The ethical failures in Canada’s pandemic response
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Summary
In this episode, we talk with Dr. Kerry Bowman, who teaches bioethics and global health at the University of Toronto, about the implications of COVID-19, vaccine mandates, and much, much more.
Transcript
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Hi, I'm Anthony Fury. Thanks for joining us for the latest episode of Full Comet.
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Let's talk about COVID-19 and bioethics, the ethical considerations of lockdowns,
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vaccine mandates, and so much more. It seems like whenever the issue is raised,
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it's hastily brushed aside. Well, not today. Today, we're going to do a deep dive on the topic
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with our guest, Professor Kerry Bowman, who teaches bioethics and global health at University
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of Toronto. Hey, Kerry, welcome to the show. Happy to be here, Anthony. Yeah, great to have
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you on. And it must have been a really interesting past, I guess, almost two years for someone in
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your line of work focusing on issues of bioethics. It really has been, you know, and throughout my
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career, and I'm well into my career in bioethics, you know, I've never seen so much ethical
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material, so to speak, as I've seen with this pandemic. It's quite amazing to see. Mind you,
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I'm going to say this. I would also say that there's been a fair amount of silence from many
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people within the bioethics community. I would have thought people would be even more vocal than
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they have been, but I just see a profusion of ethical questions as I look around me throughout
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this pandemic. Well, just to sort of start us off with some underlying principles, bioethics. I mean,
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people have a good working sense of what the definition ethics means. What does bioethics
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mean? What is a bioethical consideration? Yeah, no, and that's a totally fair question. And,
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you know, and there's many people that don't fully grasp it through no fault of their own.
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So, you know, bio, of course, from biological. And so bioethics is really the application of ethics,
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primarily, but not exclusively, within the medical slash healthcare setting, and increasingly with
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with medical technologies that interface with those things like, you know, like medicine and
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health and well-being. So it's the direct application of those things, right? So, you know,
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within my life, I have worked and continue to work within many teaching hospitals. So I'm not,
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yes, I'm a university professor and have been for a while, but a lot of my working life actually has
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been bedside working within intensive care units, issues of end of life decision making, issues of
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policies related to all kinds of things, increasingly emerging technology, consent and capacity, brain
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death. So really think of it as the application of this. And then who are we, you know, to do these
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unbelievable and strange jobs, right? Who are we? Some of us are philosophers. A lot of us aren't.
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You know, I actually have a PhD in bioethics from the University of Toronto, from the Faculty of
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Medicine, quite interdisciplinary. And then before that, I personally was a medical social worker.
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Other people might be psychologists that become bioethicists, lawyers that become bioethicists,
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occasionally physicians. So this is why a lot of the public, you know, struggle with grasping this
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profession. I don't really blame them if they struggle with grasping it, because in a lot of ways,
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it's much more diffuse than other professions. And I guess a really multifaceted issue. I mean,
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in the way you're saying it, lawyers or people who are, in your case, the social workers, I mean,
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you can come at it from so many different angles. Yeah, that's exactly right. And that, of course,
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obviously informs enormously how a bioethicist is going to see their job, the world, the cases before
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them. So there's a lot of range there. We did an episode, a few episodes back with
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Anne Kavoukian, who's previously Ontario's privacy commissioner, very big in the world of privacy.
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And very early on in our conversation, we kind of established that, yes, there are the big ticket
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questions of COVID and privacy, but really like everything that's been happening the past almost
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two years does have a privacy consideration to it. And when I was thinking about having our
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discussion today, I thought, well, yes, there's the big ticket questions of, is it right to penalize or
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even one poll, which I'm sure we'll talk about in a bit, incarcerate people who are not being
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vaccinated? I mean, that's kind of the obvious questions, but kind of going back and peeling
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back the onion, there's ethical considerations to almost everything we've done. Is it fair to say
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that? No, I think it is fair to say that. And, you know, ethics is proportional. So that's been a
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great challenge with this, you know, with this pandemic is we're going to have, you know, lockdowns,
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let's say, well, let's look at the proportion. What's the harm? What's the benefit? And, you know,
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we tend to look at this from a viral point of view. Of course, lockdowns are a brilliant idea when it
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comes to containing a virus. But boy, the social determinants of health, you know, are very complex.
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And how much lockdowns kill too, right? So that's very, very tough. And Anne is exactly right. I mean,
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the privacy issues have just been enormous. And I actually think a lot of them have been, I didn't hear
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that interview. But I know, Anne, and I think a lot of them have been actually ignored to a large
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extent. And, you know, there's so much going on with the pandemic. But generally, we're a society
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as North American society is, meaning just Canada and the US, that enormously values the concept of
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autonomy, you know, the free choice of the individual. And it's never been without limits.
