Theater of Cruelty

What ethical principles are behind the first vaccine sticks?

Steingrimur Njalsson
Steingrímur Njálsson
Writer and associate professor at Oslo by Steinerskole
ETHICS / Behind the authorities' vaccination strategy is an ethical chaos.


Are you one of those people who sits at home and dreams and even hopes? Dreaming of and hoping that it will soon be your turn to take the coronary vaccine?

However, getting the vaccine is not so easy. Vaccination takes a long time. On March 25, around 595 had received the first dose of the vaccine, but only 000 had received the second dose. At Easter, some municipalities even took a holiday from the vaccination. Vaccine coordinator in Bærum municipality stated: "It is about utilizing an opportunity space to keep the Easter holidays holy." While older people who had been looking forward to finally meeting grandchildren again after receiving a dose of two, still had to stay home alone, the municipality spent Easter practicing Orwellian new speech.

Equally problematic is the way in which the authorities have chosen to distribute the limited goods. On Sunday 27 December 2020, the first vaccine dose was set in Norway. In line with the health authorities' priorities, it was a nursing home resident who received the first blow. The prioritization has had age and probability of serious illness as criteria. The most vulnerable first, then the oldest, then the second oldest and so on.

Criticism from several quarters

This prioritization has garnered criticism from several quarters. The Norwegian Nurses' Association is among those who asked early questions about why health professionals were not in the highest priority group, and the first week in January, the leader of the Education Association demanded that teachers should also be given priority, as they must be considered part of society's first line service. Although the teachers were met with a good dose of skepticism, the Education Association's leader Steffen Handal is right in that teachers have been more exposed to infection than many other occupational groups. But what about people in socially critical positions who have otherwise been given special consideration below pandemic, why have they not been prioritized? And why not take into account life expectancy and vaccinate the young risk group at the same time as the older one?

If the goal was to reduce infection rates, why not vaccinate those who spread the most

As for the nurses, the health authorities responded to the criticism and said that health workers would be given priority. Although the teachers were not consulted, the vaccination strategy has been changed several times along the way. Among other things, advertised Public Health (NIPH) on March 9 that they should start "giving more vaccine doses to particularly infected areas". NIPH also stated that they introduced "a new distribution key of vaccines to the municipalities based on the number of people over 18 years".

Behind government strategies lie not only medical but equally ethical decisions. The corona year between March 2020 and March 2021 has been full of ethical dilemmas. Then it is relevant to ask what kind of ethical principles and thoughts are the basis. First, however, we need to clarify some ethical theories.

Ethical theories are not just airy thought castles from the academic ivory tower – they are used as tools to think through important decisions that affect actual people. For police officers, nurses, journalists, child welfare educators, psychologists, doctors and teachers, general ethical theories are included in basic education. To the extent that these theories help us to understand both general decision-making situations and our own decisions better, it is more correct to refer to them as ethical ways of thinking. We can also consider them as prisms that make us see things in a new light.

Ethics of duty, ethics of consequences and ethics of virtue

Roughly speaking, we distinguish between three main groups of ethical ways of thinking: ethics of duty, ethics of consequences and ethics of virtue. In ethics of duty, the thinking is that duty should guide our choices. The decisive factor in the decision is the idea behind it and whether we have followed a rule or a principle. Or as it is called by Immanuel Kant: whether the principle we have followed can be made a general rule. For example, most people will think that we have a duty to help people who are injured in traffic, a duty to follow the laws, speak the truth, and the like. The thought behind what you do counts the most.

