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What do philosophers and social scientists say about the coronavirus?

What do philosophers and social scientists say about the coronavirus?

Last months both general public and scientific world is concerned about one thing only - and it is of course the pandemic of an infectious disease Covid-19 caused by novel coronavirus SARS-Cov-2. Philosophers and social scientists are among those who analise the global pandemic and the responses to it. Below we present an overview of the most interesting philosophical articles.

INCET's debates (in Polish)

  • Intensive care in times of crises

    Włodzimierz Galewicz, Andrzej Kübler, Anna Paprocka-Lipińska, Tomasz Pasierski, Janina Suchorzewska, Mariusz Piechota, Jakub Pawlikowski, Krzysztof Kusza, Piotr Grzegorz Nowak, Anna Duława, Jan Duława, Kazimierz Szewczyk

  • Normative status of high risk medical services

    Włodzimierz Galewicz, Wojciech Ciszewski, Jan Piasecki, Arkadiusz Sobczyk, Joanna Haberko, Barbara Chyrowicz

Allocating medical resources

Research articles

  • Hans-Jorg Ehni, Urban Wiesing, Robert Ranisch. Saving the most lives — A comparison of European triage guidelines in the context of the COVID‐19 pandemic. Bioethics; 00: 1– 10 (December 2020)

    Hans‐Jorg Ehni, Urban Wiesing and Robert Ranisch in Bioethics compare triage recommendations from five European countries, published between March 6 and March 27, which combine medical and ethical reflections on pandemic situation. Their aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms they want to identify shortcomings in regard to a common European response to the current situation.

  • Julian Savulescu, James Cameron, Dominic Wilkinson. Equality or utility? Ethics and law of rationing ventilators. British Journal of Anaesthesia (April 2020)

    In British Journal of Anaesthesia Julian Savulescu, James Cameron and Dominic Wilkinson analyze ethical and legal aspects of allocating ventilators in times of the COVID-19 pandemic.

  • Ezekiel J. Emanuel i inni. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. The New England Journal of Medicine (March 2020)

    In New England Journal of Medicine specjalists propose six recommendations about how to allocate medical resources in time of the pandemic.

  • Tyler M. John, Joseph Millum. First Come, First Served? Ethics 130, no. 2: 179-207 (January 2020)

    Abstract: Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, but its use is justified across a range of pretheoretically compelling scenarios. First, there is a duty of fairness prohibiting line cutting where a sufficiently just queue exists. Second, where candidates are in relevantly similar circumstances, allocating by waiting time is efficient, maximizes distribution equality relative to other Pareto efficient distributions, and approaches the fairness of an equiprobable lottery.

  • Richard Yetter Chappell. Against ‘Saving Lives’: Equal Concern and Differential Impact. Bioethics 30(3): 159-164 (July 2015)

    Abstract: Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life‐saving’ treatment.

Popular science articles

  • Robert D. Truog, Christine Mitchell, George Q. Daley. The Toughest Triage — Allocating Ventilators in a Pandemic (March 2020)

    Robert D. Truog, Christine Mitchell and George Q. Daley propose special triage committees for the purpuse of deciding about allocation of medicas resources to buffer clinitians from harm.

  • Julian Savulescu, Dominic Wilkinson. Who gets the ventilator in the coronavirus pandemic? These are the ethical approaches to allocating medical care (March 2020)

    When there is a pandemic, difficult decisions have to be made. Julian Savulescu and Dominic Wilkinson consider how can we allocate medical care and equipment, such as ventilators, in the midst of Covid-19 pandemic. They distinguish five approaches. First is egalitarianism, which can be summed up as the ‚first come, first served’ approach. Second is utilitarianism, which requires the best use of resources. Third is contractualism, introducing ‚the veil of ignorance’. Fourth option is ‚flatten the curve’ strategy imposing restrictions on citizens to stop the spread of the virus. Unfortunately, in many countries it is now too late for that and medical systems will be overwhelmed, even if societies will be very obedient. Fifth is paternalistic approach: some doctors say that ventilating some patients - those who have little chance to survive - is harmful to them.