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Of course, there's always been, you know, limits to that. But when you look at the entire world,
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and you look at which societies really, really honed down on the concept of autonomy, it's first
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the United States, and really, secondly, Canada, even Western Europe, the concept of autonomy within
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healthcare plays out very differently. Physicians tend to have much, much more determination in what
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they see as futile, and you know, what they see as best interest. Whereas within Canadian society,
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autonomy has been very powerful. And here's the thing, what's been really difficult with this
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pandemic is, you know, have we got the right model? Because so much of what we've been facing is what
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is our responsibility to other people. And with this pandemic, you know, this is, you know, the moral
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equation is really much more about interdependence than independence with this. And so then the question
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becomes, you know, have we got, you know, the right stuff to be dealing with this? Do we have to
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really change our ethical foundation to approach this? So very, very challenging questions are
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emerging. Well, I remember from my U of T ethics class in philosophy, not, not, not the bioethics
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classes you teach, the notion of using people as a means to an end, as opposed to an end in and of
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themselves. And it's interesting when you talk about autonomy and how so much of what we've done has
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been, you know, the number of times you've been told, yeah, I know you're, you know, you're in your
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late thirties, you got two vaccines. I mean, this isn't about you. Everything's fine, but you've got
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to do this. You got to do that. Your child has to lose their schooling X, Y, Z, because this thing
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may happen to someone else in the abstract. I mean, that seems to me, like I said, I was just taking a
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first year, second year class. We were talking about those sort of dynamics. That seems almost a
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hallmark of an ethical consideration. Yeah, it very much is. And, you know, what's challenging with
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you need to do this for other people is, you know, how strong is a scientific foundation that
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we're building upon? And, you know, it's there, but, you know, science has been emerging throughout
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this pandemic. And, you know, if you look at something like that, so if you look at the
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vaccination of children as one example, which we're now, you know, in the midst of within this
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country. So we do know that children, and I'm just building on what you've said, you know, that
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the children do not get nearly as ill with COVID. They can, but they rarely get as ill with COVID
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as other people would get. Yet we have this massive national vaccination campaign. And, you
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know, one of the stronger justifications for vaccinating children is for kind of the population
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of health of everyone else, right? So, you know, the question then becomes from an ethical point of
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view, are we using our own children as a means to an end? And, you know, within society, usually we
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make massive sacrifices to protect the children as opposed to, and I'm not saying it's necessarily a bad
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decision. But the, you know, the ethical decision of vaccinating children is actually quite different
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than, than vaccinating adults. And I personally think the choice for that absolutely, and I speak
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of young children, not teenagers when I make these comments, by the way, but, you know, the choice for
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that really, really needs to stay with the parents. And we really need to respect, you know, give them
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every element of information possible. But, but really, the parents are the ones that need to make
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that choice without a lot of guilt and pressure from other people.
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You know, it's funny you should say that because it brings to mind a comment that one of the members
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of the United Kingdom's JCVI, their, their committee on vaccination, I guess their version of, of Canada's
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NASI said, and the UK is not rolling out vaccines for, for children under 12. I think they make it
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available to children with medical conditions. And, and I guess if there's a real compelling reason to do
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it, they provide it, but they're not doing a mass vaccine campaign. And, and one of the doctors on that
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committee, the name escapes me, but he said something along the lines of, well, well, this is
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not a thing we typically do with kids. We vaccinate them for their own safety, but we don't vaccinate
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them solely or predominantly because of other people's safety. And I think he used something
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like a phrase, you know, that's not ethical in there. So what is it? Because UK is doing one thing,
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Yeah, well, and cultural differences in how this plays out. And, you know, one of the greatest concerns
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is both countries may very well say, as Canada certainly has said, and I suspect the UK has
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said, we're following the science. Well, you see, this erodes the, you know, the, the trust in
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science when you've got these really quite sophisticated nations with a lot of very intelligent
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and accomplished people that land in very different places with similar facts in front
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of them. So what it says to me is that the vaccination of children, we can call that a medical
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question and a medical certainty, but, but it's not really, it's, it's profoundly an ethical
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question. I don't know if I'd go as far as to call it unethical because so many of the facts
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aren't available. I think what would be unethical is to push people in a direction they don't want
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to go in on that one. So it takes us in very different directions because some people would say
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we are using children as a means to an end. So, so that's what makes it tough. But yeah, you know,
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it's, it's, it's been a tough haul in Canada and, you know, we, we've kind of dealt with this and
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what I think is sometimes a superficial way interviewing doctors that say, well, I, you know,
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I'm vaccinating my kids. I took them this morning that, well, that's fine. That's good. You know,
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and they have a right to say that, but that doesn't necessarily mean that that's ultimately the right
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thing to do. Those are their children. What about your own children?
