Full Comment - The ethical failures in Canada’s pandemic response

00:00:00.000 Hi, I'm Anthony Fury. Thanks for joining us for the latest episode of Full Comet.

00:00:07.920 Let's talk about COVID-19 and bioethics, the ethical considerations of lockdowns,

00:00:13.920 vaccine mandates, and so much more. It seems like whenever the issue is raised,

00:00:18.500 it's hastily brushed aside. Well, not today. Today, we're going to do a deep dive on the topic

00:00:23.020 with our guest, Professor Kerry Bowman, who teaches bioethics and global health at University

00:00:28.360 of Toronto. Hey, Kerry, welcome to the show. Happy to be here, Anthony. Yeah, great to have

00:00:33.700 you on. And it must have been a really interesting past, I guess, almost two years for someone in

00:00:39.760 your line of work focusing on issues of bioethics. It really has been, you know, and throughout my

00:00:46.920 career, and I'm well into my career in bioethics, you know, I've never seen so much ethical

00:00:53.720 material, so to speak, as I've seen with this pandemic. It's quite amazing to see. Mind you,

00:01:03.160 I'm going to say this. I would also say that there's been a fair amount of silence from many

00:01:08.000 people within the bioethics community. I would have thought people would be even more vocal than

00:01:12.660 they have been, but I just see a profusion of ethical questions as I look around me throughout

00:01:17.980 this pandemic. Well, just to sort of start us off with some underlying principles, bioethics. I mean,

00:01:23.720 people have a good working sense of what the definition ethics means. What does bioethics

00:01:28.280 mean? What is a bioethical consideration? Yeah, no, and that's a totally fair question. And,

00:01:32.540 you know, and there's many people that don't fully grasp it through no fault of their own.

00:01:36.740 So, you know, bio, of course, from biological. And so bioethics is really the application of ethics,

00:01:42.720 primarily, but not exclusively, within the medical slash healthcare setting, and increasingly with

00:01:48.780 with medical technologies that interface with those things like, you know, like medicine and

00:01:53.860 health and well-being. So it's the direct application of those things, right? So, you know,

00:02:00.240 within my life, I have worked and continue to work within many teaching hospitals. So I'm not,

00:02:06.720 yes, I'm a university professor and have been for a while, but a lot of my working life actually has

00:02:12.760 been bedside working within intensive care units, issues of end of life decision making, issues of

00:02:19.600 policies related to all kinds of things, increasingly emerging technology, consent and capacity, brain

00:02:25.560 death. So really think of it as the application of this. And then who are we, you know, to do these

00:02:32.620 unbelievable and strange jobs, right? Who are we? Some of us are philosophers. A lot of us aren't.

00:02:39.160 You know, I actually have a PhD in bioethics from the University of Toronto, from the Faculty of

00:02:45.800 Medicine, quite interdisciplinary. And then before that, I personally was a medical social worker.

00:02:51.920 Other people might be psychologists that become bioethicists, lawyers that become bioethicists,

00:02:56.800 occasionally physicians. So this is why a lot of the public, you know, struggle with grasping this

00:03:04.680 profession. I don't really blame them if they struggle with grasping it, because in a lot of ways,

00:03:09.000 it's much more diffuse than other professions. And I guess a really multifaceted issue. I mean,

00:03:14.140 in the way you're saying it, lawyers or people who are, in your case, the social workers, I mean,

00:03:19.540 you can come at it from so many different angles. Yeah, that's exactly right. And that, of course,

00:03:24.400 obviously informs enormously how a bioethicist is going to see their job, the world, the cases before

00:03:31.780 them. So there's a lot of range there. We did an episode, a few episodes back with

00:03:36.840 Anne Kavoukian, who's previously Ontario's privacy commissioner, very big in the world of privacy.

