Corona and epidemiological ethics

In a previous article, I promised to single out epidemiological ethics with a special article. Most of the discussions about the Corona virus were preoccupied with either medical discussion or follow-up to news and spread of the virus, or religious debate related to collective ritual performance, or so; but the moral debate remained absent or unfulfilled.

If the medical questions are clear and practical, such as: How do we stop the spread of the epidemic? What treatment saves people's lives? Ethical questions are applied, and if they are based on theoretical discussions, then they are many, including: In the event of a pandemic, any health system becomes unable to absorb a large number of intensive care patients at one time, due to the lack of equipment and the medical team, in which case it must The doctor must choose: for whom should the treatment be given first?

Is the travel ban and the closure of airports, mosques and markets justified morally? Are the measures of social isolation and quarantine ethically justified? If justified, how do we ensure that basic needs reach people in this case? How do we prevent stigmatization of people with HIV? What are the virtues that individuals should possess in the case of epidemics, whether in their movements or in their consumption and storage of goods, or in volunteering to help health agencies if necessary, or in compliance with the instructions of the competent authorities?

And if thinking about self-interest is an innate feeling, what is the best behavior towards the poor and needy who live day by day in this ordeal? If a person becomes infected with the virus, how does he act, and should he inform the authorities? What is the duty of every person to prevent the spread of the virus? What if he knew that another person was infected but did not isolate himself, would he report it first or advise him to inform the health authorities first?

It is doubted that he is infected, what does he do in the stage of doubt? Does he have to isolate himself immediately to make sure or continue his normal life until he is confirmed? On another level: which research has priority now in epidemic time? Does the state have to disclose the spread of the disease transparently to educate people about the dangers surrounding them, or does it have to mitigate it on the pretext of not causing panic among people?

We can move away from moral questions during epidemic times, which deal with the state, the individual, and the group, but they are due to two main issues: “normative ethics” that assesses actions whatever their subject, and “ethics of virtue” that focuses on the subject himself and his virtues, a previous stage On the verbs embodied in them at the same time.

If we go along with normative ethics, we will find that it raises a lot of discussion because it deals with actions and is unlimited, and relates to the complexities of the relationship between religion, law and ethics. Moreover, epidemics impose exceptional behaviors on us that contradict the established rights and provisions in normal conditions. For example, health policies tend to restrict the freedoms and movements of people, such as voluntary social isolation, health isolation for patients, and quarantine for a city or region, which may include patients, suspects, and healthy people. Together, they are all actions that go against basic human rights and need moral justifications so that they are based on well-founded principles and explanations.

For example, the closure of mosques and the disruption of Friday and congregational prayers aroused great controversy because it is a matter of worship. However, most of the comments did not discuss the matter from an ethical approach, and this procedure was rarely linked to other groupings and collective activities (cultural, sports, etc.), because the reason behind all of them is the same, and it is built On a specific medical diagnosis, then the discussion should have gone to discussing the cause itself and how it was achieved first, then in the extent of the effectiveness of such a procedure in achieving the goal second, then in weighting between the values ​​to be achieved, both in the case of maintaining collective activities - including rituals Religious- or in the case of I. To cancel it.

Collective activities relate to a set of values: the right to worship, freedom of movement and self-preservation, which are all entrenched rights for individuals, but also the moral responsibility of the state in relation to the public health of citizens, especially that any risk like this will endanger the state's capabilities to damage, which will affect its future and its path as happened in many epidemics Historically, groups of people have been harvested, and the state forces have been exhausted, which accelerated its political, economic and social collapse.

The field of ethics, then, helps us define the principles and ethical values ​​that govern our actions in times of epidemics and infectious diseases, as it helps us in formulating our priorities and our due choices between a set of actions, and helps us in determining what is valid or invalid, and to provide the necessary justifications to make what is true or right It is a mistake by mistake, in an organized manner in which consistency, coherence and rationality are achieved based on the sources in which a society is recognized (religion, reason and custom ...). All of these ethical explanations are necessary if we are to change the behavior of individuals and institutions, as long as we speak of individuals who enjoy their freedom and independence.

Epidemiology ethics, like standard ethics in general, is based on ethical reasoning, providing criteria for setting priorities and balancing two or more actions to determine what is best or most appropriate, but the most important thing here is that we are talking about actions and assessments in an exceptional time, and I can distinguish between the exceptions between Necessities and emergencies.

Islamic jurisprudence knew cases of necessity and distinguished them with special provisions, but I consider that the state of emergency is a more accurate case, as it is an expression of an unfinished event but is still forming and we do not know it has a final form yet, and requires dynamic and active policy, and requires speed in taking the decision. It is a case that practically tests the possibilities of aligning principles and values ​​that are fixed in natural conditions with what is available or possible at the present moment. As for the state of necessity, it is often a static or stable condition.

Since we limited the discussion here about the normative ethics of actions, defining the ruling values ​​and principles and the balance between them is a central issue, and in the case of epidemics we talk about a set of values, including: the preservation of life and health, the individual freedom and the justifications for restricting it, the moral responsibility towards the soul and others, and the responsibility of the state towards Society, professional duties for medical personnel, and others.

As we have pointed out, the moral viewpoint is based on building the necessary explanations for the actions, and defining the criteria upon which the priorities are determined, and here a balance is made between the duties themselves, between the interests among them, between the evil among them, between the interests and the evil together, and between the minor and transgressive act, And between private and public, and between harm and harm, etc.

But it remains - according to Islamic jurisprudence - that knowing the rulings ’ills and their ramifications is a main condition for conducting moral reasoning and fatwa as well, and here the faqih and lack thereof appear, neither in narration of texts nor in the tale of the doctrines sayings without knowing the intent of each statement and its reason, so that we can download it to reality and know its usefulness .

