Vol 12, Iss 4 – Dec 2020

Bidding farewell to 2020, we present our fourth and final December issue of this year’s volume 12, and question: What lessons have we learned and what can bioethics continue to teach us?

The importance of recognising the interconnectedness of both responses and failures in the COVID-19 pandemic to wider social and ethical issues has never been greater. The collective contributions to this December issue demonstrate this all too clearly. Than et al. (2020) offer empirical insights to the levels of awareness among medical postgraduate students in Myanmar towards research ethics and research ethics committees (RECs) in delivering scientifically sound, ethically robust research. The theme of efficiency and effectiveness is continued by Ooi (2020) in the context of overtreatment in the clinical setting, warning of the vagaries of factors that drive a tendency towards overtreatment in modern healthcare systems; once again, lessons here are particularly poignant when already-stretched services are put under further strain by a public health emergency. Turning to the economic dimensions of healthcare provision, Wong (2020) uses the example of a healthcare overpricing scandal in Singapore to examine what fair and just pricing might look like from a Confucian perspective.

Ni et al. (2020) take us right back to the putative geographical  source of the pandemic – Wuhan – where two case studies are examined to unpack the role and deeper meaning of the value of reciprocity in the times of COVID-19. Analysis is provided of social media such as video blogs of professionals and citizens who were asked by authority figures to undertake exceptional personal measures – such as head-shaving – to address shortages in PPE. The findings are used to inform quarantine principles that are fit-for-purposes in the current pandemic, as well as to enrich our understandings of reciprocity in an increasingly connected world. Frowde et al. (2020) offer commentary on the human rights implications of governmental responses to COVID-19, but with something of a twist. Whereas there are extensive (and often well grounded) concerns that active measures such as quarantine and lockdown can pose threats to citizens’ rights, we argue the counter-perspective that governmental inaction – as demonstrated by the woeful example of the UK government’s response to COVID-19 – can equally undermine human rights, potentially on a much longer timeframe as failure after failure shows only too well that an unplanned response is an unethical response beyond justification or defence.

As indicated in the September editorial, many of the contributions to our successful Call for Papers on ethical dimensions of COVID-19 seek to capture and reflect country-by-country responses to the pandemic, and we anticipate the value of a trenchant comparative analysis in due course. For now, our readers will find contributions from an intriguing range of countries, including India from Arunachalam and Halwai (2020), Bangladesh from Siraj et al. (2020), and Pakistan from Khalid and Ali (2020).

Further contributions focus on particular aspects of COVID-19 and in doing so they point out that the pandemic has writ large stubborn social injustices and has made them worse. Thus, Cheung and Ip (2020) examine public mental health ethics and the disproportionate effects that lockdown have on persons living with mental ill-health. Salutary lessons arise as a result. Linking back to themes of scarce resources and human rights, Chen and McNamara (2020) examine triage arrangements and the risks associated with relying on quality of life assessments in medical decision-making during a pandemic. This is all the more important as the realities of ‘long COVID’ becomes clearer and it is likely that more persons will have to live with some form of chronic disability even if they survive infection with COVID-19. On the questions of poverty and social injustice, Timmermann (2020) advocates for an increased role for engagement exercises with long-term economically disenfranchised groups in society, who for too long have not so much been ‘hard-to-reach’ but more accurately ‘easy-to-ignore’. This approach holds the promise of more informed lessons for policymakers in designing more just responses to COVID-19.

Our final two contributions are connected by the concept of care. From Malaysia, Chong et al. (2020) consider the experiences of trying to deliver paediatric palliative care in circumstances where close contact between parents and children is difficult or impossible, and at a time when the imminence of death becomes an imperative to make every moment count. While Dine (2020) argues for an holistic and interdisciplinary approach to dealing with COVID-19 that attempts to capture the ‘sameness’ of humanity, as well as the duties that we owe to each other (while having our own rights duly respected).

