'Extreme altruism' in a pandemic

“It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.” That’s Sydney Carton, hero of Charles Dickens’s A Tale of Two Cities, as he awaits the guillotine. He is laying down his life so that his best friend can return to the girl they both love. An example of extreme altruism if ever there was one.

The Covid-19 pandemic offers employment opportunities for many more Sydney Cartons, even for, or especially for, elderly patients infected with the virus, write Julian Savulescu and Dominic Wilkinson, both eminent bioethicists from Oxford University, in the blog of the Journal of Medical Ethics. At the moment these people are just sitting around in nursing homes or slipping away in ICU wards when they could be doing something useful. They write:

there is a constant national emergency: we are all aging and slowly dying. There is a war against aging and death: we are fighting it with medicine. And people should be able sacrifice their interests or lives in this war.

They give several startling, not to say ghoulish, examples of what they mean.

Volunteering for risky trials in COVID patients with severe illness. “People should be able to consent to take part in trials, or even compassionate use, of risky interventions on COVID-19 provided these generate usable knowledge of benefit to others.”

Voluntary research euthanasia. “When a patient will certainly die, they should be able to consent while competent to experimentation being performed on them for others, even if the experimentation may itself likely or possibly end their life sooner.”

Organ donation euthanasia. “A person could consent in advance to donation of their organs if it were decided that they would have medical treatment withdrawn on usual grounds, and they would certainly die of respiratory failure over a period of hours or days” – provided, of course, that the organs were not infected with Covid-19.

Military research service. “Early or risky vaccine trials of a COVID-19 vaccine could be conducted on soldiers in exchange for avoiding active service, which involves risk of death.”

Nursing home volunteers for risky research. The elderly could perhaps take place in risky challenge studies for coronavirus or early trials of vaccines or treatments. “Perhaps many nursing and care home residents wouldn’t want to take part in risky research. But they ought to be given the opportunity, if they are competent.”

The Economist recently noted that “The pandemic is … an unmitigated calamity. But in some quarters it, too, is spurring innovation, as firms come up with new ways to keep making existing products despite disrupted supply chains, or, as demand collapses amid self-isolation, create new ones.”

Oxford’s bioethicists are also turning lemons into lemonade by spruiking ideas which would have been regarded as too barbaric to mention in polite company two months ago. Removing organs from the dying so that they won’t go to waste? Experimenting on people who are going to die anyway? Turning your grandmother into a guinea pig for risky drugs?

The underlying assumption of these swivel-eyed suggestions is that the dying and elderly can redeem their effectively worthless lives by sacrificing themselves for science. Of course, they would sign a form registering their informed consent. But apart from myriad other ethical issues, how could a person give truly informed consent in extremis?

Perhaps these guys have read A Tale of Two Cities too many times. Remember when Sydney Carton says self-pityingly, “I care for no man on earth, and no man on earth cares for me”? For lonely, self-pitying nursing home residents or isolated and ill patients in a coronavirus ward, these bioethicists are painting extreme altruism as a redemptive option. “I see the lives for which I lay down my life, peaceful, useful, prosperous and happy,” the siren voices murmur in their ears.

This is one pandemic innovation which should, which must, end up in the rubbish bin.


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