COVID19 – Ethical Dilemmas Surrounding Movement Restrictions

It is day 16 since the start of the Movement Control Order (MCO). We are in a very unprecedented time and if you are anything like me, things might have been looking a little hazy lately. What was brewing late of last December in a place far away from here has crossed the shores and taken the world by storm. Although we have been challenged by many disease outbreaks in the past, the world wasn’t quite ready for a pandemic like this one. 

As a response to the inevitable, many countries have been racing towards finding the best strategies to contain the virus. In times like this, we cannot help but take a look back at history. What has been known since the 14^th century to be the best and most effective way in disease containment is now being used as a weapon in a war against the COVID-19. Many nations at this point have implemented some form of policy restricting movement of individuals. Words like ‘Lockdown’, ‘Quarantine’, ‘Social Distancing’ or the more locally known, ‘Movement Control’, although each having very individual unique definitions, all have one common goal,  to reduce disease transmission.

When our country first announced its restrictions, it got the libertarian in me thinking. Movement restrictions, or quarantine-like measures while designed for the greater good of public health, also significantly interfere with basic civil liberties. This includes the rights to freedom of movement, freedom from arbitrary detention, the right to privacy and non-discrimination. If the above libertarian rights have been protected by universal human rights declarations, wouldn’t quarantine measures already be obsolete?

No, fortunately, it does not work that way. When movement restrictions are executed with the sole intention to eradicate a global pandemic, when done in a fair and non-discriminatory way, this coercive public measure can be legitimately used to justify public health interests over libertarian rights. This seems like a pretty good answer already, but I really wanted to understand the ethics behind what it took to ensure movement restrictions were done properly and orderly. Before I could do that, I had to go back to the basics, and that was to understand the fundamentals, i.e. the ethical problems with quarantine.

To keep things simple, there are 2 main ethical dilemmas with movement restrictions – the principle of non-maleficence and distributive justice.

Non- maleficence describes the principle of doing no harm. While widespread quarantine-like measures are hardly ever associated with any immediate bodily harm to a population, the burden of mental health problems and the potential effects of a dwindling global economy have been well recognized.  The economy lost a whopping 40 billion dollars in markets during the SARS pandemic and countries most affected like China, Hong Kong and Canada saw many of their civilians succumb to psychological issues such as Post Traumatic Stress Disorder (PTSD) and Depression. With widespread movement restrictions having long term side effects, formulating an ethical justification in its favor is certainly challenging. Adding to this dilemma is a looming fear of restrictions which unnecessarily causes more harm than good to any community. In such circumstances, questions on authority for restriction implementation may arise.

Next, the principle of justice in the public health context demands the practice of a fair distribution of benefits.  In these trying times, upholding such principles  can be difficult, especially concerning people with very little resources to begin with.  An example of this is the limited access to public places such as markets, grocery stores and pharmacies. Additionally, with closure of mass transit systems and other forms of transportation, obtaining necessities from places that do remain accessible becomes a challenge. This will even prevent certain populations from obtaining medical care.

So, how do we achieve ethically acceptable movement restriction measures? Practical solutions involve the ability to alleviate the above ethical problems.

An ideal solution to maintaining the practice of non-maleficence would be to have transparency in the implementation of restriction policies. These policies should be receptive to inputs on criteria for decision making from all different groups of society. It is important that any restriction policies are done fairly with adequate planning in place. With those measures in place, not only will the standards for ethical principles be met but the likelihood of public acceptance for an already very controversial measure can be assured.

To ensure the practice of justice is in place, solutions would include having the government to structure a carefully studied network for the distribution of basic necessities to people who are most disadvantaged. They should also cater transport services to those who require medical care and other essential needs. The system needs to be robust, consistent and reliable while ensuring proper infection control precautions are not compromised by equipping volunteers with the proper protective equipment. However, I must admit that this is only ideal in a resource rich setting. In most cases, where there are resource and logistical constraints, the very least is for government bodies to have proper planning in terms of allocation. This strategy involves having to inform the public of the essential requirements and in what quantity needed during such implementation.  This will allow people to be prepared for the inevitable.

So yes, with more than 800,000 infected COVID-19 cases thus far, movement restriction measures are essential in combating the virus. While they expose the tensions between public health interests and libertarian rights, I believe that even the most unwavering libertarian must understand and accept the restrictions that are being employed for the benefit of all. Having said that, authorities must also play their role in ensuring that such policies are implemented fairly, with civilians as partners in this war against COVID-19.