Evolving an ethical framework for Covid-19 management in India

Abstract

The Covid­19 pandemic has caused millions of cases and deaths worldwide and has caused a massive global economic contraction. Governments, policymakers, and medical professionals have been confronted with several complex bioethical dilemmas during these exceptional circumstances. In developing countries like India, having a large population base, inadequate preexisting public health infrastructure, and a multi­level government system with complex administrative mechanisms imposes enormous barriers and challenges in the effective and ethical management of the pandemic. Furthermore, endemic corruption, limited bureaucratic and organisational accountability, and weak oversight, especially among stakeholders in the vast private and non­government health and allied services sector, complicate the assessment of their adherence to ethical public health practices. All this constitutes a moral imperative for practitioners of medical ethics in India to develop a framework for ethical preparedness during a pandemic. Failure to do so runs the grave risk of moral and ethical chaos from ad­hoc decision making that is deprived of ethical guidance when confronted with an unprecedented public health crisis. In this narrative, we provide some of the building blocks for a comprehensive ethical framework for decision making and shaping public health responses to pandemic situations and associated challenges.