Towards a New Space-Time of the Ethics?

1 University of Rouen, France, jp.clero@orange.fr Abstract: In just a few days, the certainties that seemed the most solidly grounded have floundered. What happened to the Chinese people could now reach us; our medicine which we believed to be particularly powerful demonstrated its fragility today and in the future. The notion of ‘nation’ which appeared outdated could likely to be back with a vengeance. The pandemic backfires on what we fancied to be the one-way road to globalization, indefinitely open ahead of us, it brutally brings to a halt half the world, and most notably the one half which we believed to be most invulnerable. This distress is probably the starting point of a change that none of us dared to envision.


An unimaginable break away from both personal and business matters
Prior to the health crisis occurring earlier this year, I had started to throw in some ideas as I envisioned to write an article on the matter. Following all the work conducted in medical ethics for half a century across countries that have at their disposal a medicine which is similar to ours, I focused this matter on two main points. The first was the question of pharmacy, which functions too much apart from any ethical consideration, whatever be the language in which it is expressed, whereas it would be relevant for it to be endowed with an ethical reflection comparable to the one that doctors have irreversibly adopted. The second matter was the question of ethics unification in a sort of searching community which could reach beyond an ad hoc practice, dealing with the problems as we go along, each ethician for himself. I must confess my consternation and the shock that represented for me this extraordinary epidemic of coronavirus, which seemed first to be limited to China, but then spread at full and terrific speed throughout Europe, before crossing the Channel and then further reaching the United States; I also avow my sideration in seeing the medicine I believed powerful enough to keep a pandemic in check, however dire, recommend to politicians from its greatest authorities, approaches that appeared outdated to resolve the crisis. How could it be possible, nowadays, in order to spare the greatest part of the population from being killed by the pandemic, to condemn everybody to containment measures, paralyzing nearly all the non-sanitary activities, crippling the world economy and endangering a stability which many imagined to be the world order? We are living and experiencing, to this day, one of the oddest phenomena, that one could have only envisioned in a science fiction movie or a novel, and that suddenly came to remind us, by the very nature of the facts and the brutality of their occurence, of the frailty of our health system, which can be jeopardized and held in check in spite of the exceptional individual results obtained by the patients cured by today's medicine. Without being compromised, these results assessed through probability calculus, are counterweighted by overwhelming statistical measures when they provide a death count that is significantly increased across the world, including in the most medically advanced places.

Far from the thought-experiments, the intrusion of the reality
The pandemic we experience without having ordered it, or perhaps having involuntarily triggered it, is nothing like the thought-experiments that are often used in ethics: an illness happens unexpectedly, before we had time to see it coming, leaving us no time to understand its danger, its contagiousness, dreaded by many categories of patients at risk of developing it: although we ignore the principle of it, it makes such direct cuts across different societal directions and groups that are clearly exposed as to be read like an open book with clarity and precision, that we could not dare to imagine it possible. We knew the existence of inequalities, but usually they were not visible: children had school meals; promiscuity is too confined in flats and partially obviated by street life; if it occurred any trouble or illness, public hospital might more or less remedy the problem. We now have our back against the wall because the viral disease cannot be directly treated.
Moreover, if social inequalities are always at the background of all others, they are not the only ones. If one exceeds the age of 70, one discovers that he or she may not count among those who will not be automatically resuscitated if necessary or that there would be only a few chances to be chosen if one must be in competition with younger patients, and in any case not without a deliberation on selective criteria. What was a simple textbook case becomes reality. Probabilities are no more those of a remote problem, but these of a situation in which danger, though invisible, is present, imminent and destabilizes the balances on which our society was unconsciously founded. The dramatic situation of the movie Melancholia (2011), the context of which was the event of a disastrous astronomical configuration, has become our sanitary situation. Never before has it been more obvious that we do not judge of a situation in the same way when the danger is coming and when, rightly or wrongly, it seems to have passed. To these age-related considerations, which suddenly flush out school hypotheses, must be added inequalities issued from long-term illnesses. Usually well-cured by our medicine up to be indiscernible, during a long time, from healthy people, the patient finds himself faced with the real possibility of lifetime reduction, changing his generally well tolerated vulnerability into an uneasy walk on the edge of the abyss.
In a few days, in a few hours perhaps, the covid-19 embarked us in a situation that cannot be observed from outside of a probable world, but in which everybody must put his stake, with the issue that our decision making process has an immediate effect. Usually, we transform reality into a game to bear it; for once, it is reality that crashes into in the game, imposing an experiment with real risks that may cost a high price to those who take them. This situation, for which we still misperceive the final outcome and will not remain at such high degree, is now already subsiding: this is perfectly normal. But it would be despairing that the opportunity of its terrible warning be missed.