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So when we talk about ethical considerations, we can talk about abstract things about,
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you know, is it right to incarcerate the unvaccinated, which as I said before, we'll
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get to that in a couple of minutes because it's quite an excitable conversation there. Those are
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kind of abstract ones where we can insert ourselves into the conversation, sort of, sort of public
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ethical talks. But there are, I guess also, and you referenced in your work, of course, you know,
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end of life care, those issues that arise, there are ethical considerations that the individual
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physician must make. And to what degree have doctors been confronting or avoiding their own
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ethical considerations that they are presumably tasked by their, just by sheer being in their
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profession to consider in these decisions they make? Because to your point, I think we've seen some
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people who have been rather flippant in their statements. Yeah, no, I know. And they have
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been. And, you know, I think it's very tough because there's obviously a highly elevated moral
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responsibility to being a physician and to many, not all, but many professions, absolutely. And the
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influence of these positions is enormous. So when doctors speak publicly, they're really influencing a
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lot of people. So if they take a, and it's rare, but we was in the news yesterday, you know, if they
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take a strong anti-vax position, that's not just their personal opinion, they're really, really
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influencing a lot of people. But many people in the field have had to consider what they say and what
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the influence on others will be as they say it. So, you know, I think people have to be very careful.
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I've tried very hard not to be really prescriptive with this is ethical, this is unethical. I mean,
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because a lot of these things are a matter of perspective. I actually think as an ethicist, I can
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be more useful by which I have attempted to do. We'll see how successful that is. I don't know. But
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what I've attempted to do in the pandemic is at least point out why so many of these things are of
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ethical importance and where the ethical tension lies. And I think when you look to bioethics, that's
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where bioethics can make a contribution, not just this is how to think, but this is why this matters
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ethically. You know, I'm going back yet again to the example of the children. I actually think,
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you know, passing that off as a no-brainer medical decision, I thought was really wrong. I think it's
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much more of an ethical one. And I don't think that got a lot of coverage.
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Well, if I can leave it open-ended to you in this next question, sort of give you the floor to say,
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what do you think are the prevailing, the predominant ethical considerations right now? Because I know
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there's tons of them out there, but what are the ones that I think should be discussed more or have
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been the main concerns? Yeah, I mean, the role of the state has become, you know, very, very powerful
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in recent, I can't say months anymore, because it depends. What can I say? Years is the right term,
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right? The role of the state has become much, much more powerful. And I think it's sort of slipped up on
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us. And I don't think we realize just how powerful it is in terms of determination, what people need
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to do and what people kind of have to do. And I think people have picked up on the fact that, yes,
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you know, we're all, you know, that we have obligations to each other. But, you know, whether
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the state is overstepping their authority or not, many people feel that they're beginning to.
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You know, there's a lot. Freedom of information. You know, we heard that the Public Health Agency
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of Canada is using our cell phone data for pandemic movement tracking. So on the surface of it, and,
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you know, it's anonymized and all those things, as we're told. And, you know, on the surface of it,
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that sounds to many people maybe, well, so what? That's no big deal. It's anonymized. First of all,
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I don't know enough about technology. There's been a lot of things that have been claimed to
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be anonymous that turn out actually not to be. So I don't know if that's a reality,
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but it certainly could be. But here's the thing. They didn't tell us, like, are you kidding?
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You know, so the question is one of transparency. Like, why did they not tell us earlier on in this
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pandemic that, or whenever it started, that we're going to be using this data and here's why,
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and at least have a public conversation about it. And so it's not just that they're using it,
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but the fact that they would, and, you know, I felt the responses in the interviews I saw were like,
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so what, right? Like, this is no big deal because it's anonymized. But, you know, and again, I don't
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really know enough about that. And it's not just that it's anonymous. That data is yours and mine. I
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mean, it's still not right to be using that without telling people. So the role of the state,
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I think, has very, very much expanded, including the lockdowns. And what I really worry about with
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the lockdowns is, including, you know, I'm in Ontario and we're potentially about to lift and
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we will see. But the proportionality element. So from a point of view of pandemic and virus,
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you know, we might as well stay the lockdown till May just to see how things are going.
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But, you know, the reality is, and that's, that would be wonderful from a viral control.
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But what doesn't get enough coverage is the fact that lockdowns kill. And I know I'm using a strong
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word, but they literally do. They gut people's lives. You know, there's an elevated suicide rate.
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God knows what they do to the socialization of young children that haven't been in school for
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long periods of time. The true effect on each of our lives, and even whether we struggle or don't
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struggle, I mean, all of our lives, is almost immeasurable. And what I worry about is the
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proportionality. You know, the epidemiologists, which I respect and I think are doing their jobs
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to the best of their ability, but boy, they have a whole lot more say than the rest of the country
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does in how these decisions are made. And I worry, and our politicians, they do care about, you know,
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and they know there's mental health issues and they know these things. But, you know,
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who speaks for that socially isolated person hanging on for a thread, tucked away in a little
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apartment as we enter year three? Those voices are really not heard. And so I wonder if we really
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do have a true balance with this. And that's what I wonder about. And I think, you know, it's tough.
