They entail ethical questions about how we balance different interests (e.g. individual and collective; economic and social) and different risks (e.g. of COVID infection, and of poor health associated with poverty and isolation); of what and who we should prioritise when it comes to the crunch (e.g. COVID-19 over other health needs; the young, the elderly or key workers?); about who bears responsibilities for supporting those in need (Government, industry, communities, individuals); about whether we have not only national, but also international responsibilities; about how privacy will be protected when contact-tracing apps get up and running, as Matt Hancock has said they will, very soon; about the implications of mass testing for disease or immunity – what is the validity of the tests; who gets an ‘immunity certificate’, and where does that leave the rest of us?
These are critically important issues that affect many people – indeed everybody - in many ways and we need to talk about them, together. And yet the Westminster Government does not seem to want to engage or take on board other views on any of these issues; nor is it evident that they are thinking about them, or taking advice on them from a social and ethical perspective. “We are following the science” is the supposedly reassuring message. But following the science is not politically or morally neutral. Every scientist will tell you that science does not provide certainty (and is usually contested); and it does not deliver policy answers – that involves values and judgements for which people are responsible and should be scrutinised, and accountable. Which values are in play and what judgements are being made? By whom? On what advice? When senior political advisors join expert advisory groups such as SAGE, what is being brought into and taken away from those discussions? We understand that there is now an ethical advisory group for the app development, but public information about this is limited and obscure.
This is not merely a matter of curiosity. It is a matter of fundamental democratic accountability. Decisions are being made and are due to be made that go to the very heart of what governments are there to do: to protect the freedom and well-being of their people. But they must do so openly, transparently, and accountably, especially where those decisions impinge on precisely that freedom or aspects of well-being. Democratic governments must be subjected to public debate and challenge. The fact of an emergency or crisis makes things difficult, but is no justification for closing down on public discourse. On the contrary, if we are all at risk, and we are all in it together, we all need to know and all need to have a voice.
The big question at the moment is about the strategy for easing current restrictions. The UK Government claims to have published it, in a five-point set of criteria. Once again this is massively simplified. (Compare it to this analysis from the Government of South Africa, and to the openness of Nicola Sturgeon on Thursday.) These five points do not address any questions of how risks are being balanced; of what gets prioritised and why; of who bears the greater burdens and why that is (or is not) fair; of what principles or values are informing the decisions about how to proceed with the ‘exit’; or what arrangements will be there when we get to the other side, and why.
Organisations like the Nuffield Council on Bioethics don’t have ready-made answers to these problems, and do not have authority to speak on behalf of everyone, but we and others are ready and eager to join the discussion. There are civil society groups and charitable bodies; there are community groups and health-related bodies; there are academics from a range of disciplines, all of whom have much to offer on all of the questions at issue. The UK has great intellectual resource that is frustrated in not being consulted or involved. Most importantly, it also has a public that has much to say but no opportunity to say it.
Either there is no capacity to open up a wider public discourse, or there is no political will to do so. The civil service is stretched, diminished, and overwhelmed by Brexit and COVID-19, so capacity to run urgent public engagement exercises may be difficult, but there are others who can be commissioned to do this. And there are ways - citizens’ assemblies, for example, going beyond simple consultation, are effective in facilitating public deliberation. Capacity should not be an excuse. So is there a lack of political will? As far as we can see, neither the UK Government nor any of the devolved administrations have taken advice from their own Moral and Ethical Advisory Group, established last year to advise precisely on pandemics (and other things). To do that much would be the absolute minimum requirement. If they have consulted MEAG, they have not made it public.
It is right to regard COVID-19 as a crisis; it is right to talk about urgency, even an emergency. It would be wrong, however, to allow it to become an excuse for bad governance.
We have set out in earlier blogs (here and here) our concerns about obscurity and lack of engagement in decision-making; about how important transparency is for trust and trustworthiness. Let us now be completely clear about what we think this means for the UK Government. It should:
These exhortations arise from the basic principles of democratic governance. We should not need to remind the UK Government of them, least of all at a time when we really are all in it together.
Dave Archard, Chair
Hugh Whittall, Director
On behalf of the members of the Nuffield Council on Bioethics:
Simon Burall
Victoria Butler-Cole
Carol Brayne
Simon Caney
Melanie Challenger
Clare Chambers
Tara Clancy
John Coggon
John Dupré
Frances Flinter
Elaine Gadd
Anne Kerr
Shaun Pattinson
Michael Reiss
Mehrunisha Suleman
Susan Tansey
Christine Watson
Heather Widdows
07 Jan 2022
1
