Editor’s Note: March 2021

March, 2021 marks one year since COVID-19 reached pandemic proportions, and accordingly, this has been a vital year for bioethics, as the world grapples with new and intensified ethical questions surrounding health, isolation, the rationing of health care resources such as ICU beds and vaccines, the protection of the vulnerable, and more. Since we have no clear idea when life will return to ‘normal,’ it seems that such questions will be with us for the foreseeable future. The Kennedy Institute of Ethics Journal will be focusing on emerging ethical issues of immediate, pressing importance throughout the pandemic.

In the first paper of this issue, “State Responsibilities to Protect us from Loneliness During Lockdown,” Bouke de Vries takes up such an emerging issue—one that was not even recognized as falling within the scope of bioethics until now. Given that measures to contain the pandemic involve imposed isolation, he asks, what responsibilities does the state have to protect people from loneliness? Reframing loneliness as a side effect of the pandemic reorients ethical thought. De Vries suggests a series of measures that governments can take to mitigate loneliness, from making the internet accessible to encouraging and enabling pet companionship, and argues that addressing pandemic-induced loneliness is a state responsibility and not just an individualized problem.

In this issue’s featured article, “Anti-Vaxxers, Anti-Anti-Vaxxers, Fairness, and Anger,” Justin Bernstein begins from the outrage that many people feel at those who refuse to vaccinate their children. He argues that duties to vaccinate are best understood as rooted in a principle of fairness, by which we should not gain from the cooperative labor of others without doing our fair share. He argues that the anger that many people feel at anti-vaxxers is best understood as grounded in a reaction to the violation of the fair terms of social cooperation. Although his focus is on the MMR vaccine for children, Bernstein’s analysis has immediate relevance for thinking about duties to receive the COVID vaccination if one is eligible to receive it, and our social reaction to COVID vaccine skepticism.

Xavier Symons and Reginald Chua’s piece, “Rationing, Responsibility and Blameworthiness: An Ethical Evaluation of Responsibility-Sensitive Policies for Healthcare Rationing,” argues against using individual responsibility for risky behavior as any sort of criterion for health care rationing. The question is whether people’s past actions and choices should play a role in determining whether or how they receive care for any health needs they have as a result of those actions and choices. Although Symons and Chua’s argument is general, once again, it has immediate relevance during the pandemic, since there have been suggestions that people who take unnecessary risks when it comes to contracting COVID should be lower priority for ICU beds and other treatments than those who have been more careful. Symons and Chua argue that any link between individual responsibility and health care rationing implicitly relies on a substantial and shaky theory of personal identity. They show that we cannot connect past choices with present blameworthiness without presupposing a specific and controversial picture of how past and present selves are morally and metaphysically related to one another. In the place of responsibility-based rationing, they argue for interventions that focus on preventing risky actions rather than punishing people for prior actions.

Finally, in “Publicly Funded Health Care for Pregnant Undocumented Immigrants: Achieving Moral Progress Through Overlapping Consensus,” Rachel Fabi and Holly A. Taylor ask what kind of care we as a society owe to pregnant undocumented immigrants. Relevantly, in this country, the children of pregnant people who are undocumented will typically be American citizens at birth, so the story is made more complex by the fact that care given to an undocumented pregnant person is likely to benefit a future American citizen as well. They explore three accounts of the purported obligations that a liberal democracy has towards its undocumented immigrants, and extend those accounts to consider pregnant people in particular. They conclude that there is an overlapping consensus, among people committed to the equal moral worth of all humans, that pregnant undocumented immigrants are owed...