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The need for ethical decision-making

19 Feb 2021

A common issue can not only bring people together, but can also divide them, depending on how it is dealt with. By the looks of it, the Covid-19 pandemic is merely a disease that is arduous to contain. However, containing it requires something more than technical solutions, as it is human lives that are at stake. From the very first time Sri Lanka imposed curfew on 20 March 2020 until it began the vaccination programme early this year, all decisions pertaining to managing the Covid-19 situation were taken by the Government; public institutions, including but not limited to the Health and Defence Ministries; and the Government appointed, Army Commander-led National Operation Centre for Prevention of Covid-19 Outbreak. Their decisions helped stifle the spread of Covid-19. However, as the pandemic situation worsened and turned out to be almost uncontrollable with its second wave, Sri Lanka is now at a juncture where ending the pandemic is not the only priority, as the pandemic hit not only the state of being alive, but also the concept of living. In this case, the adoption of mere technical and scientific solutions is unlikely to cut it, and healing people’s shattered souls requires being conscious about the ethical aspects of the Covid-19 management efforts. This concern came to light recently, when the Ethics Committee of the Sri Lanka Medical Association (SLMA) requested government authorities to establish a national ethics committee to provide ethical guidance to Sri Lanka’s Covid-19 response efforts. The SLMA Ethics Committee also raised concerns over the Government’s controversial policy of allowing only the cremation of the Covid-19 dead and matters pertaining to identifying the priority groups in the Covid-19 vaccination programme, which the public too have raised concerns about. The Government’s policy of cremating those who died due to Covid-19, despite World Health Organisation (WHO)-issued guidelines recommending that safe burial is possible, caused months-long protests and debates. What’s more, on top of the allegations concerning human rights levelled against Sri Lanka, this particular policy was also viewed by some as an act of discrimination against the country’s minority Muslim community who fought back as cremation is not approved in their religion. Even though Prime Minister Mahinda Rajapaksa last week stated in Parliament that the Government is willing to allow the cremation of the Covid-19 dead, which many thought was the end of the Government’s “cremation-only” policy, it appears to be a hollow promise, as there is not even sign of the Premier’s words turning into action. Secondly, when carrying out the Covid-19 vaccination programme, Sri Lanka, like all other countries, had to make a hard decision, i.e. making a priority list, mainly due to the limited number of doses that were available and the aggressive nature of Covid-19. Sparking hope among the general public, the Government this week started the second phase of the vaccination programme which prioritised members of the general public who were identified to be at a higher risk of contracting Covid-19 than others, especially due to high interactions with others, and this phase included Members of Parliament as well, even though they were not under the first phase. The concept of “triage”, in medical use, means identifying and giving priority to those in the highest degree of need of medical attention, and in the Covid-19 vaccination programme, especially when identifying the priority groups, this was necessary. Decisions pertaining to health concerns, especially a pandemic that threatens the existence of the human race, need to be taken carefully and wisely, and most importantly, with consideration of the fact that it involves human lives. Returning to normalcy is not confined to people regaining their lost health and freedom, nor does it mean the country resuming all activities that came to a standstill due to the pandemic. More than those, it means that people’s sense of living and being has to return to normalcy.


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