Covid-19: public health, individual freedom, social solidarity

28 May 2020


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In this opinion, the ICB seeks to provide a bioethical frame of reference to the many issues raised by both the COVID-19 pandemic and the measures taken to counter it. The ICB takes note of the exceptional nature of the threat posed by COVID-19 to the health of individuals and the community, which calls for renewed reflection a) on health, in its multiple dimensions (physical, psychological, social), b) on the relationship between individual health and public health, c) on the relationship between the principle of freedom and autonomy of the individual in managing his or her own health and the principle of solidarity.

In considering the dialectic between these principles, the ICB considers it essential to distinguish between "extraordinary" interventions (lockdown and limitation of citizens' freedom), adopted in the most acute phase of the pandemic and justified by the seriousness of the threat to public health and "ordinary" interventions, in line with current health policies (which as a rule do not conflict with individual autonomy, since they leverage citizens’ awareness). The reflection of the ICB is particularly useful today, when efforts are being aimed at resuming the "normal" life of the country, without however excluding a return to using exceptional measures in correlation with a possible exacerbation of the pandemic curve. It should be noted that the reflection itself takes place in a climate of general uncertainty, due to the paucity of scientific knowledge so far on the virus and the still limited experience of interventions to counteract a pandemic of this seriousness. Dialogue is required between different branches of knowledge and social experience, as well as collaboration on an equal footing, in order to manage uncertainty.

The opinion takes into account the experience gained in the first months of the pandemic, in the dual direction of 1) taking stock of the lessons learnt (with reference to the preparedness and imbalances of the NHS) 2) providing an overview of the challenges that are still to be faced (assessment of the impact of public containment measures on fundamental rights, on inequalities between citizens, to verify that those which already exist are not accentuated, or new ones created, or that differences translate into inequalities). In this context, special attention is given to particularly vulnerable groups (from children, to people with disabilities, to the elderly, prisoners and others). Public contagion containment strategies range from actions that fall within the scope of ordinary public health policies up to the limitation of certain fundamental freedoms (due to their exceptional nature, according to the criteria of proportionality, efficacy and time limitation).

The ICB calls for: a) an overall rethinking of our welfare system, and its strengthening after years of cuts; b) taking account of the fact, dating back, that the alteration of ecosystems has favoured and favours the spread of previously unknown pathogens; c) a return to the fore of "ordinary" public health policies, which are based on the awareness of citizens as a fundamental element for the protection of health, when planning prevention measures for the phases following lockdown.

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