Fostering hope and resilience amidst intractable ethical dilemmas brought about by the COVID-19 pandemic

This special issue of Etikk i Praksis – Nordic Journal of Applied Ethics features four articles that address a number of urgent ethical issues that arise in the COVID-19 pandemic.

The ”foreign” virus?

In response to the COVID pandemic, the Norwegian government implemented the strictest border controls in modern Norwegian history, barring entry to most foreign nationals. The Prime Minister, Erna Solberg, justified these policies with reference to the rise of new COVID variants and the need to limit visitors to Norway as much as possible. As this approach has severe adverse effects on many people, there is a need to critically examine the justification given for closing the border. In this paper, we argue that while many border restrictions are legitimate, (1) the arguments given for the recent banning of entry for groups of people are not convincing, and (2) that the ban unduly limits personal freedoms and places an unjust burden on transnational citizens and Norwegians with close relations abroad. Keywords: COVID-19, Border Closure, Border Restrictions, Justice, Sovereignty, Nationalism, Immigration, Freedom, Ignorance

Reverse Triage and People Whose Disabilities Render Them Dependent on Ventilators

The COVID-19 pandemic has occasioned a great deal of ethical reflection both in general and on the issue of reverse triage; a practice that effectively reallocates resources from one patient to another on the basis of the latter having a more favourable clinical prognosis. This paper addresses a specific concern that has arisen in relation to such proposals: the potential reallocation of ventilators relied upon by disabled or chronically ill patients. This issue is examined via three morally parallel scenarios. First, the standard reallocation of a ventilator in accordance with reverse triage protocols; second, the reallocation of a personal ventilator from a chronically ill patient ordinarily reliant on it; and, third, the reallocation of a personal ventilator owned by a financially privileged individual but who is not ordinarily reliant on it. This paper suggests that whilst property rights cannot resolve these scenarios in a satisfactory manner, it may be possible to do so if we draw on the resources of phenomenology. However, in contradistinction to a recent paper on this topic (Reynolds et al. 2021), we argue that ethical claims to ventilators are not well grounded by the overly demanding notion that they are embodied objects. We suggest that the alternative phenomenological notion of homelikeness provides for a more plausible resolution of the issue. The personal ventilators of individuals who commonly rely upon them become part of their ordinary, everyday or homelike being. They are a necessary part of the continuation or maintenance of their basic state of health or wellbeing and the reallocation of such objects is unethical. Keywords: Phenomenology, COVID-19, Pandemic, Triage, Reverse triage, Ventilation, Chronic illness, Allocation of resources

Public health priority setting: A case for priority to the worse off in well-being during the COVID-19 pandemic

In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions. Keywords: COVID-19, Prioritarianism, Priority Setting, Public Health, Severity

Comments on Rozas

This is a commentary to Mat Rozas "Two asymmetries in population and general normative ethics".

Two asymmetries in population and general normative ethics

This paper examines a dilemma in reproductive and population ethics that can illuminate broader questions in axiology and normative ethics. This dilemma emerges because most people have conflicting intuitions concerning whether the interests of non-existent beings can outweigh the interests of existing beings when those merely potential beings are expected to have overall net-good or overall net-bad lives. The paper claims that the standard approach to this issue, in terms of exemplifying the conflict between Narrow Person-Affecting Views and Impersonal Views, is not correct. It argues that, instead, we can approach the issue through the distinction between Symmetrical and Asymmetrical Views about the relative importance of positive and negative value. The paper also claims that Asymmetrical Views provide the most intuitively satisfactory solution to the dilemma and can in addition be defended independently on further grounds. Keywords: person-affecting views, impersonal views, symmetry, asymmetry

What our hopes and fears tell us about our values

This open issue of the Nordic Journal of Applied Ethics consists of four papers that discuss topics covering fetal diagnostics ethics, value conflicts in the use of artificial intelligence, abortion and population ethics.

Ethical guidelines for the use of artificial intelligence and the challenges from value conflicts

The aim of this article is to articulate and critically discuss different answers to the following question: How should decision-makers deal with conflicts that arise when the values usually entailed in ethical guidelines – such as accuracy, privacy, non-discrimination and transparency – for the use of Artificial Intelligence (e.g. algorithm-based sentencing) clash with one another? To begin with, I focus on clarifying some of the general advantages of using such guidelines in an ethical analysis of the use of AI. Some disadvantages will also be presented and critically discussed. Second, I will show that we need to distinguish between three kinds of conflict that can exist for ethical guidelines used in the moral assessment of AI. This section will be followed by a critical discussion of different answers to the question of how to handle what we shall call internal and external values conflicts. Finally, I will wrap up with a critical discussion of three different strategies to resolve what is called a ‘genuine value conflict’. These strategies are: the ‘accepting the existence of irresolvable conflict’ view, the ranking view, and value monism. This article defends the ‘accepting the existence of irresolvable conflict’ view. It also argues that even though the ranking view and value monism, from a merely theoretical (or philosophical) point of view, are better equipped to solve genuine value conflicts among values in ethical guidelines for artificial intelligence, this is not the case in real-life decision-making. Keywords: AI; ethical guidelines; algorithm-based sentencing; value conflicts

Assessing RRI

This is a review of the book Assessment of Responsible Innovation: Methods and Practices, edited by Emad Yaghmaei and Ibo van de Poel, London: Routledge, 2020. 394 pages https://doi.org/10.4324/9780429298998

Abortion and multifetal pregnancy reduction: An ethical comparison

In recent years, multifetal pregnancy reduction (MFPR) has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health (2014) that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR. Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis to ascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intention argument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore — despite what several discussants seem to think — that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics, medical ethics, MFPR, selective MFPR