00:03:42.380 And very early on in our conversation, we kind of established that, yes, there are the big ticket

00:03:46.720 questions of COVID and privacy, but really like everything that's been happening the past almost

00:03:52.160 two years does have a privacy consideration to it. And when I was thinking about having our

00:03:57.400 discussion today, I thought, well, yes, there's the big ticket questions of, is it right to penalize or

00:04:02.800 even one poll, which I'm sure we'll talk about in a bit, incarcerate people who are not being

00:04:06.520 vaccinated? I mean, that's kind of the obvious questions, but kind of going back and peeling

00:04:10.700 back the onion, there's ethical considerations to almost everything we've done. Is it fair to say

00:04:15.700 that? No, I think it is fair to say that. And, you know, ethics is proportional. So that's been a

00:04:21.640 great challenge with this, you know, with this pandemic is we're going to have, you know, lockdowns,

00:04:28.840 let's say, well, let's look at the proportion. What's the harm? What's the benefit? And, you know,

00:04:33.900 we tend to look at this from a viral point of view. Of course, lockdowns are a brilliant idea when it

00:04:38.900 comes to containing a virus. But boy, the social determinants of health, you know, are very complex.

00:04:44.780 And how much lockdowns kill too, right? So that's very, very tough. And Anne is exactly right. I mean,

00:04:51.420 the privacy issues have just been enormous. And I actually think a lot of them have been, I didn't hear

00:04:57.820 that interview. But I know, Anne, and I think a lot of them have been actually ignored to a large

00:05:03.940 extent. And, you know, there's so much going on with the pandemic. But generally, we're a society

00:05:11.380 as North American society is, meaning just Canada and the US, that enormously values the concept of

00:05:18.360 autonomy, you know, the free choice of the individual. And it's never been without limits.

00:05:23.740 Of course, there's always been, you know, limits to that. But when you look at the entire world,

00:05:29.720 and you look at which societies really, really honed down on the concept of autonomy, it's first

00:05:35.440 the United States, and really, secondly, Canada, even Western Europe, the concept of autonomy within

00:05:40.420 healthcare plays out very differently. Physicians tend to have much, much more determination in what

00:05:46.260 they see as futile, and you know, what they see as best interest. Whereas within Canadian society,

00:05:52.240 autonomy has been very powerful. And here's the thing, what's been really difficult with this

00:05:57.420 pandemic is, you know, have we got the right model? Because so much of what we've been facing is what

00:06:03.420 is our responsibility to other people. And with this pandemic, you know, this is, you know, the moral

00:06:10.180 equation is really much more about interdependence than independence with this. And so then the question

00:06:16.780 becomes, you know, have we got, you know, the right stuff to be dealing with this? Do we have to

00:06:21.420 really change our ethical foundation to approach this? So very, very challenging questions are

00:06:26.760 emerging. Well, I remember from my U of T ethics class in philosophy, not, not, not the bioethics

00:06:32.480 classes you teach, the notion of using people as a means to an end, as opposed to an end in and of

00:06:40.120 themselves. And it's interesting when you talk about autonomy and how so much of what we've done has

00:06:45.160 been, you know, the number of times you've been told, yeah, I know you're, you know, you're in your

00:06:47.840 late thirties, you got two vaccines. I mean, this isn't about you. Everything's fine, but you've got

00:06:51.380 to do this. You got to do that. Your child has to lose their schooling X, Y, Z, because this thing

00:06:56.280 may happen to someone else in the abstract. I mean, that seems to me, like I said, I was just taking a

00:07:03.400 first year, second year class. We were talking about those sort of dynamics. That seems almost a

00:07:06.820 hallmark of an ethical consideration. Yeah, it very much is. And, you know, what's challenging with

00:07:14.140 you need to do this for other people is, you know, how strong is a scientific foundation that

00:07:18.180 we're building upon? And, you know, it's there, but, you know, science has been emerging throughout

00:07:22.740 this pandemic. And, you know, if you look at something like that, so if you look at the

00:07:27.120 vaccination of children as one example, which we're now, you know, in the midst of within this

00:07:31.680 country. So we do know that children, and I'm just building on what you've said, you know, that

00:07:36.580 the children do not get nearly as ill with COVID. They can, but they rarely get as ill with COVID

00:07:42.900 as other people would get. Yet we have this massive national vaccination campaign. And, you

00:07:48.900 know, one of the stronger justifications for vaccinating children is for kind of the population

00:07:53.460 of health of everyone else, right? So, you know, the question then becomes from an ethical point of

