Personal care treatments

UW bioethicist calls for justice in distribution of global COVID treatments

By Mahlon Meyer
Northwest Asia Weekly

Jessica Ruan helped her mother pack boxes with masks (From the HUST Alumni Association of Seattle)

On the morning of April 22, 16-year-old Julia Ruan woke up with a sore throat. Her parents tested her at home and the result was negative. She went to school and a sleepover that night.

What happened next, and how the family coped with it, was not just another lesson in the devastation the pandemic still brings, no matter how small, but on the other hand, a lesson in maybe what is the key to solving it.

Nancy Jecker, Professor of Bioethics at the University of Washington (UW) School of Medicine and US Fulbright Scholar for South Africa, in a recently published article, argues that the kind of solidarity that exists in the family is a good “starting point”. for how we should think about global interdependence.

“In small, supportive groups, like families, people’s lives are interconnected in the sense that what happens to one person has a profound impact on what happens to others. Bonds of love and benevolence unite the members of the group, leading them to take into account the interests of each. Yet these same interconnections do not bind strangers who have never met,” she wrote in the article “Global Sharing of COVID-19 Therapies During a ‘New Normal’,” which she co- written with C. Atuire, published April 25. in the journal “Bioethics”.

Western countries, like the United States, must move away from an ethic in which the needs of the individual are paramount and focus more on a group ethic, in which the well-being of each member matters.

Since we share a biosphere in which pathogens are transmitted everywhere and new variants can harm anyone, “a self-centered approach” allowing other parts of the world to remain without medical treatment for COVID-19 is not only dangerous, but myopic.

“It fails to build the social capital needed to deal with 21st century health threats,” Jecker said. “We live in a globalized world with an interconnected economy, cyber-connections via the Internet and common challenges to avoid nuclear war; we are more globally interconnected than ever before.

A principle of justice stems from recognizing that all members of a group are connected, which is why Jecker and Atuire chose a family to begin their discussion, Jecker said.

During a pandemic, everyone participates in an equality of susceptibility which imposes an interdependence on them.

“Such interconnectedness is apparent wherever people meet – in schools, stores, restaurants, gyms and workplaces, as shared spaces create pathways for the spread of disease and the prospect of illness and disease. death,” they wrote. “During an infectious disease outbreak, people are more aptly thought of as ‘victims and vectors, sick from something that comes from others and could go to others’.”

In the case of Julia’s family, the crisis that emerged showed how family members went beyond their usual roles to consider the needs and well-being of others.

The mother, Qiong, after the crisis ended, reflected on the questions and strategies posed by Jecker’s article and found surprising results.

After Julia went to the sleepover, she came home feeling worse. This time she tested positive. Immediately, the family sprang into action.

Julia’s father, who had picked her up and was with her in the car, realized he might have been exposed, so he started wearing a mask full time around the house.

Julia retired to her room for a full quarantine.

Qiong cooked all the meals and delivered them to her bedroom door.

Each family member slept in a separate room and none went out.

But Qiong realized the importance of social contacts for her daughter. During the first year of the pandemic, like many students, Julia had found remote learning isolating.

And when she was able to participate in outdoor badminton matches at the end of 2020, it made a huge difference in her mood and well-being.

“When the school was closed, she really missed her friends,” Qiong said. “So when badminton started, even though she had been playing it for years, she really got into it. She loved him so much she could see his friends.

So Qiong tried to think of ways for her daughter to get through her quarantine without feeling too isolated.

“We were all communicating with each other via FaceTime, from our separate rooms, but I was worried that wasn’t enough for her,” Qiong said.

The opportunity came when Julia asked if she could have more time on her phone to connect with her friends. Usually the family adheres to strict schedules. If Julia gets enough sleep, Qiong will give her half an hour a day to play or socialize electronically.

But now it was different.

“She asked me if she could have an hour a day to contact her friends,” Qiong said. “I gave him two.”
This is precisely the type of dynamic that Jecker calls between nations. Watching over the most vulnerable is the only way to ensure the safety of the group.

But Jecker draws a sharp distinction between the “negotiating for self-interest” philosophies that drive the West and those of the cultures of the Far East and Global South that seem to prioritize group welfare.

“In the West, you often assume that everyone is an outsider, so you want to maximize your own self-interest and protect yourself from outside threats,” she said.

On the contrary, the ethics she has explored outside the West, including the ubuntu ethics in sub-Saharan Africa or classical Confucianism, emphasize embeddedness in social relations.
Given the interconnectedness of 21st century globalization, there really is no other way to think about the planet, Jecker and Atuire write.

The result, they argue, is that rich countries, once they have ensured the safety of their own most vulnerable members, must share treatments with other nations. But this should not be done through acts of charity, which involve condescension to the less equal.

Rather, it should be done through the principle of justice, which treats everyone equally.

Qiong agrees. But she said it took her some time to fully develop her thinking about it.

“When I first met my husband, before we got married, he had been through a lot and he said to me, ‘We have to be selfish,’ and I remember being shocked,” a- she declared.

But after becoming a mother with her eldest daughter, things changed.

“It was 19 years ago, and it was very difficult to get an American visa. My parents wanted to come help but were refused. So my husband and I were alone with the new baby. After I came home from the hospital, I tried to take care of the baby at night so that my husband could sleep and take care of the baby during the day. Since I had to wake up at night anyway to feed the baby, I could also change the nappies. But after a few days, I was in such bad condition that I couldn’t move at all. It really scared my husband and me. That’s when I realized that if I didn’t take good care of myself, I couldn’t take care of my baby,” she said.

She added, “The same ‘selfish’ logic applies to my emotional needs. When I’m exhausted, depressed, and feeling unloved, how can I love my children, my family, and the rest of our world? Only when I am emotionally healthy can I regulate my emotions and behaviors and do what a mother, wife, daughter, or good citizen is supposed to do.

After finding her balance, Qiong was able to devote herself to others.

At the start of the pandemic, as president of an alumni association of one of China’s major universities, based in Wuhan, she led a campaign that brought masks to China, then participated in a for the Seattle area.

A coalition of several Chinese-American groups, Chinese airlines, local delivery services and a core of volunteers, including its alumni association, delivered nearly a million masks to hospitals and others healthcare providers in the first year of the pandemic.

His organization raised $1.2 million for COVID-19 relief in that region.

When asked if she was influenced by Confucianism, she remarked that she didn’t know, but it was probably “in her blood”.

“I mean, what are countries made up of? They are made up of families. And what are families made up of? They are made up of individuals. Only after taking care of my family can I take care of the world,” she said.

Qiong’s personal story echoes Jecker’s cry for an “everyone on deck” approach to treatment sharing.

Jecker argues that it will take almost as many types of intrastate organizations as there are to make drug sharing and distribution possible.

“We need to think about global health governance beyond states,” she said. “We already have pharmaceutical companies, philanthropic foundations, civil society groups involved, healthcare institutions, local and national governments, regional groups, like the EU and the African Union, but we need have someone in the background who supports things so they are more coordinated together.

Mahlon can be reached at [email protected]

This health series is made possible by funding from the Washington State Department of Health, which has no editorial input or oversight of this content.