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And then the justification sometimes is much like when a country goes to war. Well, ethics is great,
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but, you know, I mean, we're not at war. But when countries are at war, they would say, yeah,
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but we're at war or something like we've got a real emergency. What I would say to that, though,
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in a state of emergency, when is it more important to hang on to your core ethical values than in a
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crisis? That's really what's important. So there are people out there that say ethics, you know,
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we've kind of heard enough about that. We're in a crisis. We'll deal with that later. The goal is to
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simply get through this in any way we can. I also have a deep worry that we could be really,
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really changing the kind of moral fabric of our society, because especially as this pandemic drifts
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into the years, that we may never really get back to, you know, free and informed consent truly of
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the individual and that the role of the state may be greatly elevated because it's been sort of a slow
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burn and, you know, it creeped up upon us. We'll be back with more full comment
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00:19:39.720
Professor Bowman, let's pick up on what you're saying there, moral fabric of our society,
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because there's definitely been so much change, I guess, just to the way we live our lives,
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the way we think about our lives and our interactions with government, with our neighbors.
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We're being told where to stand in the grocery store. A lot of neighbors have called the police
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on other neighbors at times when they were believed to have had more than two people over
00:20:04.080
for dinner, whatever the rule was on that given month. Thankfully, that's behind us for the most
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part. But that stuff really happened. And I feel like that does kind of rewire the way you think
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about yourself in relation to your community. Yeah, I think it really, really does. And,
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you know, because we've been in a very, very difficult situation, I think we've given our
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leadership an awful lot of leeway in terms of making decisions in a crisis. And, you know,
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I think we might be coming towards the end of that. But what I really do worry about is,
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you know, if this ends, and it's probably going to end slowly. And I mean, who knows? I don't know,
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and neither does anyone else exactly what our endpoint is going to be. But that we will be a
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society that, you know, really didn't notice the slow creep of invasions to our privacy,
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and how much, you know, how much our governments can kind of take over. You look at Quebec,
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you know, proposing a taxation on the unvaccinated. Now, my guess is it was a ruse,
00:21:03.660
because we've heard nothing more about it. But, you know, these are powerful, powerful forces. And
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I do worry that it will change the very way we see things. Also, you know, the kind of war on the
00:21:18.560
unvaccinated has been really, really poisonous. You know, you could just about go after the
00:21:25.720
unvaccinated with a lynch mob, and you'd have support for that. Like, it and you know, the us and
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them element of it. Earlier in the pandemic, we're all in this together, you know, people singing
00:21:36.000
opera from the balconies. I mean, I think if anyone sang opera from the balconies, now they'd have,
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you know, rotten fruit thrown at them or something. People are not in the mood anymore. But,
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but, you know, we've come a long, long way from that. And that's really, really shifted. And,
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you know, the role of the state now, I think they've really encouraged an us and them kind of thing,
00:21:56.440
it became very politicized. And human nature being what it is, us and them, are you kidding?
00:22:02.080
I mean, we're, we're primates, look at how we're wired. You do not want to feed that beast. And I
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think they were really wrong to turn on the unvaccinated. I support vaccination fully, I do
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think there's a moral obligation to be vaccinated. But that's, that's me, I can't speak for the rest of
00:22:18.880
the country and how people see these things. And, and, you know, I also think the unvaccinated did not
00:22:24.720
cause, oh, I know the unvaccinated did not cause this pandemic. And, and I worry, Anthony, that
00:22:30.880
there's a big distraction here with these vaccine wars. And that distraction is the greatest threat
00:22:36.500
to all of us as Canadians is without question, the global pandemic, which we are doing next to
00:22:44.280
nothing about. And, you know, the, and I think in the years ahead, when the books are written on this
00:22:50.060
and the deep dive is done, this is what will be highlighted, how we really ignored the big
00:22:55.480
picture. We have a nationalistic government, well, I shouldn't say nationalistic, but they are when it
00:23:00.600
comes to the pandemic. Yes, we've got COVAX and on paper, Canada's a marvel, but we're not actually
00:23:05.600
doing it when you look at the numbers. And, you know, what I also blame, I know this is a harsh thing
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to say, but I blame a lot of people that are actively doing pandemic commentary, because whenever it
00:23:17.560
rarely comes up and when it does, they say, no, it's not either or we'll do both, but we're not doing
00:23:21.920
both. We do very little with COVAX. And it's not just COVAX. It's also the infrastructure that goes
00:23:27.820
with COVAX, etc. So I do global work myself. And, you know, I've been in Yemen twice in the last few
00:23:35.280
months, and they had a vaccination rate of 0.5. And I didn't say five, I said 0.5%. You know,
00:23:42.780
And that's first dose. You're not talking about the booster. No, I'm talking first dose. You had
00:23:48.160
healthcare workers that had not, you know, had any protection. I saw people that were essentially
00:23:53.780
suffocating from being unable to breathe. And it was almost certainly secondary to COVID. And, you
00:24:00.900
know, we've done nothing on that front. And you don't need me to tell you or anybody listening,
00:24:04.800
we know how this works. You know, this also becomes just a factory for creating new variants
00:24:11.920
that can come back at us. And so when we endlessly agonize over the unvaccinated, you know, and we're
00:24:18.780
close to 90%. If someone had told us a year ago, that we'd reached that people would have fallen off
00:24:24.680
their chairs, really. So I'm not saying we shouldn't focus on it. I think we should. But we also don't
00:24:30.360
know within that 10% who these people really are. The assumption is they're rabbit hotheads. But not all
00:24:37.000
of them are. We don't really understand it. No, absolutely. And, you know, it's interesting
00:24:42.500
talking about being in Yemen just the past few months. And I contrast that with there's been a
00:24:46.820
lot of criticism of what's called the laptop class. Now, I definitely know of people who to this day,
00:24:52.720
they are probably triple vaccinated. They are investing in increasingly elaborate masks. And
00:24:58.300
they have concerns that it is not safe for them to be at the grocery store, to be at a restaurant.