I will list here a number of budgets and how to explain them so that the foregoing becomes clear. In public health ethics at a time of epidemics, we are faced with a balance between two approaches: a method that prioritizes respecting the rights of individuals and does not restrict their freedom except to the extent necessary only, and an approach that gives the highest priority to the interest of the group and to the preservation of public health, but opinion What is consistent with Islamic jurisprudence and the rules of interests is that the interest of the group is presented here, especially since we are talking about exceptional measures and restricted by a specific circumstance that ceases to exist.

The closure of mosques, for example, requires first identifying the character of this act, and is it the one who preserved religion? And if so, what is his rank? Is it necessary (preserves the existence of religion itself) or is it a complement to the necessary (not related to the existence or absence of religion but it is diminished)? If it is a complementary, then the complementary does not have the power to oppose the necessity, for the group is established everywhere and with the lowest number, and the Friday has an alternative that is resorted to in the lesser of circumstances, which is the performance of the duty of the noon.

God Almighty has permitted hatred to utter disbelief to protect oneself, which originally created a balance between two faculties: preserving religion and preserving oneself, and permitting the provision of self-preservation over the preservation of religion, especially since preserving religion does not save souls, and the souls of creation have perished historically because of the plagues, The mosques, the gathering, and the groups themselves were disrupted, and the two values ​​were lost together!

Similarly, in washing the dead person with corona, for example, here it is necessary to determine the ruling and the value attribute of washing the dead: is it a duty or a year? Is washing the right of the individual or the right of the group? Is purity (including washing the dead) a necessary, improvement, or complementary issue? If the infringement of the right of the individual then contradicts the right of the group that can be infected here, then it is the previous criterion in public health ethics, which is that the general right is preceded by the private right.

And if the washing of the deceased was a complementary or an improvement, and the fear of infection occurred and the necessary damage (which is the preservation of souls) was caused by it, then there is no doubt that the necessity is before the supplement. But if it is possible to resort to a specialized team that performs washing with due medical precautions and is able to solve these inconsistencies, then this is undoubtedly the first.

A problematic example of setting priorities is the answer to a question: Who should start the medical team if he has to choose, because of the lack of equipment needed for treatment and the insufficiency of the medical teams? Although this issue is debated in the field of medical and epidemiological ethics in particular, some have found an opportunity to insult the West and to prove that it is immoral in dealing with patients, without trying to engage in serious discussion about the standard that must be followed in this case, and why? Should the sickest be presented? Or please innocent? A young mother? Or the most vulnerable groups, such as the elderly and children? Or health workers?

Views differ here and there is no standard subject of agreement, and when there is no probability and the face of interest or truth is hidden and arguments are absent; jurists usually resort to lots, and if the interest or right is determined in one direction, they do not permit the resort to the lot. It is an objective way to sweeten hearts and remove the charge of inclination and prejudice, and they have applied this on many issues. But the example presented here, even if it is an accident, is related to old doctrinal issues and discussions on several issues: what is taking place "knocking", "being timid" and "moving from one cause of death to another", all of which deal with preserving rights and preserving values , Or differentiate between them.

And if the juristic discussion devotes a lot to the discourse of the individuals themselves and the conditions that are necessary in the one who is inspired (who was the reason for sustaining life), such as if the ability is available, for example, and to present the closest to the one closest to him when the duties are crowded, then our discussion here is focused on the competent authorities that are responsible for the shame of people, Whether they are medical teams or a health ministry that sets out general policies.

It does not seem to me that the lottery works as a means here, because the choice between patients in this case is based on conflicting interests that are balanced between them and subject to the rules of the budget, as we are talking about emergency ethics that require a speedy decision-making based on scientific rather than arbitrary data. But it remains that the choice here will upset the value of justice and equality among patients in obtaining equal access to the necessary treatment, but this is not available in light of the prevalence of epidemics, that is, the power requirement is not available.

Western debates here revolve around two criteria: diagnosing the condition and the degree of need for treatment, and estimating the desired recovery rate; the philosophy of duty (deontology) is consistent with the first criterion, utilitarianism and the consequences of actions (consequentialism) are consistent with the second criterion.

Muslim jurists have fought similar moral debates, and an example here is: If a fire has arisen in a ship, for example, how should its passengers behave? And the standard here is what they think most likely to be safe: whether staying in it or leaving it and jumping from it to the water. But what if the two things are equal? Al-Shafi’i and Ahmad go to the choice, so the passengers choose whatever they want. As for Al-Awza’i, he said: They are two deaths, so choose the easier ones for you. More than death, because keeping souls is an obligation as much as possible

Returning to the central question about the criterion of choice, it is necessary to differentiate between two concepts: medication and shame (saving life), and the jurists differentiate between them based on the diagnosis of the person's condition, and based on an assessment of the efficacy of the treatment itself which is suspect and if the degree of thought varies. Whoever supervises perdition must treat his treatment to those who are still in the early stages of the disease, and the criterion here is shame and the degree of need, and there is no difference here between a young man and an old man, because the souls are equal in value, but the elderly who suffers from other diseases associated with (underline medical conditions First to apply, because this will double the risk of his death by disease, and then the severity of his need for urgent treatment, if not hopeless for his recovery.

Thus, it appears that moral discussions are necessary and rich at the same time, and that their basis is to explain and present coherent arguments; I have been confined here to a party of normative ethics without fulfilling all the questions raised, but my account is that I discussed the idea in general and the possibilities of its application.