• Users Online: 170
  • Print this page
  • Email this page


 
 
Table of Contents
BRIEF COMMUNICATION
Year : 2021  |  Volume : 3  |  Issue : 1  |  Page : 49-52

Postmodernism and Utilitarianism during the COVID-19 Pandemic: Throwing Ourselves under the Bus


Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission30-Jul-2020
Date of Decision03-Dec-2020
Date of Acceptance13-Dec-2020
Date of Web Publication29-Apr-2021

Correspondence Address:
Dr. Migita D’cruz
Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wsp.wsp_68_20

Rights and Permissions
  Abstract 


The novel coronavirus pandemic is both shaped by and an agent of the postmodern, posttruth, utilitarian times we live in. It is associated with an overload of both information and mis-information with an increasing loss of the distinction between the two. The disconnect between governance and the health-care professions and the lack of a consensus within health-care professionals have left us ill equipped to offer a unified response to the pandemic. Further, the difficult decisions that we have to make in allocating scarce resources during this crucial period has thrown open health care's divides – between health-care providers and patients and within health-care professionals. With the global lockdown, economic, social and gender disparities have been highlighted in an unprecedented manner. There are no easy ways out of this crisis; however, I advocate for inclusivity and parity in decision-making to navigate bioethical and moral pitfalls.

Keywords: Bioethics, COVID-19, health-care divides, health-care parity, severe acute respiratory syndrome-COV-2, sustainable development, utilitarianism


How to cite this article:
D’cruz M. Postmodernism and Utilitarianism during the COVID-19 Pandemic: Throwing Ourselves under the Bus. World Soc Psychiatry 2021;3:49-52

How to cite this URL:
D’cruz M. Postmodernism and Utilitarianism during the COVID-19 Pandemic: Throwing Ourselves under the Bus. World Soc Psychiatry [serial online] 2021 [cited 2021 May 7];3:49-52. Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/1/49/315125



We live in postmodern, posttruth times, where reality is subjective and facts – the last bastion of rationalism, science, and evidence-based medicine – can be tailored to meet our needs.[1],[2] This is obvious to the point of being a trite truism – to say so means that I may as well say that the grass in green (it usually is) and the sky is blue (again, it usually is).

The novel coronavirus (how easily those phrases roll off the tongue, now), the causative agent of the COVID-19 pandemic is both a product of and an agent of these interesting, postmodern times. The sheer information overload that has emerged in the wake of the WHO declaring it a Public Health Emergency of International Concern on January 30, 2020, has been overwhelming and exhausting.[3] Conspiracy theories abound-the virus was genetically engineered in a laboratory in Wuhan, no-in Seoul.[4] The sound waves generated by clapping or banging pots and pans are virucidal.[5] Drugs and vaccines appear to generate some hope – hydroxychloroquine, for example, – and just as quickly fall from grace as randomized controlled trials fail to find evidence for their safety or efficacy.[6] I am not placing these posttruth events on a common platform or equating them with each other. However, there is a common theme underpinning all of these – we are clearly desperate for an answer (and a cure) and are clutching at straws.

One would (and certainly I did, initially) expect medicine to demonstrate resilience against unproven theories and myths about the novel coronavirus. We are after all, built on millennia of evidence and experience. We can fact-check these theories and guide efficient public health programmes and policies to contain the pandemic.[7],[8] We are the heroes nobody asked for, and the gods walking the earth. We believe we have control over life and death (a common fallacy). In truth, medicine has been, and perhaps always will be about relieving the suffering of the patient, and helping them reconcile to their illness. On our worst days – we go home and examine whether we have lived and practised according to the central tenet of bio-ethics– Primum non nocere – first, do no harm.[9]

Perhaps, the postmodern approach to a pandemic is not a surprise in hindsight. The medical profession has been shaped by and founded on utilitarianism – the good of the many outweighs the good of the few.[10] This may be why it has been so easy for doctors to reconcile ourselves to the lockdown across the world and in India to contain the spread of the coronavirus – despite the human rights crisis it has unleashed, despite the plight of migrants and refugees who are trapped at border zones without food or shelter or employment.[11],[12]

What is also surprising (and perhaps should not be) is the disconnect between governance of countries and the medical profession. This is further compounded by the lack of a consensus on disease control measures and health-care policy within the medical profession.[13],[14] How can we advise the government and our patients when we are not sure of what to do ourselves – the novel coronavirus is of course, novel to everyone, and no practising doctor today was alive and practising during the last major pandemic – influenza in 1918 on the tail end of World War II.[15] We are all in this together and we are all new to this virus.[16]

What does utilitarianism mean for the medical profession during the COVID-19 pandemic? It means that we have several, hard decisions to take.[17] We have to decide which of those infected to admit and treat and whom to send home.[18] Italy sent infected patients over 80 years home, while grappling with the shortage in intensive care resources – a form of triage with questionable ethical basis.[19] We have to decide which of the noninfected patients should be treated now and which can be deferred until the pandemic is better controlled. This means that severe mental illnesses, including dementia do not have access to elective services such as outpatient consultations, psychotherapy, and cognitive retraining.[20],[21] We assume that they can afford to wait, and will survive the pandemic, and will come back to the hospital afterward.