00:25:03.320
Here you are telling an anecdote about how you've been traveling back and forth to a country with that
00:25:07.760
pretty much has no vaccinations available. Presumably, you went by plane, you weren't, you know, on a raft
00:25:12.960
six feet apart from any other person. So it's interesting, these different personal choices that
00:25:18.860
people are making and to what degree, for a certain period of time, we were supposed to celebrate
00:25:25.420
this staying at home culture as the right choice, noble or what have you. But to what degree is that
00:25:32.220
focus, that hyper focus on the triple vaccinated mass person's own safety, getting in the way of a
00:25:39.620
more broader ethical consideration of getting our communities going or to your point, helping out
00:25:43.840
the world? Yeah, no, I think, you know, in my opinion, I, this is my opinion. So a lot of people
00:25:50.580
don't agree with me on this. But I actually think Canada is probably one of the most risk avoidance
00:25:54.640
societies in the entire world. And I've spent a lot of time outside of Canada.
00:25:58.480
The stats being that true, longest lockdowns, really almost in the world.
00:26:03.120
Yeah, you know, and you see children with helmets on and triple life jackets, and you know, they're in
00:26:09.240
a kayak that's in 18 inches of water, you know, like, you know, you got to protect children, I get
00:26:14.360
it. But we go to extremes in this country. And I think we lose sight of the bigger picture. And,
00:26:20.440
you know, and yeah, and you know, you know, my own trip to Yemen, I mean, one could argue,
00:26:24.740
I'm, you know, I'm creating risk all round. But you know, I'm double and triple, I'm triple
00:26:30.460
vaxxed. And then, you know, multiple testing before going before entering, retesting before
00:26:35.180
entering, you know, I certainly I was I was there for work reasons. But it I struggle because I'm
00:26:42.220
doing global work with with, you know, do I sit in my, you know, my living room and kitchen? Or do I
00:26:49.200
get out and do this work? I have been going out in between the the official don't travel kinds of
00:26:55.260
things. But it's a tough one. It's a tough one. And but again, I draw your attention to the global
00:27:01.720
picture. And I am shocked. And you know, what I think is any boy, this is going to sound nasty. I
00:27:07.280
don't mean this to sound as nasty as it sounds. But a lot of our leadership, you know, public health
00:27:12.200
agency of Canada, etc. I mean, these are much more managers than visionaries. And in fairness to them,
00:27:18.980
I know that sounds awful. But in fairness to them, they weren't hired. And it's not their mandate to
00:27:25.680
be dealing with the planet Earth. It's their mandate to be dealing with the nation, or to be
00:27:29.980
dealing with the province or territory or municipal. So in fairness to them, they're doing their jobs to
00:27:34.920
the best of their ability. My point is no one, including our government and prime minister really
00:27:41.380
has their eye on the big picture. And what nation what nation is showing global leadership? It's not the
00:27:47.180
United States. I mean, pandemic global leadership. I don't see it. I don't see it.