00:07:59.260 view, are we using our own children as a means to an end? And, you know, within society, usually we

00:08:05.760 make massive sacrifices to protect the children as opposed to, and I'm not saying it's necessarily a bad

00:08:12.300 decision. But the, you know, the ethical decision of vaccinating children is actually quite different

00:08:17.620 than, than vaccinating adults. And I personally think the choice for that absolutely, and I speak

00:08:23.540 of young children, not teenagers when I make these comments, by the way, but, you know, the choice for

00:08:28.240 that really, really needs to stay with the parents. And we really need to respect, you know, give them

00:08:33.900 every element of information possible. But, but really, the parents are the ones that need to make

00:08:40.200 that choice without a lot of guilt and pressure from other people.

00:08:44.340 You know, it's funny you should say that because it brings to mind a comment that one of the members

00:08:47.540 of the United Kingdom's JCVI, their, their committee on vaccination, I guess their version of, of Canada's

00:08:53.000 NASI said, and the UK is not rolling out vaccines for, for children under 12. I think they make it 0.97

00:08:59.880 available to children with medical conditions. And, and I guess if there's a real compelling reason to do

00:09:05.360 it, they provide it, but they're not doing a mass vaccine campaign. And, and one of the doctors on that

00:09:09.280 committee, the name escapes me, but he said something along the lines of, well, well, this is

00:09:12.980 not a thing we typically do with kids. We vaccinate them for their own safety, but we don't vaccinate

00:09:18.340 them solely or predominantly because of other people's safety. And I think he used something

00:09:23.080 like a phrase, you know, that's not ethical in there. So what is it? Because UK is doing one thing,

00:09:28.180 Canada is doing the opposite.

00:09:30.380 Yeah, well, and cultural differences in how this plays out. And, you know, one of the greatest concerns

00:09:34.840 is both countries may very well say, as Canada certainly has said, and I suspect the UK has

00:09:40.120 said, we're following the science. Well, you see, this erodes the, you know, the, the trust in

00:09:46.920 science when you've got these really quite sophisticated nations with a lot of very intelligent

00:09:51.920 and accomplished people that land in very different places with similar facts in front

00:09:56.980 of them. So what it says to me is that the vaccination of children, we can call that a medical

00:10:03.540 question and a medical certainty, but, but it's not really, it's, it's profoundly an ethical

00:10:09.200 question. I don't know if I'd go as far as to call it unethical because so many of the facts

00:10:14.840 aren't available. I think what would be unethical is to push people in a direction they don't want

00:10:20.100 to go in on that one. So it takes us in very different directions because some people would say

00:10:26.820 we are using children as a means to an end. So, so that's what makes it tough. But yeah, you know,

00:10:32.320 it's, it's, it's been a tough haul in Canada and, you know, we, we've kind of dealt with this and

00:10:38.120 what I think is sometimes a superficial way interviewing doctors that say, well, I, you know,

00:10:42.360 I'm vaccinating my kids. I took them this morning that, well, that's fine. That's good. You know,

00:10:47.000 and they have a right to say that, but that doesn't necessarily mean that that's ultimately the right

00:10:53.500 thing to do. Those are their children. What about your own children?

00:10:56.320 So when we talk about ethical considerations, we can talk about abstract things about,

00:11:02.060 you know, is it right to incarcerate the unvaccinated, which as I said before, we'll 1.00

00:11:06.380 get to that in a couple of minutes because it's quite an excitable conversation there. Those are

00:11:11.240 kind of abstract ones where we can insert ourselves into the conversation, sort of, sort of public

00:11:16.040 ethical talks. But there are, I guess also, and you referenced in your work, of course, you know,

00:11:21.700 end of life care, those issues that arise, there are ethical considerations that the individual

00:11:26.100 physician must make. And to what degree have doctors been confronting or avoiding their own

00:11:35.080 ethical considerations that they are presumably tasked by their, just by sheer being in their

00:11:41.940 profession to consider in these decisions they make? Because to your point, I think we've seen some

00:11:45.800 people who have been rather flippant in their statements. Yeah, no, I know. And they have