With regard to self-regulation within the medical fraternity – there are other, no less hard decisions to take. Doctors and nurses are working with potentially infected and confirmed cases of COVID-19 equipment without adequate personal protective equipment (PPE).[22] We have to make the decision to self-isolate to avoid passing on the risk of infection to friends and family.[23]

There are other decisions to make where the answers and ethics are less clear. Most hospitals have put interns and resident doctors on back-to-back duties while older, more senior faculty are rested or given administrative duties to minimize their exposure.[24],[25] Some hospitals allot more duties to single or unmarried or childless doctors and nurses – while those with small children and aging parents at home are given less duties.[26] The gender gap has widened in the wake of the pandemic – the PPE and duty rooms are clearly designed for men than women, for bigger builds than smaller builds.[27]

Much as we would like to say that duties are allotted on the basis of evidence-based medicine-the power imbalance within the medical profession has predated the pandemic and will likely outlast it.[28] Does this mean some lives are worth more than others? Or, from a salutogenic perspective, does this mean that some demographic groups are more resilient than others and therefore can be exposed more to risk. There is preliminary evidence that younger adults and women are more likely to survive the novel coronavirus infection than older adults and men.[29],[30],[31] Does this justify the health-care administrative decisions we take? Moreover, what are the costs of these decisions to doctors and nurses over the years? Further, in choosing to ignore these pressing imperatives – has the health-care profession thrown itself under the bus?

Finally, what is the ethical basis of the utilitarian decisions we have decided to take to contain the COVID-19 pandemic, and how shall we justify this, years later in books on history and public health.[32] For this comes eerily close to the practise and defence of eugenics in Nazism and Fascism – which were too, of course, founded on utilitarian principles and spurred the need for bioethical principles and the regulation of medicine in the first place.[33],[34]

The ethical quandary to consider while bridging health care's divides (between patients and health-care providers as well as within providers) during the global response to the COVID-19 pandemic is:[35],[36]

Quis custodiet ipsos custodes?-who guards the guardians?[37]

There are no easy answers to this, or even, a single homogenous response available. However, I have this slogan for inclusivity from identity activism to offer as a moral and ethical guide:

Nihil de nobis, sine nobis – nothing about us without us.[38]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aylesworth G. Postmodernism. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Spring 2015. Stanford University: Metaphysics Research Lab; 2015. Available from: https://plato.stanford.edu/archives/spr2015/entries/postmodernism/. [Last accessed on 2020 May 01].  Back to cited text no. 1
    
2.
Driver J. The History of Utilitarianism. In: Zalta EN, editor. The Stanford Encyclopedia of Philosophy. Winter 2014. Stanford University: Metaphysics Research Lab; 2014. Available from: https://plato.stanford.edu/archives/win2014/entries/utilitarianism-history/. [Last accessed on 2020 May 01].  Back to cited text no. 2
    
3.
Coronavirus Disease (COVID-19) - Events as they Happen. WHO. Available https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Last accessed on 2020 May 01].  Back to cited text no. 3
    
4.
What Can the Coronavirus Tell Us About Conspiracy Theories?-The Atlantic. Available from: https://www.theatlantic.com/health/archive/2020/04/what-can-coronavirus-tell-us-about-conspiracy-theories/610894/. [Last accessed on 2020 May 01].  Back to cited text no. 4
    
5.
Corona Come? Crowding Streets to Beat Thalis Won't Help us Defeat Coronavirus. Available from: https://www.news18.com/news/buzz/corona-come-crowding-streets-to-beat-thalis-wont-help-us-defeat-coronavirus-2546699.html. [Last accessed on 2020 May 01].  Back to cited text no. 5
    
6.
Harrison C. Coronavirus puts drug repurposing on the fast track. Nat Biotechnol 2020;38:379-81. Available from: https://www.nature.com/articles/d41587-020-00003-1. [Last accessed on 2020 Mar 25].  Back to cited text no. 6
    
7.
Watkins J. Preventing a covid-19 pandemic. BMJ 2020;368:m810. Available from: https://www.bmj.com/content/368/bmj.m810. [Last accessed on 2020 Mar 25].  Back to cited text no. 7
    
