For political leaders, preventing the further spread of the corona virus is the main priority, with the central objective of relieving the healthcare system to save as many lives as possible. But those who thought that the most trying time for governments was now over and that they had no more difficult decisions to make, would probably be sorely mistaken. Now that the dust has settled somewhat after the political storm of the first weeks of the corona crisis, public and political attention is partly shifting to the wicked dilemmas we’ll be facing in the coming months. Wicked dilemmas that science cannot easily solve either.
- The approach to tackling the coronavirus is entering a phase of grim trade-offs and degrading calculus. Governments currently have to deal with a worldwide healthcare crisis and, at the same time, account for the inevitable economic consequences of the lockdown.
- The ethical dilemmas are not restricted to governments and their parliaments. They are part of a wider social debate where scientists, business men, health care professionals and the general public all participate and share their opinion, expertise and advice on the dilemmas. In the public debate, the tradeoff between direct healthcare costs and indirect health costs (as a consequence of an enduring economic crisis) is increasingly highlighted. The difficulty lies in the fact that often contradictory perspectives and interests are both reasonable and plausible. For instance, on the one hand business men emphasize the unintended and severe economic consequences of a prolonged lockdown but, on the other hand, healthcare professionals emphasize the dangers of easing the lockdown too soon.
- Related to this is the bioethical question of the economic value of a human life, a question that has been relevant for some time now in healthcare, but that all of society is now being confronted with in a radical way.
- Furthermore, we lack time for endless deliberation and informed debates. Some ethical and political dilemmas are already visible in the daily decisions of professionals. In hospitals the most urgent dilemma might be the issue of priority that could arise when intensive care units reach maximum capacity. Doctors might then be forced to make decisions about who gets to live and who dies. Medical triage isn’t new, but the scale currently occurring in peacetime might become unprecedented.
- Finally, although this list of dilemmas is anything but exhaustive, the question looms what tradeoff should be made between the individual and his fundamental freedoms in society. Whereas before, discussions of this matter were rife with criticism of the East and its surveillance measures, the West now seems to be tacking partly, or at least a fundamental reconsideration seems to be expected of how the individual relates to the collective, how freedom relates to safety and how privacy relates to surveillance. These last dilemmas are political questions too that have been around a while (e.g. in the terrorism debate after 9/11, the migration debate and the big tech surveillance debate), but the pandemic is radicalizing and accelerating this reconsideration and reappraisal of fundamental rights and values. It’s imposing it upon all of society.
Connecting the dots
While hospitals are doing everything humanly possible to save as many lives as they can and the government is attempting to assuage the initial political storm with clear measures and considerable economic support packages, more wicked dilemmas for the medium-term are rearing their heads in the public debate, such as the issue of priority of ICU beds, the economic value of a human life and the tension between freedom and privacy (see observations).
These dilemmas are a major political and ethical challenge, there is no easy way out in terms of clearly good or bad solutions, it’s usually a matter of choosing the lesser of two evils. In a democracy at least, the public debate, in interplay with the government, is the domain where decisions need to be taken collectively. One of the most important participants in the public debate, especially during times of crisis, is the expert or the scientist. Society and its political representatives are in need of experts who can resolutely and legitimately lay claim to the truth, providing clarity and bringing about concord in decision-making. But the interplay between science, politics and society is now threatened by two problems. The first is unequivocally the perfectly new and idiosyncratic nature of this crisis and the need to come up with a swift response. Because so little is known yet, science is continually lagging behind reality.
The second problem is reaching concordance in the transdisciplinary issues we are confronted with in times of crisis. The desired agreement and unity are only partial now. Especially scientists and experts are often copiously doling out contrasting information and advice on how to deal with the crisis. They all view the world from their own perspective and share these views with the public domain. The multitude of perspectives and fundamental concepts demand assessment, and of course, that’s where the difficulty often lies. It’s a slow and complex process, combining medical, political, economic, sociological and philosophical perspectives in a just decision. While these problems are not unfamiliar to politics in regular times, in times of crisis there simply isn’t time for lengthy and careful deliberation. And yet, the politician is asked, or even expected, to decide justly, resolutely and immediately.
Given that there is no simple solution to this crisis, more attention and room for transdisciplinary research may be needed in the public debate. Transdisciplinary research is a scientific approach that is geared towards the integration of knowledge, besides specialization. In many cases, scientific specialization and differentiation are partly what drives scientific progress and delivers (partial) solutions in domains such as oncology and neurology. But in times of crisis, the natural sciences simply don’t suffice, as the societal questions and dilemmas we face nearly always transcend disciplines.
Transdisciplinary sciences and scientific cross-pollination have two main advantages on single disciplines.
First, by definition, integration of knowledge has already taken place, which means that fewer assessments will have to be made afterwards. To illustrate, assessing what should be the tradeoff regarding the Bureau for Economic Policy Analysis’ (in Dutch: CPB) current economic projection and the corresponding psychological dynamics of people and markets, relates to one of the basic tenets of behavioral economics. This integration beforehand ensures that in times of crisis, these sciences are able to immediately provide as much integrated knowledge as possible to political leaders and the public debate.
The second advantage is that transdisciplinary research confronts us again and again with the political and human naiveté that always lurks in our belief that society can fully rely on “objective scientific insights” to control the world and make the right decisions (technocracy). Transdisciplinary sciences such as systemic theory, cybernetics and ecology on the other hand, often rely heavily on complexity thinking and portray the world as a complicated field of interdependent networks and systems communicating with each other. These complex insights usually don’t yield simple or unambiguous political recommendations. Researchers in fields of scientific cross-pollination such as bioinformatics, neuropsychology and behavioral economy are usually modest as well when it comes to the scientific ability to control reality and deduce political decisions from their findings. Institutes such as the Netherlands National Institute for Public Health and the Environment (in Dutch: RIVM) are usually aware of this and openly accept accountability for it, but among the general public and in political debate, this often goes unnoticed. What these disciplines and society can learn now is that the world around us is fickle and unpredictable, that scientific control of the world is very difficult to achieve and that the gap between scientific insights and political decision-making is not easily bridged.
But we shouldn’t necessarily succumb to pessimism and fatalism. Politics has never been grounded in bare scientific fact and has always been a public affair, which science itself is a part of. Cultural values and interests should also be taken into consideration; bare facts are not enough to make good decisions, especially in a crisis like this. Politics is a practice in which we can definitely strive to be guided and even controlled by science, but ultimately, values and interests cannot be reduced to it. Not least because technocratic control and guidance themselves embody a political value.
The scientific provision of information is crucial to decision-making, as the RIVM has now clearly shown, but can never be its be-all and end-all. The political and ethical dilemmas the government will be faced with in the coming months will make that painfully clear.
Besides transdisciplinary research and complexity thinking, we can expect artificial intelligence to come to play a larger role in the political decision-making process. Not as smart systems that will completely take over decision-making, but in the form of a continuing dialogue between artificial intelligence and the public debate, allowing for dynamic measures to be taken when new knowledge is acquired. Artificial intelligence thereby integrates the complex network of dependencies and subareas in real-time and presents this in simplified form to the public, so it can be taken into consideration during deliberations. There is already a tendency towards this model of decision-making in Healthcare.