Bioethics Forum Essay
Covid-19 in Argentina and the Abuse of Bioethics
More than a year after the beginning of the Covid-19 pandemic, many Latin American countries are being devastated by excessive loss of life, many sectors of society falling below the poverty line, and health systems being overwhelmed. As collateral damage, some countries in the region are witnessing an eruption of populism and autocratic trends and an increasing erosion of already weak and unstable democracies.
Can bioethics be a useful tool for managing this crisis? Argentina provides a case study.
In June 2020, the Argentine Ministry of Health convened a group of experts in bioethics and ordered the formation of the Ethics and Human Rights Committee in Covid-19 Pandemic. According to its foundational principles, the role of the committee is to advise the government on “the bioethical dilemmas posed by the Covid-19 pandemic in Argentine society,” essentially in public health, supporting the protection of human rights and dignity of the individuals,with particular emphasis in achieving justice by promoting equality in burdens and benefits in a framework of fairness and transparency.
The committee has issued seven reports. Five of them are conventional bioethics documents: reflections on resource allocation during emergencies, the enumeration of the committee’s purview, recommendations for accompanying hospitalized persons during the pandemic, a report to the Ministry of Health, and the criteria for prioritizing access to the health care system during the pandemic.
The last two reports, produced last month, depart from bioethical considerations, and take on a markedly partisan tone in defense of the Argentine government’s position on the role of the independent press and the attempt, thwarted by the Supreme Court, to close public schools in the Autonomous city of Buenos Aires. One of them is entitled “Iatrogenic Information: Ethical and Human Rights Considerations.” The other is called “Interruption of Educational Attendance: Ethical and Human Rights Aspects.” In both cases an explicit appeal is made to human rights, which is more common in bioethics in Latin American than in the United States.
According to one of the standard textbooks of internal medicine, “an iatrogenic disorder occurs when the deleterious effects of the therapeutic or diagnostic regimen causes pathology independent of the condition for which the regimen is advised.” The Iatrogenic information report blames independent media for exacerbating “mistrust and skepticism” within Argentinean society by manipulating the information related to the governmental handling of the pandemic, especially in the acquisition and distribution of the vaccines This critical media coverage, according to the report, undermines societal trust in the government which, due to the emergency, implies a direct attack to the imposition of public health measures.
In fact, the extensive lockdown imposed in Argentina was not based on epidemiological considerations but was the result of inadequate testing and poor decisions made by health authorities based on ideological biases rather than on public health principles. As a result, Argentina has been left with the worst possible scenario: the economy is in tatters with an unprecedent 42% of the urban Argentinean population living in poverty; almost 70,000 deaths; more than 3.3 million cases of Covid-19; and more than 10 million children and adolescents stopped attending school during the pandemic, a major factor being the lack of Internet.
The committee’s bizarre application of the clinical concept of iatrogenicity to public health implies that criticism of the health authorities’ handling of the pandemic has induced an illness in the body politic, a transparent attempt to blame the messenger. A journalistic investigation carried out in one of Argentina’s main newspapers, La Nación, revealed that Pfizer had offered the Argentine government 13.3 million doses in December 2020 that the COVAX fund, which is co-managed by the World Health Organization, offered 25 million vaccine doses, but that the former health minister accepted only 2.5 million doses of vaccines.
Or perhaps the committee is using the term iatrogenic in response to another scandal, unearthed by the media in February, when only one-tenth of the vaccines promised by the Russian government arrived in Argentina and less than 8% of the elderly and other vulnerable people were vaccinated. Again, the press denounced preferential administration of vaccines to members of the ruling party and young partisan groups. The ensuing scandal engulfed the minister of health and he was forced to resign.
Or maybe the committee’s use of the term iatrogenic refers to the critics of the opaque arrangements that the Argentine government had with Russia to receive Sputnik V, the vaccine produced by the Gamaleya Research Institute of Epidemiology and Microbiology, and the consequences of the Russian government’s failure to deliver vaccines as promised. In part because of that agreement, only 11% of Argentina’s population has been vaccinated so far.
The second report, “Interruption of educational attendance: Ethical and Human Rights Aspects,” supports the federal government’s decision to shut down the schools in Buenos Aires. Buenos Aires is divided into the nation’s capital–the Autonomous City of Buenos Aires–and the province of Buenos Aires. The latter is ruled by the Peronist party, which also holds the national government. The former is governed by a coalition formed by the opposition.
The federal government ordered the suspension of classes in both districts. That decision was not based on epidemiological grounds, as many public health experts testified, but on political scuffles within the government. Fearing a federal intervention, the Buenos Aires governor brought the case to the Supreme Court, which reaffirmed the constitutional status of the capital city and left the decisions about in-person schooling to the local government. This second committee report explicitly supported the Argentinean president, who, frustrated by the Supreme Court ruling, stated, “I will take care of the health of Argentines no matter how many pages of sentences they write.”
What is worrisome is the use of a government-appointed bioethics committee as a partisan tool, especially when discussions should be conducted based on the ethical and moral considerations of the difficult issues being discussed and not on political interests. Even more worrisome is the idea of a bioethics committee urging that the free press be silenced or that the separation of powers should be overridden, a cornerstone of democratic norms.
The dramatic circumstances brought about by the Covid-19 pandemic call for dispassionate reflection on all the elements at stake that will affect the lives of millions in the years to come. Both bioethics and human rights are words that carry moral significance. The banal and partisan use of these words by bioethics committees only succeeds in stripping them of their meaning and gravity.
Sergio G. Litewka, MD, MPH, is an associate professor of surgery at the University of Miami Miller School of Medicine and director of international initiatives of the Institute for Bioethics and Health Policy. Jonathan D. Moreno, PhD, is the David and Lyn Silfen University Professor at the University of Pennsylvania, where he is also professor of medical ethics and health policy, of history and sociology of science, and of philosophy. He is a Hastings Center fellow, @pennprof.