00:27:52.580
Now, it's an interesting point. And we have heard though, from the WHO, from the United Nations,
00:27:56.180
particularly from UNICEF, really concerned about things that are happening. I mean, I'm really
00:28:00.920
concerned about the way children are being treated in Canada. I think it's over the top. And some of it
00:28:05.140
is pretty much abusive. But at the same time, I saw UNICEF report that kind of said, well, if you think
00:28:09.920
that's bad, the sort of, you know, forcing the three-year-olds in masks and whatnot, wait till
00:28:14.520
you get a load of, you know, the rise in child marriage that is going on because of the pandemic,
00:28:18.720
like crazy things that thankfully we don't really have happening here have been ballooning in other
00:28:23.680
countries around the world. Yeah, yeah. It's a huge one. And we have the WHO. And, you know,
00:28:29.640
they're good people doing a good job. But boy, we have underfinanced the WHO for so, so long.
00:28:36.460
And, you know, the mandate they have is, you know, it's political. I don't know what the
00:28:41.840
answer is. So, you know, they don't allow Taiwan in. I mean, are you kidding? So their hands are
00:28:48.180
kind of tied. And then, you know, they were so aggressively attacked early in the pandemic
00:28:53.300
with their relationship to China that I think they lost so much credibility. I'm not sure all of that
00:28:58.340
was fair, by the way, that we just don't have global leadership on this. And we have a global crisis.
00:29:04.600
I want to go back to talking about the vilification of the unvaccinated a little bit,
00:29:09.080
because based on polling numbers, it seems that a lot of people wouldn't agree with you. Perhaps
00:29:14.700
the majority of people, I want to read to you some polling stats from Maru Public Opinion. I have it
00:29:20.120
open here. They conducted this just a few days ago, asking Canadians about different restrictions on
00:29:27.080
the unvaccinated. 61% of respondents support having people pay out of pocket for full medical costs
00:29:32.780
if they are admitted to hospital because of COVID-19. 61% monthly health care surcharge of
00:29:39.860
up to $150 per month. 37% say refuse to allow them access to any publicly funded hospital.
00:29:48.220
27% give the thumbs up to having them serve up to five days as part of a jail sentence. I've
00:29:53.280
got to say, no one's floating these ideas. So the pollster clearly just made these things up and
00:29:56.720
then that said, do you like it or do you not like it? But it shows that a certain amount of the mob
00:30:00.660
said, we like it. None of that, Anthony, surprises me. People love to hate. I mean,
00:30:07.240
we're feeding into the weakest, darkest, ugliest sides of ourselves. People love to hate. And also,
00:30:14.240
we have had, you know, our leaders have been feeding this to us as well. None of that surprises me. But,
00:30:21.320
you know, what I would say is, do we want a health care system that looks at the patient in front of us,
00:30:26.200
remembering that one day this may be you or me and makes determinations about whether we think you
00:30:31.780
had too many glasses of wine with dinner last night? We don't like your body weight. You know,
00:30:37.620
you smoke. Do we really want to, you know, move away from a medical determination of access to care
00:30:44.820
to sort of a social determination of access to care? And I think people would say something quite
00:30:49.940
different. Or I don't know if they would, but I think they probably would on that. That's what I worry
00:30:55.200
about. And when I speak of the shift in the social fabric, I feel our leadership may be really
00:31:00.760
feeding into this kind of thing. Because if we do, you know, if we eat, I think even a vaccination
00:31:05.920
tax is absolute folly. I think it's the beginning of sort of a movement towards making judgments about
00:31:13.680
patients. I also don't think, you know, it has to be effective. If you look at the potential vaccination
00:31:18.680
tax of Quebec, you know, Omicron wave is on top of us, if not cresting above us at this point,
00:31:25.440
or just slightly past, it'll be with us for a while. So if people, if you tax them tomorrow and
00:31:30.500
they got vaccinated next week, that's vaccination number one. Vaccination number three is six to nine
00:31:36.680
months away. So, you know, it doesn't even really hold up very well. And vaccination number one would
00:31:42.460
help, but it's, you know, you're really not there yet. So, you know, and I think politically
00:31:49.680
knowing, you know, the kind of numbers and polls you just wrote off, any wise politician is going
00:31:56.240
to be using this and they are. And it's not in any of our best interest.
00:32:01.740
I want to get your read on an idea, on a, I guess, a concept or a doctrine known as behavioral
00:32:08.320
sciences. I have an Ontario science table, a paper in front of me right now. It was published
00:32:13.360
April 22nd, 2021 behavioral science principles for enhancing adherence to public health measures.