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All articles in this issue enjoy either Free Access (some via PubMed Central) or Open Access. They can all be downloaded and printed, even without a subscription – simply click on the title. The copyright of Free Access articles is shared by Springer Nature and the National University of Singapore. The copyright of Open Access articles remains with the respective authors.

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Editorial – Free Access
Bidding farewell to 2020: What lessons have we learned and what can bioethics continue to teach us?
Graeme T. Laurie
December 2020 – 12(4): 375-378 – doi: 10.1007/s41649-020-00152-0

Original Article – Free Access via PMC
Knowledge, Awareness, Attitudes and Practices towards Research Ethics and Research Ethics Committees among Myanmar Postgraduate Students
Mo Mo Than, Hein Htike, and Henry J. Silverman
December 2020 – 12(4): 379-398 – doi: 10.1007/s41649-020-00148-w

Original Article – Free Access via PMC
The pitfalls of overtreatment: Why more care is not necessarily beneficial
Kanny Ooi
December 2020 – 12(4): 399-417 – doi: 10.1007/s41649-020-00145-z

Original Article – Free Access via PMC
Ethical Pricing: A Confucian Perspective
Gabriel Hong Zhe Wong
December 2020 – 12(4): 419-433 – doi: 10.1007/s41649-020-00146-y

Special Section – COVID-19: Assessing Ethical Responses to the Pandemic

Original Article – Free Access
Reciprocity in Quarantine: Observations from Wuhan’s COVID-19 Digital Landscapes
Yanping Ni, Morris Fabbri, Chi Zhang, and Kearsley A. Stewart
December 2020 – 12(4): 435-457 – doi: 10.1007/s41649-020-00150-2

Original Article – Open Access
Fail to Prepare and You Prepare to Fail: The Human Rights Consequences of the UK Government’s Inaction during the COVID-19 Pandemic
Rhiannon Frowde, Edward S. Dove, and Graeme T. Laurie
December 2020 – 12(4): 459-480 – doi: 10.1007/s41649-020-00151-1

Perspective Article – Open Access
An analysis of the ethics of lockdown in India
Meghna Ann Arunachalam, and Aarti Halwai
December 2020 – 12(4): 481-489 – doi: 10.1007/s41649-020-00133-3

Perspective Article – Free Access
The Infectious Diseases Act and Resource Allocation in Times of Pandemic in Bangladesh
Md. Sanwar Siraj, Rebecca Susan Dewey, and A.S.M. Firoz Ul Hassan
December 2020 – 12(4): 491-502 – doi: 10.1007/s41649-020-00149-9

Perspective Article – Free Access
COVID-19 Lockdowns: A Public Mental Health Ethics Perspective
Daisy Cheung, and Eric C. Ip
December 2020 – 12(4): 503-510 – doi: 10.1007/s41649-020-00144-0

Perspective Article – Free Access
Disability Discrimination, Medical Rationing and COVID-19
Bo Chen, and Donna Marie McNamara
December 2020 – 12(4): 511-518 – doi: 10.1007/s41649-020-00147-x

Perspective Article – Free Access
Epistemic ignorance, poverty and the COVID-19 pandemic
Cristian Timmermann
December 2020 – 12(4): 519-527 – doi: 10.1007/s41649-020-00140-4

Perspective Article – Free Access
Paediatric Palliative Care during COVID-19 pandemic: a Malaysian perspective
Lee Ai Chong, Erwin J. Khoo, Azanna Ahmad Kamar, and Hui Siu Tan
December 2020 – 12(4): 529-537 – doi: 10.1007/s41649-020-00142-2

Perspective Article – Free Access
Socio-Ethical Dimension of COVID–19 Prevention Mechanism—The triumph of Care Ethics
Charles Biradzem Dine
December 2020 – 12(4): 539-550 – doi: 10.1007/s41649-020-00143-1

Student Article – Free Access
COVID-19 and its Challenges for the Healthcare System in Pakistan
Atiqa Khalid, and Sana Ali
December 2020 – 12(4): 551-564 – doi: 10.1007/s41649-020-00139-x