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Proportionality, Pandemics, and Medical Ethics

19 December 2022

While the conduct of clinicians during the Covid-19 pandemic is admirable, approaching medical ethics from the perspective of heroism is neither sustainable nor robust enough to cope with the complexity of emergency conditions during a pandemic. This is unfair because the expectation of heroism assumes that clinicians will shoulder a disproportionate share of the burden that should be spread more widely. When medical ethicists assess clinical practice in terms of the proportion of burdens and benefits, they invoke the doctrine of proportionality. A choice is proportionate when the benefits outweigh the burdens. One of the limitations of traditional medical ethics, particularly evident in pandemic emergencies, is that it focuses almost exclusively on the doctor-patient diad. Adopting a broader conception of proportionality can help practitioners maintain professionalism when they feel vulnerable and heroism can no longer carry them through change. Proportionality can provide the means to redistribute the burden of care more equitably, so you don't have to be a hero to practice ethically. Proportionality in emergency situations that go beyond a focus on the individual patient can also influence decisions about rationing intensive care and allocating institutional resources for palliative care.