00:11:51.480 been. And, you know, I think it's very tough because there's obviously a highly elevated moral

00:11:59.000 responsibility to being a physician and to many, not all, but many professions, absolutely. And the

00:12:05.380 influence of these positions is enormous. So when doctors speak publicly, they're really influencing a

00:12:12.000 lot of people. So if they take a, and it's rare, but we was in the news yesterday, you know, if they

00:12:16.680 take a strong anti-vax position, that's not just their personal opinion, they're really, really

00:12:22.720 influencing a lot of people. But many people in the field have had to consider what they say and what

00:12:28.780 the influence on others will be as they say it. So, you know, I think people have to be very careful.

00:12:34.440 I've tried very hard not to be really prescriptive with this is ethical, this is unethical. I mean,

00:12:39.680 because a lot of these things are a matter of perspective. I actually think as an ethicist, I can

00:12:45.840 be more useful by which I have attempted to do. We'll see how successful that is. I don't know. But

00:12:52.300 what I've attempted to do in the pandemic is at least point out why so many of these things are of

00:12:56.980 ethical importance and where the ethical tension lies. And I think when you look to bioethics, that's

00:13:02.780 where bioethics can make a contribution, not just this is how to think, but this is why this matters

00:13:09.080 ethically. You know, I'm going back yet again to the example of the children. I actually think,

00:13:14.680 you know, passing that off as a no-brainer medical decision, I thought was really wrong. I think it's

00:13:20.560 much more of an ethical one. And I don't think that got a lot of coverage.

00:13:24.980 Well, if I can leave it open-ended to you in this next question, sort of give you the floor to say,

00:13:28.680 what do you think are the prevailing, the predominant ethical considerations right now? Because I know

00:13:33.580 there's tons of them out there, but what are the ones that I think should be discussed more or have

00:13:39.320 been the main concerns? Yeah, I mean, the role of the state has become, you know, very, very powerful

00:13:45.700 in recent, I can't say months anymore, because it depends. What can I say? Years is the right term,

00:13:52.520 right? The role of the state has become much, much more powerful. And I think it's sort of slipped up on

00:13:58.660 us. And I don't think we realize just how powerful it is in terms of determination, what people need

00:14:04.260 to do and what people kind of have to do. And I think people have picked up on the fact that, yes,

00:14:12.100 you know, we're all, you know, that we have obligations to each other. But, you know, whether

00:14:16.460 the state is overstepping their authority or not, many people feel that they're beginning to.

00:14:22.040 You know, there's a lot. Freedom of information. You know, we heard that the Public Health Agency

00:14:30.840 of Canada is using our cell phone data for pandemic movement tracking. So on the surface of it, and,

00:14:38.320 you know, it's anonymized and all those things, as we're told. And, you know, on the surface of it,

00:14:43.780 that sounds to many people maybe, well, so what? That's no big deal. It's anonymized. First of all,

00:14:49.180 I don't know enough about technology. There's been a lot of things that have been claimed to

00:14:53.380 be anonymous that turn out actually not to be. So I don't know if that's a reality,

00:14:57.980 but it certainly could be. But here's the thing. They didn't tell us, like, are you kidding?

00:15:03.720 You know, so the question is one of transparency. Like, why did they not tell us earlier on in this

00:15:09.540 pandemic that, or whenever it started, that we're going to be using this data and here's why,

00:15:15.620 and at least have a public conversation about it. And so it's not just that they're using it,

00:15:20.520 but the fact that they would, and, you know, I felt the responses in the interviews I saw were like,

00:15:25.660 so what, right? Like, this is no big deal because it's anonymized. But, you know, and again, I don't

00:15:32.520 really know enough about that. And it's not just that it's anonymous. That data is yours and mine. I

00:15:37.280 mean, it's still not right to be using that without telling people. So the role of the state,

00:15:43.460 I think, has very, very much expanded, including the lockdowns. And what I really worry about with

00:15:49.260 the lockdowns is, including, you know, I'm in Ontario and we're potentially about to lift and

00:15:55.060 we will see. But the proportionality element. So from a point of view of pandemic and virus,

00:16:01.880 you know, we might as well stay the lockdown till May just to see how things are going.