8.
Berger ZD, Evans NG, Phelan AL, Silverman RD. Covid-19: Control measures must be equitable and inclusive. BMJ 2020;368:m1141. Available from: https://www.bmj.com/content/368/bmj.m1141. [Last accessed on 2020 Mar 25].  Back to cited text no. 8
    
9.
Gifford RW. Primum non nocere. JAMA 1977;238:589-90. Available from: https://jamanetwork.com/journals/jama/article-abstract/354858. [Last accessed on 2020 May 01].  Back to cited text no. 9
    
10.
Marseille E, Kahn JG. Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health. Philos Ethics Humanit Med 2019;14:5. Available from: https://peh-med.biomedcentral.com/articles/10.1186/s13010-019-0074-7. [Last accessed on 2020 May 01].  Back to cited text no. 10
    
11.
Lancet T. COVID-19 will not leave behind refugees and migrants. Lancet 2020;395:1090. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30758-3/fulltext. [Last accessed on 2020 May 01].  Back to cited text no. 11
    
12.
India: Migrant Workers' Plight Prompts UN Call for 'Domestic Solidarity' in Coronavirus Battle. UN News 2020 Apr 2. Available from: https://news.un.org/en/story/2020/04/1060922. [Last accessed on 2020 May 01].  Back to cited text no. 12
    
13.
Considerations in Adjusting Public Health and Social Measures in the Context of COVID-19. Interim Guidance. WHO 2020 Apr 16. Available from: https://apps.who.int/iris/bitstream/handle/10665/331773/WHO-2019-nCoV-Adjusting_PH_measures-2020.1-eng.pdf. [Last accessed on 2020 May 01].  Back to cited text no. 13
    
14.
Benton K, Polite S. The disconnect between public health and health care. Health Prog 2016;97:58-61. Available from: https://www.chausa.org/publications/health-progress/article/march-april-2016/the-disconnect-between-public-health-and-health-care. [Last accessed on 2020 May 01].  Back to cited text no. 14
    
15.
Whiting K. COVID-19: How did Spanish flu Change the World? |. World Economic Forum 2020 Apr 30. Available from: https://www.weforum.org/agenda/2020/04/covid-19-how-spanish-flu-changed-world/. [Last accessed on 2020 May 01].  Back to cited text no. 15
    
16.
Yong S by E. Why the Coronavirus Is So Confusing. The Atlantic. Available from: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/?utm_source=pocket&utm_medium=email&utm_campaign=pockethits. [Last accessed on 2020 May 01].  Back to cited text no. 16
    
17.
Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. Engl J Med 2020;382:2049-55. Available from: https://www.nejm.org/doi/10.1056/NEJMsb2005114. [Last accessed on 2020 May 01].  Back to cited text no. 17
    
18.
Matheny Antommaria AH, Gibb TS, McGuire AL, Wolpe PR, Wynia MK, Applewhite MK, et al. Ventilator triage policies during the COVID-19 pandemic at U.S. hospitals associated with members of the association of bioethics program directors. Ann Intern Med 2020;173:188-94. Available from: https://annals.org/aim/fullarticle/2765364/ventilator-triage-policies-during-covid-19-pandemic-u-s-hospitals. [Last accessed on 2020 May 01].  Back to cited text no. 18
    
19.
Blasi ED. Italians Over 80 'Will be Left to Die' as Country Overwhelmed by Coronavirus 2020 Mar 14. Available from: https://www.telegraph.co.uk/news/2020/03/14/italians-80-will-left-die-country-overwhelmed-coronavirus/. [Last accessed on 2020 May 01].  Back to cited text no. 19
    
20.
Cullen W, Gulati G, Kelly BD. Mental health in the Covid-19 pandemic. QJM 2020;113:311-2. Available from: https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcaa110/5813733. [Last accessed on 2020 May 01].  Back to cited text no. 20
    
21.
Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, et al. Dementia care during COVID-19. Lancet 2020;395:1190-1. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30755-8/fulltext. [Last accessed on 2020 May 01].  Back to cited text no. 21
    
22.
Shortage of Personal Protective Equipment Endangering Health Workers Worldwide. Available from: https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide. [Last accessed on 2020 May 01].  Back to cited text no. 22
    
23.
Chen A, Bebinger M. Bringing Home Something Deadly: How Health Workers Are Isolating From Their Families. 2020 Apr 03. Available from: https://www.wbur.org/commonhealth/2020/04/03/bringing-home-something-deadly-how-health-workers-are-isolating-from-their-families. [Last accessed on 2020 May 01].  Back to cited text no. 23
    
24.
Crowe S, Clarke N, Brugha R. 'You do not cross them': Hierarchy and emotion in doctors' narratives of power relations in specialist training. Soc Sci Med 2017;186:70-7. Available from: https://www.sciencedirect.com/science/article/pii/S0277953617303507. [Last accessed on 2020 May 01].  Back to cited text no. 24
    