00:32:21.260
And in my sort of layman's take, I'm increasingly seeing the phrase behavioral science to mean
00:32:26.100
the noble lie, to mean a little white lie, to mean sometimes just flat out lying to push people in one
00:32:33.340
direction or another. How do you approach the idea of behavioral sciences and particularly
00:32:38.180
how it's been rolled out throughout COVID? Well, it depends what they mean. And I'm not
00:32:42.200
sure what, can we come up with an example of how that would play out? I think it means the nudge,
00:32:47.340
right? Yeah. I mean, the original thing of being told, oh, masks don't work, silly. There's no
00:32:52.440
reason to wear masks. And why were they saying that? And then they later fessed up, well, there
00:32:55.960
weren't many of them and we wanted to keep them for healthcare workers. We didn't want there to be a
00:33:00.520
run on them from the general public. So I'm like, oh, okay, well, you know, I'm an adult. You can tell me
00:33:03.960
that. You don't need to tell me masks somehow don't work. And then suddenly three months later,
00:33:07.520
I find the cops are throwing you out of the store because you're not wearing one in the grocery
00:33:10.980
store. Yeah, no. And, you know, what I think is that transparency is really an ethical foundation
00:33:18.140
to a mature democratic society. And there's no question about that. And I don't think we've had
00:33:22.940
enough transparency with this pandemic. So that includes the behavioral science element. There's
00:33:28.160
something furtive about it, I find, or there can be, maybe not in every example, but we really haven't
00:33:34.480
had enough transparency in general. And that includes not just what decisions are made. You
00:33:40.440
see this provincially and you see it federally. It's not a question of just what decisions are
00:33:45.160
made. It's how did we make this decision? And, you know, so often in ethics, you've got two
00:33:51.220
freaking awful alternatives. This is the reality. And you see it working in hospitals. Both alternatives
00:33:57.360
are terrible. But ethics is which one are we going to pick and why, right? It's not. And we don't see
00:34:04.140
enough of that with our government because they've got lots of awful alternatives. None of them are
00:34:07.940
great. But we don't see enough of the balancing. And I do think there's been kind of a covert,
00:34:14.000
you know, how do we kind of, you know, manipulate people into things. And I think, you know, in a lot
00:34:18.920
of ways, a vax attack is at least a lot more transparent than these other things. Yeah, so we'll see.
00:34:25.600
You said something very interesting at the beginning of our conversation, how
00:34:29.300
many other people who are interested in medical ethics, bioethics, haven't really said much
00:34:35.800
the past two years. What's going on there? Yeah. So, you know, there's someone,
00:34:39.820
and the name escapes me right now, but she herself is a bioethicist and American at Harvard. And she's
00:34:46.540
writing a book on the failure of bioethics in the pandemic. I think it's so difficult and so
00:34:53.340
politically controversial that it's safer for people to not do it. I also think that a lot of
00:35:01.200
bioethicsists and my position with the hospitals is different. I'm not a full-time hospital employee.
00:35:06.760
I used to be, but I'm no longer. And I think if I was, I would not be able to speak as freely as I
00:35:11.700
have. And I think that is the reality is you've really got to be safe in terms of academic freedom.
00:35:17.660
I think bioethicsists working in the hospitals would have a very hard time speaking freely
00:35:22.220
at this point. But, you know, that's not a good reason. I mean, that means the profession's not
00:35:27.080
in good shape. Also, bioethics itself, I think, in recent years has become very procedural.
00:35:33.540
Policies, this and that, you know, as opposed to the deeper questions, I think it's become very
00:35:38.940
procedural. And I think it's risk. I made a decision early in the pandemic that I wanted to remain
00:35:44.240
independent. I didn't want to go on any government task force or provincial. I wanted to remain
00:35:49.540
independent. I'm thankful now that I did. But also, if I was on any of the government boards,
00:35:55.600
they would say I could speak freely, but I'm not sure I really could. And so I think that's part of
00:36:02.700
it. Well, let me ask you about the other part of ethical considerations in terms of physicians
00:36:07.920
potentially being compromised in that we know there's just there's a lot of cross appointments,
00:36:13.560
people. They do their teaching. They do their clinical work. And then they'll help out this
00:36:19.140
pharmaceutical company or that company with this or that trial. And it's a thing that's been
00:36:22.820
happening for decades. And it's usually disclosed. It's supposed to be disclosed. But there's just
00:36:27.680
there's so many interests going on, so much money flowing around. And look, I'm not resenting anyone
00:36:33.200
for getting bonus pay when it's totally earned for the stuff they've been doing. But you still look
00:36:38.220
at that whole framework and go, you know, how do I know I'm getting the 100% real story from this
00:36:43.660
person? Well, you may not be you may not be and I think in the pandemic, we've really stopped. And
00:36:51.820
you're right, it has come a long way. By the way, the hospitals, the research institutes, the rules are
00:36:56.720
a whole lot better. And the reporting is a whole lot better than than some years ago. But it's still
00:37:01.320
it's still very, very problematic. You know, when when we look to a lot of things, I mean,
00:37:09.360
unfortunately, at times, we're doing science through press releases. If you look at the Pfizer
00:37:13.640
medication that was released a week ago, look, I have no reason at all to believe that it is not as
00:37:19.980
effective as people say that, you know, everything I've seen, it looks like it absolutely is. And it
00:37:24.920
may be a lifesaver. But, you know, please remember, it's coming from Pfizer, right? You don't even have
00:37:29.980
an independent study yet. So pre pandemic, you know, we probably wouldn't have put up with this.