  • Joshua Parker, Mikaeil Mirzaali. The Moral Cost of Coronavirus (March 2020)

    Joshua Parker and Mikaeil Mirzaali point out the moral cost of difficult (but necessary) decisions of doctors in time of the pandemic. In individual cases someone has to make decisions about allocating medical care and equipment. Enormous weight of moral responsibility should not be neglected. What is more, there is a risk of making a moral mistake, enlarged when factors such as stress and busy, overwhelmed system. Those costs are a weight that doctors have no choice but to accept.

Research ethics in a public health crisis

Research articles

  • Stephanie Harvard, Gregory R. Werker, Diego S. Silva. Social, ethical, and other value judgments in health economics modelling Social Science & Medicine 253 (May 2020)

    Abstract: Modelling is a major method of inquiry in health economics. In other modelling-intensive fields, such as climate science, recent scholarship has described how social and ethical values influence model development. However, no similar work has been done in health economics. This study explored the role of social, ethical, and other values in health economics modelling using philosophical theory and qualitative interviews in British Columbia, Canada. Twenty-two professionals working in health economics modelling were interviewed between February and May, 2019. The study findings provide support for four philosophical arguments positing an essential role for social and ethical values throughout scientific inquiry and demonstrate how these arguments apply to health economics modelling. It highlights the role of social values in informing early modelling decisions, shaping model assumptions, making trade-offs between desirable model features, and setting standards of evidence. These results point to several decisions in the modelling process that warrant focus in future health economics research, particularly that which aims to incorporate patient and public values.

  • Alex John London, Jonathan Kimmelman. Against pandemic research exceptionalism. Science (April 2020)

    Alex John London i Jonathan Kimmelman argue in Science that crises are no excuse for lowering scientific standards.

  • Mariusz Maziarz. Response to 'Modelling the pandemic': reconsidering the quality of evidence from epidemiological models. The BMJ 2020; 369 (April 2020)

    Mariusz Maziarz responds to the article on modelling the pandemic in The BMJ journal.

  • Marc Lipsitch, David Swerdlow, Lyn Finelli. Defining the Epidemiology of Covid-19 - Studies Needed. New England Journal of Medicine (March 2020)

    Authors analise uncertainty of available knowledge about the novel coronavirus and Covid-19. They show how using different methods to estimate fatality rate of the new disease leads to different results and argue that what governments will do to fight the pandemic depend on those results and their credibility. Exrapoating from studies of SARS and H1N1 flu epidemic, authors point on what types of studies should be conducted.

  • Graziano Onder i in. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. The Journal of American Medical Association, New Online (March 2020)

    Authors study the issue of estimating the fatality rate of diseases. Article shows how different strategies of testing in China and in Italy may influence on estimating the fatality rate of the novel coronavirus. They argue that higher fatality rate in Italy is caused by rarer testing and higher number of older people among the sick.

  • Giuseppe Lippi. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clinical Chemistry and Laboratory Medicine. Ahead of Publication (March 2020)

    Abstract: Coronavirus disease 2019, abbreviated to COVID-19 and sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the latest biological hazard to assume the relevance of insidious worldwide threat. One obvious question that is now engaging the minds of many scientists and healthcare professionals is whether and eventually how laboratory medicine could efficiently contribute to counteract this and other (future) viral outbreaks. Despite there being evidence that laboratory tests are vital throughout many clinical pathways, there are at least three major areas where in vitro diagnostics can also provide essential contributions to diagnostic reasoning and managed care of patients with suspected or confirmed SARS-CoV-2 infection. These include etiological diagnosis, patient monitoring, as well as epidemiologic surveillance. Nonetheless, some structural and practical aspects may generate substantial hurdles in providing timely and efficient response to this infectious emergency, which basically include inadequate (insufficient) environment and shortage of technical and human resources for facing enhanced volume of tests on many infected patients, some of whom are with severe disease. Some proactive and reactive strategies may hence be identified to confront this serious healthcare challenge, which entail major investments on conventional laboratory resources, reinforcement of regional networks of clinical laboratories, installation of mobile laboratories, as well as being proactive in establishing laboratory emergency plans.