00:16:05.660 But, you know, the reality is, and that's, that would be wonderful from a viral control.

00:16:11.080 But what doesn't get enough coverage is the fact that lockdowns kill. And I know I'm using a strong

00:16:17.500 word, but they literally do. They gut people's lives. You know, there's an elevated suicide rate.

00:16:24.360 God knows what they do to the socialization of young children that haven't been in school for

00:16:28.940 long periods of time. The true effect on each of our lives, and even whether we struggle or don't

00:16:35.440 struggle, I mean, all of our lives, is almost immeasurable. And what I worry about is the

00:16:41.220 proportionality. You know, the epidemiologists, which I respect and I think are doing their jobs

00:16:47.140 to the best of their ability, but boy, they have a whole lot more say than the rest of the country

00:16:51.940 does in how these decisions are made. And I worry, and our politicians, they do care about, you know,

00:16:57.720 and they know there's mental health issues and they know these things. But, you know,

00:17:01.380 who speaks for that socially isolated person hanging on for a thread, tucked away in a little

00:17:07.040 apartment as we enter year three? Those voices are really not heard. And so I wonder if we really

00:17:13.920 do have a true balance with this. And that's what I wonder about. And I think, you know, it's tough.

00:17:22.800 And then the justification sometimes is much like when a country goes to war. Well, ethics is great,

00:17:27.900 but, you know, I mean, we're not at war. But when countries are at war, they would say, yeah,

00:17:31.620 but we're at war or something like we've got a real emergency. What I would say to that, though,

00:17:36.820 in a state of emergency, when is it more important to hang on to your core ethical values than in a

00:17:43.720 crisis? That's really what's important. So there are people out there that say ethics, you know,

00:17:49.080 we've kind of heard enough about that. We're in a crisis. We'll deal with that later. The goal is to

00:17:53.200 simply get through this in any way we can. I also have a deep worry that we could be really,

00:17:59.200 really changing the kind of moral fabric of our society, because especially as this pandemic drifts

00:18:05.340 into the years, that we may never really get back to, you know, free and informed consent truly of

00:18:12.000 the individual and that the role of the state may be greatly elevated because it's been sort of a slow

00:18:17.420 burn and, you know, it creeped up upon us. We'll be back with more full comment

00:18:22.820 after these short messages.

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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,

00:19:43.840 because there's definitely been so much change, I guess, just to the way we live our lives,

00:19:48.100 the way we think about our lives and our interactions with government, with our neighbors.

00:19:53.160 We're being told where to stand in the grocery store. A lot of neighbors have called the police

00:19:59.960 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

00:20:07.500 part. But that stuff really happened. And I feel like that does kind of rewire the way you think

00:20:12.260 about yourself in relation to your community. Yeah, I think it really, really does. And,

00:20:17.680 you know, because we've been in a very, very difficult situation, I think we've given our

00:20:22.420 leadership an awful lot of leeway in terms of making decisions in a crisis. And, you know,

00:20:28.320 I think we might be coming towards the end of that. But what I really do worry about is,

00:20:34.700 you know, if this ends, and it's probably going to end slowly. And I mean, who knows? I don't know,

00:20:41.900 and neither does anyone else exactly what our endpoint is going to be. But that we will be a

00:20:46.560 society that, you know, really didn't notice the slow creep of invasions to our privacy,

00:20:51.900 and how much, you know, how much our governments can kind of take over. You look at Quebec,

00:20:58.300 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

00:21:11.420 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

00:21:31.300 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,

00:21:41.220 you know, rotten fruit thrown at them or something. People are not in the mood anymore. But,

00:21:45.980 but, you know, we've come a long, long way from that. And that's really, really shifted. And,

00:21:50.720 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

00:22:07.900 think they were really wrong to turn on the unvaccinated. I support vaccination fully, I do

00:22:13.200 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 1.00

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

00:23:11.820 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.

00:41:33.880 Thank you so much for joining us.

00:41:35.720 Thank you, Anthony.

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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00:41:57.960 and by telling your friends about us. Thanks for listening.

Full Comment - January 24, 2022

The ethical failures in Canada’s pandemic response

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