00:37:35.640
And that's one of the things I worry about as well is science through press releases is a very
00:37:41.060
dangerous thing. So are we doing that? And I think our kind of I hate the word, but our surveillance of
00:37:47.420
these things has really slipped as well during the pandemic. So I turn I turn my thoughts again to
00:37:53.460
to sort of an erosion in in kind of the moral fabric, which is potential.
00:37:59.240
Well, speaking of the sort of press release language, we certainly started hearing early on these mantras
00:38:05.260
around what we've heard mantras about everything, but around vaccines safe and effective, safe and
00:38:08.720
effective, take the first one offered to you, the best vaccine is the first one offered to you. And
00:38:12.880
and this was Justin Trudeau was tweeting this out, but also supposedly unaffiliated doctors on
00:38:18.380
television were just we're just saying this. Now, I take the point that if you're on a four minute
00:38:22.380
television segment, you don't get time to talk at great length about the details of clinical trials,
00:38:27.020
but you saw basically talking points. It seemed like political slogans. And then suddenly you find
00:38:32.060
out that Health Canada says, well, I don't people under 30 shouldn't really take Moderna. We're going
00:38:36.320
to try and make sure they take Pfizer because apparently those talking points weren't, you know,
00:38:40.300
100 percent perfect when they were saying them. Yeah, yeah, I know. And I think what's happened with
00:38:45.560
physicians is talking points is what people want. And I, you know, I know there's some radicals out
00:38:51.740
there. But what I would say, one of the things that scares me in this pandemic is, is if someone did
00:38:57.180
have evidence based or observational, but, you know, in need of further research, concerns or
00:39:05.380
evidence based concerns about safety. It's very risky, you know, in a lot of ways, there's such a
00:39:13.420
force against any kind of questioning of anything that I that does worry me to some extent, I don't think
00:39:20.640
anything's being buried. I've looked at the data a lot of times, to the best of my ability, right?
00:39:25.120
I'm not an epidemiologist or a virologist, but, you know, I've been in hospitals most of my life,
00:39:29.780
I know how to read medical reports. But, you know, I think things are are what people are saying they
00:39:35.220
are. And there's a lot we don't know. But people have said there's a lot we don't know. But we do
00:39:40.000
have a culture that I worry could have elements of intolerance that could catch up with us at some
00:39:45.380
point. That's interesting saying people want the talking points, though. There's that old phrase,
00:39:49.720
you get the democracy you deserve, you get the government you deserve. Are we here in Canada?
00:39:54.120
I know we've acknowledged that we've pretty much been one of the most restricted when all is said
00:39:58.000
and done jurisdictions in the world, and in some cases, particularly Ontario, particularly Quebec.
00:40:03.420
Can it be said that we get the lockdowns we deserve? We get the COVID rules we deserve?
00:40:10.260
I don't know. I mean, I think Canadians are going to put up with a lot of stuff that other cultures may
00:40:14.760
not put up with. You know, the Americans sometimes laugh at us, you know, in terms of what we're
00:40:19.480
willing to put up with. But again, there's a different culture with that. I'm surprised people
00:40:24.580
have been as patient as they have been. I mean, I'm not saying all the decisions made have been
00:40:28.780
awful. And I do think Omicron is a game changer. We're just not out of it yet to see which way it's
00:40:33.720
going to change. But you know, I worry that if we don't sort of loosen up a bit towards the end of
00:40:39.600
the Omicron wave, you know, there may be another wave coming. And I hate to say this, but we all know it
00:40:44.900
could be worse. And in which case, we really have to have the public on board for further
00:40:49.620
interventions. And so that's why I think the Omicron wave has to be handled judiciously at
00:40:54.880
this point. So I think we've put up with a lot as Canadians. But my observation is I see
00:41:00.960
psychologically, I see it in my students, I see it in people around me, people are at the end of
00:41:06.940
their rope, people that cope well, are really, really reaching a wall. You know, the, you know,
00:41:14.080
I'm in Ontario, it's the dead, well, it's the dead of winter throughout the country. But I'm in
00:41:17.780
Ontario, the winter is deepening, it's very restrictive in terms of weather, there's a
00:41:22.840
lockdown, it's awful. And this is the third year in, I mean, how much more can people take?
00:41:29.340
How much more can they take? Professor Kerry Bowman, this has been a fascinating conversation.
00:41:36.940
Full Comment is a post media podcast. I'm Anthony Fury. This episode was produced by
00:41:43.120
Andre Proulx, with theme music by Bryce Hall. Kevin Libin is the executive producer. You
00:41:48.340
can subscribe to Full Comment on Apple Podcasts, Google, Spotify and Amazon Music. You can listen
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