Medical Ethics in Extraordinary Times
On January 30, 2023, a report in Singapore's Lianhe Zaobao mentioned that the National University of Singapore had recently held a global ethics lecture on the topic of "how to fairly and justly allocate medical resources," delivered by Professor Ezekiel Emanuel, a U.S. health-policy scholar and advisor on healthcare reform during the Obama era.Professor Ezekiel Emanuel said that, for a long time, bioethics has focused on issues such as individual informed-consent rights and clinical care. However, the global outbreak of COVID signals that bioethics must in the future pay more attention to the allocation of resources among individuals, groups, and nations. When life-saving resources become very scarce, doctors and scholars are forced to confront many dilemmas and ethical problems in resource allocation.That this issue can be listed as a major subject shows that, in our era, public health resources have become so scarce that they cannot be ignored. Many patients need medical resources to relieve their suffering and save their lives, yet they cannot obtain these life-saving resources in time.The epidemic is not over, and the phenomenon of medical resource crunch still occurs from time to time in every country; exhausted medical staff have become the norm. Many patients cannot get timely diagnosis and treatment, and many problems are unprecedented new ones with no effective solution yet, and this state of affairs will continue for a long time. Even in a country like Singapore, which claims to have well-developed medical resources, during each peak of the epidemic emergency patients had to wait an average of 6 to 8 hours just to see a doctor; needless to say how it is in other countries and regions.Being a doctor in such an era is not easy. Yesterday I received, by courier from a neurologist in Dandong, a box of their local specialty, Dandong Hongyan strawberries. After receiving it I sent her a few words of thanks; as colleagues and friends, we both understand very well where the other is coming from at this moment.In the past we might have chatted a bit more, but yesterday, after saying a few words, she told me she had been on shift for 36 consecutive hours and needed to get some sleep. These days there are especially many neurology patients; every year, from the Spring Festival to the Qingming Festival, there are more stroke patients than usual, and this year, with the added impact of COVID, there are even more.Running on nonstop is basically the norm for doctors in this era. I have always been very cautious; when I worked at a hospital before, a retired, rehired chief physician told me that although doctors are all rigorous, in her whole life as a doctor she had never seen anyone more meticulous at work than me. In her view, it would have been inconceivable for me to make a mistake at work. But during this period I have made frequent mistakes, both in life and at work, because we no longer have the energy to deliberate as carefully as we used to.But patients do not fully understand this. Some patients expect the doctor to explain even which direction the pharmacy door faces, occupying the doctor's time endlessly, while the lives and deaths of other patients are simply not their concern; so conflicts between doctors and patients occur from time to time.Statistics from the World Health Organization show that global excess deaths over these three years were around 20 million, a figure that is staggering. The data reported by some countries is not fully truthful, with many deaths underreported; the true number of excess deaths is certainly much higher than this figure.What should doctors and medical institutions choose to do in this situation? Whom to save, whom to give up, and who gets to decide? I remember that in 2020 Italy's medical community already raised this question. At that time Italy had too many patients; many could only lie in tents outside the hospital, ventilators were in short supply, and there were many patients who needed them. Doctors faced the dilemma of whom to allocate these life-saving resources to.Many patients' expectations are still stuck before the epidemic. They hope doctors will patiently and carefully provide them with diagnosis and treatment and answer their questions, but this wish is very unrealistic. Even Japanese doctors, who used to be renowned for their warmth, can no longer, when the epidemic arrives, take the time to serve patients gently and courteously as before. The warmth of Japanese doctors before the epidemic was built on a relatively small number of patients and the doctors having plenty of spare time.An epidemic is far more destructive than a war. Each wave produces a great number of severely ill patients, and no matter how much doctors overextend themselves, they cannot meet all of society's needs. Yet doctors and nurses are human too, and they need rest. Drug shortages have also robbed doctors of their weapons against disease; the problem of drug supply running short exists not only in China—at the peak of the epidemic, fever medicines were equally scarce in the United States and Singapore.My friends in Switzerland and Australia, after contracting COVID and developing aftereffects, could only tough it out at home on their own, unable to see a doctor, because getting an appointment was so hard. Data from Hong Kong some time ago showed that, now, booking a doctor through the normal process for a routine visit requires a wait of one or two years. Some patients with advanced cancer, if they sought care this way, would die before they even got to see the doctor.During the past three years under the dynamic-zero policy, and now after reopening, there have been quite a few cases of people dying because they could not get timely treatment. This is a problem of our times that no one can solve. Tiny humans have many moments of helplessness before natural disasters; we are simply in one such moment now.I believe that the question of how to allocate medical resources in such an era has no answer. No matter how it is allocated, it cannot be called fair or just; there will always be many people whose lives are shortened for lack of medical resources. Because an ordinary society cannot, and does not have the financial means to, train enough medical staff to support the medical demand during an epidemic. Looking back through history, medical staff have always been in short supply during any epidemic. Moreover, usually during an epidemic, those most likely to be stricken or killed by the disease are the medical staff themselves, because they are the most exposed. So at the peak of each wave, hospitals face large-scale staff losses.Perhaps only time can resolve this medical-ethical problem. Only after the wave of infection recedes can society truly return to normal, and the medical ethics we once advocated be restored. To speak now of healthcare that is both high-quality and humanized is truly a luxury.