Six viewpoints
The six prospects that, from today's vantage point, appeared to me as fundamental for improving our health system, from an ethical point of view, are the following, without their order being understood as hierarchical:

Flagrant inequalities
Without willing to suggest that the wealthiest people escape the harshness of the pandemic, it nevertheless appears to us that the most urgent initiative is to take care of housing conditions of people who live across geographies. Obviously, the consequences of the pandemic worsen when people live in unsanitary and crowded homes.
These inequalities are so glaring that the mere notion of « republic » has been dented. The containment decisions -relevant and useful by their generality-cannot miss to be at odds in specific neighborhoods where they lose any meaning because of the lack of space of some residences where people ought to be confined; moreover they may become even more dangerous as a result of domestic violence that promiscuity triggers.

Sanctuarization of pharmaceuticals and medical supplies
It appeared extremely dangerous for States to be exclusively dependent on foreign States for drugs and medical supplies and for the quality of those productions. Globalization is unreliable in the domain of health; while it may have played an important role in exchanging merchandise, services, loaning equipment, it has also proven that commodification of pharmaceutical and medical industry could play against this mutual exchange of services, leaving caregivers and their patients greatly distraught.

A necessary change of many modes of production
In the same way, the just-in-time production, as if it were always possible to supply everybody's needs as and when required and whatever they might be, is without any doubt economically valuable for the May, 2020 Openings Volume 11, Issue 1, Supl. 2 greatest number of merchandize but it is dangerous for productions directly linked to public health that may be collectively and unpredictably threatened. The citizens must accept to carry the cost of supplies which, after a long time of idleness, may be suddenly essential. It is necessary to create reserves and keep them current, even if, most of the time, they may not be used.

Liberty of medias and lies
Moving on to the delicate matter of the functioning of the medias, one can only lament the amazing confusion of values in which some caregivers and their followers indulged, in the name of democracy -but in fact for its defiance-as if it were possible to vote on the value of a treatment, after having written a poorly substantiated petition. This practice of using the force of persuasion rather than research and critical spirit is somewhat execrable. A certain kind of press is constantly resorting to the conspiracy argument: men of power knew all about the situation but they have purposely neglected this knowledge and willingly let their fellow citizens die; they had solutions but, for the sake of some shameful objective, they did not want to use them.
In the same vein, the incredible strength of the internet must be denounced when it pours anyway diagnoses and prognoses, playing off people's fear and uneasiness under the pretext of informing, without providing the least source of information.
From this point of view, it is interesting to consider the difference of information processing between television that operates as a showcase and the web that has no regard at all to decency and operates in the backroom: indeed, some medical authorities that feign to respect one another on the television screen may wage a merciless war on the net, without the slightest substantiated argument.

Parochial and cynical behaviors
Pitiful behaviors against the containment measures were observed and which, out of an obscurantism not exclusively reserved to expert circles of superstition, claimed the right to practice in praesentia provisions without the slightest regard to the risk taken. In doing so, people involved in meeting one another exposed not only themselves, but also all the others whose opinion was duly neglected.

The question of French municipal elections of March 2020
Last but not least, it would be unacceptable, for a republican, who believes in the value and in the rule of laws to discard the first round of the French municipal elections as if the citizens who went to the polls, even in small numbers, in all the French municipalities, in last March 2020, in order to bring democracy to life, had done nothing at all. In replaying the ballot and so erasing the results of the first round, the risk would be taken to increase the feeling of helplessness in the rural areas, as if there were French people whose ballot can easily be neglected and others whose polls are truly valuable. In disqualifying a ballot, be it the first round of a municipal poll, a government would take the risk of aggravating the feeling of political ruin at all levels of the political edifice, even though the management of the sanitary crisis by most of European governments was rather to their credit.

Globalization in question
It is seldom that events provide such insight into a cross section of our social relations, be it national or international. To leverage such an opportunity, that is also a calamity, requires a combination of particular circumstances: a cause on which we have no power before a long time; a cause that does not start from men's will; a rapidly spreading phenomenon, progressing geometrically from an event on which we are far from having a complete control; a mortal danger in its effects; the realization that what could have been done is hopelessly behind and that the protagonists are caught red-handed.
It did not take much to disrupt a machine of which the operation seemed, only yesterday, for better and for worse, impossible to be hindered.
A factual event, almost similar to a cosmological one, has used the channels we have traced, willingly and unwillingly, of what we have called «globalization» as if it were to destroy them from the inside and retroactively; providing us with the opportunity, if we know how to grasp it, to open up new fields and new procedures for ethics.