Risk Trade-Offs and Equitable Decision-Making in the Covid-19 Pandemic

Lawrence O. Gostin and Sarah Wetter

Since the start of the pandemic, societies have faced agonizing decisions about whether to close schools, shutter businesses, delay nonemergency health care, restrict travel, and authorize the use of emergency Covid-19 countermeasures under limited scientific understanding. When both action and inaction can result in significant harm and irreversible damage, decisions surrounding infection control measures become complicated. Ethics can help us think about hard trade-offs. This essay proposes four key considerations for assessing risk-risk trade-offs and applies those considerations to the areas of education, economies, health care, travel and migration, social engage­ment, and medical countermeasures.

Advance Directives: The Principle of Determining Authenticity

Matilda Carter

In medical ethics, there is a well-established debate about the authority of advance directives over people living with dementia, a dispute often cast as a clash between two principles: respecting autonomy and beneficence toward patients. This article argues that there need be only one principle in substitute decision-making: determining authenticity. This principle instructs decision-makers to determine what the patient would authentically prefer to happen—based not merely on the patient’s previously expressed wishes but also on their present settled dispositions. Adhering to this principle entails that, in a significant range of cases, an advance directive can (and indeed ought to) be overruled.

Pediatric Authenticity: Hiding in Plain Sight

Ryan H. Nelson, Bryanna Moore, and Jennifer Blumenthal-Barby

The range of decisions considered permissible in pediatrics is typically understood to involve a balance between patient interests and parental or surrogate authority. This article argues that there is a distinct set of considerations relevant to pediatric decision-making that is often neglected or unacknowledged in pediatrics—namely, considerations related to patient authenticity. What is most consistent with who the patient is?

Also in this issue:

“Disability Affirmative Action Requirements for the U.S. HHS and Academic Medical Centers,” by Nicholas D. Lawson

Perspective: “On Ethicists and Their Diets,” by David DeGrazia

At Law: “Covid Vaccine Mandates and Religious Accommodation in Employment,” by Mark A. Rothstein

See the table of contents of the Hastings Center Report, January-February 2022 issue.

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