  • Abrar Ahmad Chughtai, Asim Ali Malik. Is Coronavirus disease (COVID-19) case fatality ratio underestimated? Global Biosecurity 1(3) (March 2020)

    Abstract: The number of cases of coronavirus disease (COVID-19) is increasing rapidly and case fatality ratio (CFR) is estimated to be around 2 to 3%. However, the epidemic is still ongoing and the outcome of many sick cases of COVID-19, particularly the outcome of severe cases, is not yet available, which may lead to underestimation of CFR. This was observed during the initial phase of severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak as well, where CFR increased with the passage of time. We estimated the CFR of COVID-19 by extrapolating the data using SARS as an analogy. According to our estimates, the actual CFR of COVID-19 may be around 4.4 to 4.8%. However, these results should be interpreted with cautions as we did not adjust for many confounding factors. Various epidemiological and modelling techniques can be used to estimate CFR of COVID-19 during the epidemic. Precise estimates of CFR will be available after the end of the epidemic when the outcome of all cases will be available.

  • Eugene V. Koonin, Petro Starokadomsky. Are viruses alive? The replicator paradigm sheds decisive light on an old but misguided question. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 59, 125-134 (October 2016)

    Abstract: The question whether or not “viruses are alive” has caused considerable debate over many years. Yet, the question is effectively without substance because the answer depends entirely on the definition of life or the state of “being alive” that is bound to be arbitrary. In contrast, the status of viruses among biological entities is readily defined within the replicator paradigm. All biological replicators form a continuum along the selfishness-cooperativity axis, from the completely selfish to fully cooperative forms. Within this range, typical, lytic viruses represent the selfish extreme whereas temperate viruses and various mobile elements occupy positions closer to the middle of the range. Selfish replicators not only belong to the biological realm but are intrinsic to any evolving system of replicators. No such system can evolve without the emergence of parasites, and moreover, parasites drive the evolution of biological complexity at multiple levels. The history of life is a story of parasite-host coevolution that includes both the incessant arms race and various forms of cooperation. All organisms are communities of interacting, coevolving replicators of different classes. A complete theory of replicator coevolution remains to be developed, but it appears likely that not only the differentiation between selfish and cooperative replicators but the emergence of the entire range of replication strategies, from selfish to cooperative, is intrinsic to biological evolution.
  • Thomas Pradeu, Gladys Kostyrka, John Dupré. Understanding viruses: Philosophical investigations. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 59, 57-63 (October 2016)

    Abstract: Viruses have been virtually absent from philosophy of biology. In this editorial introduction, we explain why we think viruses are philosophically important. We focus on six issues (the definition of viruses, the individuality and diachronic identity of a virus, the possibility to classify viruses into species, the question of whether viruses are living, the question of whether viruses are organisms, and finally the biological roles of viruses in ecology and evolution), and we show how they relate to classic questions of philosophy of biology and even general philosophy.

  • Siu Ling Wong, Jenny Kwan, Benny Hin Wai Yung. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Resporatory Syndrome. Science & Education 18, 95-118 (October 2007)

    Abstract: Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research in the rapidly growing field of molecular biology. The story of SARS illustrates vividly some NOS features advocated in the school science curriculum, including the tentative nature of scientific knowledge, theory-laden observation and interpretation, multiplicity of approaches adopted in scientific inquiry, the inter-relationship between science and technology, and the nexus of science, politics, social and cultural practices. The story also provided some insights into a number of NOS features less emphasised in the school curriculum—for example, the need to combine and coordinate expertise in a number of scientific fields, the intense competition between research groups (suspended during the SARS crisis), the significance of affective issues relating to intellectual honesty and the courage to challenge authority, the pressure of funding issues on the conduct of research and the ‘peace of mind’ of researchers, These less emphasised elements provided empirical evidence that NOS knowledge, like scientific knowledge itself, changes over time. They reflected the need for teachers and curriculum planners to revisit and reconsider whether the features of NOS currently included in the school science curriculum are fully reflective of the practice of science in the 21st century. In this paper, we also report on how we made use of extracts from the news reports and documentaries on SARS, together with episodes from the scientists’ interviews, to develop a multimedia instructional package for explicitly teaching the prominent features of NOS and scientific inquiry identified in the SARS research.

  • Paul Thagard. What is a medical theory? [w:] Paton, R. i McNamara L., (red.) Multidisciplinary Approaches to Theory in Medicine. Elsevier, 48-62 (2006)

    Thagard uses studies on SARS to argue that cognitive theory of theories (that theories are mind representations of mechanisms) accurately describes medical theories. 

Popular science articles

Conditions which need to be met for public health measures (such as quarantine, forced isolation and others) to be acceptable

Research articles

Popular science articles