25.
Mamas M. COVID-19: What's the Impact on Junior Doctors? Medscape 2020. Available from: http://www.medscape.com/viewarticle/928560. [Last accessed on 2020 May 01].  Back to cited text no. 25
    
26.
Farr C. Pregnant medical workers are making hard decisions about whether to treat COVID-19 patients in person. CNBC 2020. Available from: https://www.cnbc.com/2020/03/25/pregnant-doctors-dont-know-if-its-safe-to-treat-covid-19-patients.html. [Last accessed on 2020 May 01].  Back to cited text no. 26
    
27.
Sexism on the Covid-19 Frontline: 'PPE is Made for a 6ft 3in Rugby Player' | World News | The Guardian. Available from: https://www.theguardian.com/world/2020/apr/24/sexism-on-the-covid-19-frontline-ppe-is-made-for-a-6ft-3in-rugby-player. [Last accessed on 2020 May 01].  Back to cited text no. 27
    
28.
Zurn P, Poz MD, Stilwell B, Adams O. Imbalances in the health workforce: Briefing paper. WHO Evidence and Information for Policy. Health Serv Provision 2002. Available from: https://www.who.int/hrh/documents/en/imbalances_briefing.pdf. [Last accessed on 2020 May 01].  Back to cited text no. 28
    
29.
Issue Brief on Older Persons and COVID-19: A Defining Moment for Informed, Inclusive and Targeted Response United Nations For Ageing | United Nations For Ageing. Available from: https://www.un.org/development/desa/ageing/news/2020/04/issue-brief-on-older-persons-and-covid-19-a-defining-moment-for-informed-inclusive-and-targeted-response/. [Last accessed on 2020 May 01].  Back to cited text no. 29
    
30.
Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Health 2020;8:152. Available from: : https://www.frontiersin.org/articles/10.3389/fpubh.2020.00152/full. [Last accessed on 2020 May 01].  Back to cited text no. 30
    
31.
Young, Old, Male or Female: 86% of 111 Who Died of COVID-19 Had One Factor in Common. The Week 2020 Apr 7. Available from: https://www.theweek.in/news/india/2020/04/07/young-old-male-female-86-per-cent-of-111-covid-19-deaths-had-one-factor-in-common.html. [Last accessed on 2020 May 01].  Back to cited text no. 31
    
32.
Levitz E. Coronavirus Creates an Opening for Progressivism – Also Barbarism. Intelligencer 2020. Available from: https://nymag.com/intelligencer/2020/04/coronavirus-undocumented-nationalism-socialism-climate-progressives.html. [Last accessed on 2020 May 01].  Back to cited text no. 32
    
33.
Saying the Quiet Part Out Loud: Eugenics and the 'Aging Population' in Conservative Pandemic Governance | Discover Society. Available from: https://discoversociety.org/2020/04/06/saying-the-quiet-part-out-loud-eugenics-and-the-aging-population-in-conservative-pandemic-governance/. [Last accessed on 2020 May 01].  Back to cited text no. 33
    
34.
Wikler D, Barondess J. Bioethics and Anti-Bioethics in Light of Nazi Medicine: What Must We Remember? Kennedy Inst Ethics J 1993;3:39-55. Available from: https://muse.jhu.edu/article/245670/pdf. [Last accessed on 2020 May 01].  Back to cited text no. 34
    
35.
Gopichandran V, Subramanium S. Response to Covid-19: An ethical imperative to build a resilient health system in India | Indian Journal of Medical Ethics. IJME 2020;V: 91-2.  Back to cited text no. 35
    
36.
Gopichandran V. Clinical ethics during the Covid-19 pandemic: Missing the trees for the forest | Indian Journal of Medical Ethics. IJME 2020;V: 4-5.  Back to cited text no. 36
    
37.
Hurwicz L. But who will guard the guardians? Am Econ Rev 2008;98:577-85. Available from: https://www.jstor.org/stable/29730087?seq=1. [Last accessed on 2020 May 01].  Back to cited text no. 37
    
38.
Bridges D, editor. 'Nothing about us without us': The ethics of outsider research. In: Fiction written under Oath? Essays in Philosophy and Educational Research. Dordrecht: Springer Netherlands; 2003. p. 133-51. (Philosophy and Education). Available from: https://doi.org/10.1007/0-306-48043-3_10. [Last accessed on 2020 May 01].  Back to cited text no. 38
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
References

 Article Access Statistics
    Viewed88    
    Printed0    
    Emailed0    
    PDF Downloaded1    
    Comments [Add]    

Recommend this journal