The consequence ethicists believe that the duty ethicists pay too little attention to the consequences of our actions. Blindly following duties can even have undesirable consequences. We may even in some situations have to refrain from speaking the truth even though we consider this an important duty, such as when people lied about hidden Jews or resistance fighters during the war. The ethics of duty must be supplemented with consequential thinking. The most well-known and used form of consequence ethics is called utilitarianism (utility = utility). The general principle for assessing whether decisions and actions are ethically sound – formulated by philosophers such as Jeremy Bentham and John Stuart Mill in the 1800th century – is that the consequences of an action should provide the greatest possible happiness or well-being for as many people as possible. Yes, we have a duty to fight poverty and provide aid to developing countries, but in the way that benefits most. When we try to do good, we must not forget to be rational.

The ethics of virtue is not as oriented towards individual actions as the other two ways of thinking. This is more about becoming a good person and generally contributing to a good society. We will act right if we possess the right virtues, said both Plato and Aristotle, who defined virtues as attitudes or norms. Examples of classic virtues are courage, determination, sobriety, justice and wisdom. A virtue ethicist will not judge whether a decision is based on duty or a consequence calculation, but rather ask: Was this a wise decision?

What consequences has the strategy had?

Considered through these prisms, what does the vaccination strategy look like? In a consequentialist perspective, we must examine what good and less good consequences the official prioritization can bring about or have actually brought about. An obvious and good consequence is that the elderly and the sick will receive much-needed protection. At the same time, in the name of utilitarianism, we can ask whether we as a society have chosen the strategy that is best suited to stop the infection as soon as possible.

Then a follow-up question arises: If the goal was to reduce the infection numbers, why not vaccinate those who spread the most infection? It is not residents of nursing homes and old people's homes who spread the infection at parties. How about letting young people who have few symptoms, but can spread the infection without knowing it, move forward in the queue? If the groups that spread the most infection are vaccinated first – given that the vaccines we have been able to buy will actually counteract infection – this would benefit the whole of society, even the most vulnerable.

Is this inconsistency a symptom of a more general ethical confusion in politics?

The virtue ethicist's question will be: Is today's priority fair? Does it rest on wise decisions? If the vaccination strategy, for example, gives rise to a popular uprising because people perceive it as unfair, these are not wise decisions. As mentioned, several have argued that it was unwise not to start vaccinating health professionals, as many other European countries do, a piece of advice that the health authorities wisely took. In addition, young people in risk groups, with the prospect of a longer life than 80-year-olds, could with good reason claim that it is unfair that they are not included in the first pool. Compare the debate on how possible life expectancy should be weighted. It can also be said that it is unfair for young people to prioritize the elderly because the young people in a sense bear the greatest burden during the pandemic through the fact that their lives – relatively speaking – are most reduced. Aristotle's golden mean may go through taking into account both the elderly and the young, understood as vulnerable groups.

An ethical chaos

We can state that public prioritization is in accordance with several ethical values ​​that society supports: We all want a warm care society – a civilization can of course be measured by how it treats its vulnerable. Judging from this perspective, it may seem that there is also a duty-ethical thinking behind the authorities' prioritization: We have a duty to help our sick and our elderly who can no longer help themselves, and we must do so without hesitation .

In addition, it can be argued that the distribution of the vaccine is based on a principle of equality, as it should in principle be distributed equally to all municipalities. However, this part of the strategy was criticized, and the distribution key was changed so that areas with high infection were given higher priority.

The conclusion is that there is an ethical chaos in the authorities' handling of the limited number of vaccines that Norway has received. The strategy simply appears to be poorly thought out. Why this myriad of ethically partially contradictory principles? Is this inconsistency a symptom of a more general ethical confusion in politics?

Yes, presumably the confusion is symptomatic. The fact is that politicians choose and reject among ethical principles when different decisions are to be justified; in one case the decision rests on utilitarianism, the next time on ethics of duty. Here it can be argued that it would be deeply unreasonable to expect politicians to always follow one particular ethical way of thinking, or that all decisions should be ethically pure – politics is and will be the art of the possible! At the same time, it would undoubtedly be good if politicians had a more conscious relationship with the ethical dimension of politics. For despite the general avideologisation, all elected representatives are still expected to stand for certain ethical values.

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