prioritise must, as always, be made by agencies and governments together – playing to their strengths, gap spotting, and coordinating responsible collective action.

In responding to the coronavirus and its knock-on economic and social impacts, aid agencies should also build social and economic capital at the community level in volunteer networks, formal and informal services, profitable businesses, and local expertise. 

In the COVID-19 emergency, we need to raise up the humanitarian principle of voluntary service alongside humanity, impartiality, neutrality, and independence. This is because neighbourhood networks and mutual aid associations will do much of the social caring and economic sharing that will keep people alive, just as they did in the HIV/AIDS pandemic.

“In the COVID-19 emergency, we need to raise up the humanitarian principle of voluntary service alongside humanity, impartiality, neutrality, and independence.”

Widespread social mobilisation is key to addressing this crisis. Community groups respond quickest and best to local needs and give individuals and communities an experience of agency that will be vital to maintain their positive mental health and a sense of dignity and value in the storm breaking around them.

These groups will not be perfect. Human nature suggests that many such groups will feud and fragment. New charity tyrants will arise alongside new saints. But the best thing aid agencies can do is work in solidarity with the enormous surge of people power taking shape around this crisis, adding value to it by supporting religious networks, community-based organisations, local businesses, and government services. This must be a locally driven response. COVID-19 is everyone’s emergency. Everyone must be involved.

Alongside social mobilisation, the economy must be a major priority for all aid agencies no matter which sector they identify with professionally. The moral imperative must be to design aid programmes that deliver as much direct and indirect benefit to the local economy as possible. Programmes should manufacture and purchase relief equipment locally and – where informality and social distancing prohibit factory work – mobilise cottage industries. And volunteers should be paid in some way wherever possible.

The word “jobs” must be a moral mantra in this response and one that is constantly repeated. Money must be passed around at a faster rate than the virus to keep people eating, making, buying, selling, and surviving. 

Against the backdrop of these strategic socio-economic choices, we must grapple with the more intimate personal ethics of our duty of care to ourselves and others. In the COVID-19 emergency, humanitarian workers are not simply helpers. They are also potential carriers and spreaders of the virus. The arrival of aid workers from outside has long been politically ambivalent for at-risk communities. It is now also medically ambivalent because aid workers may carry and transmit COVID-19. So, here, aid workers’ personal behaviour has to be profoundly careful as well as caring.

Our duty of care also extends to our staff and volunteers, as potential victims of COVID-19. We have to protect our own from being hurt by the virus as well as limiting their potential to hurt others by spreading it.

The extent of the crisis may well mean that some of our staff prefer to opt out and be with their own endangered families during the peak of the pandemic. Agencies need to be open to enabling difficult decisions around dual loyalties.

Other staff may be genuinely fearful of infection but believe they have no choice but to keep earning. They need to know their agency is doing its best to protect them. The many staff and volunteers who are easily courageous and highly motivated must find the right balance in their behaviour between bravery and recklessness. True courage is well judged, purposeful, and selfless.

“True courage is well judged, purposeful, and selfless.”

Agencies offering services in frontline healthcare and public health are familiar with making intimate life-and-death decisions about referrals and treatment. In high-scarcity contexts, this means prioritisation and triage – choosing one life over another. But it must also mean making those policies and decisions clear through public discussion, alignment with government policies, and generating informed public and individual understanding of the triage policies.

These are terrible choices to make, but triage is a good and necessary choice, and public consent must be sought for it until a widely available vaccine arrives – which can be applied as a truly just solution. And, wherever possible, the tragedy of triage must be mitigated by compassionate palliative care of some kind. Humanitarian response must stay with the dying while it saves the living.

Health response must also find some parity between continuing to treat people who are suffering from other illnesses alongside a surge of COVID-19 cases. Maintaining separate facilities as well as a balanced portfolio of care will be constant challenges, and the best way to manage this is by choosing to use the crisis to build better national health systems, not a temporary stand-alone coronavirus response.

There will be more epidemics and pandemics after COVID-19. The moral multi-tasking required to deliver sound ethical programming in this emergency is work that will build capacity to respond well to the next one, too.

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