It would be inconsistent to criticize now public authorities which, if only as a precautionary measure, could have included the possibility of a major health crisis in their forecasts. Apparently nothing prepared us for Covid-19 because no one believed in it. We learn a lot from these moments of suffering, concern, but also commitment and self-sacrifice. If there was initially an urgency to act, the importance now is to involve citizens in the deliberations of the future, to develop a pedagogy of shared responsibility. The acceptability of supervised and progressive exit measures from the acute phase of the crisis cannot be envisaged without creating the conditions for a public debate, in a form to be defined as soon as possible.
Involving citizens in deliberationsWhat has been missing in recent weeks is a real consideration of the expertise on the ground, of those realities "on the front line" that aspired more to be taken seriously in what they testified, than to benefit from obligatory tributes. It is obvious that, as regards the political choices that will determine our social life at least in the coming months, the requirement of democratisation of arbitration will condition their admissibility. We will not be able to accept measures imposed for an indefinite period of time, based on expert opinions that do not take into account ideas, experiences and expectations, but also legitimate needs, concerns, obstacles and reservations. Obviously, what has been missing in recent weeks is a genuine consideration of the realities on the ground, of those realities "on the front line" which aspired more to be taken seriously in what they testified to than to benefit from obligatory tributes.
The logic of the triage needs to be discussed.The "degraded practices" imposed the logic of triage on so many levels of decision making, without the choices even being made according to explicit rules.Threats of contamination and the constraints of containment do not prevent us from critically analysing what has been decided, too often not faulty, in order to prevent unpreparedness. So many relegated spaces in our society have experienced the unacceptable: institutions for people with disabilities, social precariousness, psychiatric hospitals or places of detention. Never before have the most isolated and homeless people experienced such exile.
The "degraded practices" imposed the logic of triage on so many levels of decision making, without the choices even being made according to explicit rules.
While the resuscitator is accustomed to deciding whether or not to initiate resuscitation based on scientific evidence, this is not the case when lack of available beds or equipment may compel the resuscitator not to resuscitate a person who could have been saved under normal circumstances. In a pandemic situation, is it not appropriate to publicly discuss acceptable criteria for prioritizing our social priorities? What about respect for the dignity, integrity and privacy of the individual if we expect, for reasons considered superior to his or her fundamental rights?
Discuss containment exit conditionsDoubts are already being expressed as to what the appropriateness and acceptability of containment release devices would be if they were only administrative rules.At the beginning of the crisis, procedures were enacted by the administrative authorities without finding the time to accompany them with a minimum of consultation, limiting information to a few recommendations and access to the resources essential for their implementation.
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Wanting to be prescriptive in everything, according to binding standards set in a state of emergency, these bodies have taken on the responsibility of taking on, in all and for all, arbitrations that are at once novel, complex and uncertain. As a result, they could only expose themselves directly to certain misgivings, if only because of the inadequacy between certain measures enacted and the practical conditions of their applicability.
Peremptory assertions, and not only about the preventive use of masks, have been challenged on the basis of their random, conjunctural and evolutionary justifications. Public credibility has been profoundly affected. Doubts are already being expressed as to what would be the justification and acceptability of the containment release devices if they were merely administrative rules decided in the name of a competence or expertise that would not be justified and would not be open to discussion.
The public authorities have every right to implement a coherent and proactive policy to combat this pandemic, but faced with the unknown and threats that can only be countered by working together as a society, they must understand that we must work together to mobilise.
Finally trusting the expertise in the fieldLet us trust in the experience, expertise and agility of professionals, members of associations, our intermediary bodies, as well as our collective intelligence!Even in a crisis situation, consultation is therefore essential in the arbitration of decisions. Arbitrary measures should not be justified by a lack of time, while the responsibility for the lack of anticipation cannot be laid at the door of those who suffer the heaviest consequences. Let us put our trust in the experience, expertise and agility of professionals, members of associations, our intermediary bodies, as well as in our collective intelligence!
In 2006, I had proposed a "Etats Généraux" devoted to preparations for H1N1, in order to raise society's awareness of public health issues and to involve it in a debate on prioritizing choices in extreme situations. While it is essential to be sure that decisions are made according to transparent, fair and loyal rules, we still need to determine, in the context of public consultation, the principles to be used in the decisions and the control bodies that will guarantee them. In 2020, I renew this request.
State officials have made a commitment not to leave anyone by the wayside, which is understandably more perilous for those who are most affected by the human and social consequences of Covid-19. They will have to live up to their commitments. We must think together, support and accompany the political decisions which will impose constraints that everyone will have to share.
I am proud of the strength of our democracy in confronting the human and social aspects of the pandemic. Our nation is revealing itself in these circumstances, which in a way expose it, unveil what it is made of. We are all the more astonished to discover what the recent social crises might have led us to doubt. We are a society. Our cohesion is expressed and strengthened through a number of responsible initiatives, acts of solidarity and expressions of concern for the most vulnerable among us.
Decide together what to do next
It is as democrats that we must live through this time of pandemic, assume our responsibilities and reflect on what our society will be like afterwards.
If there are lessons to be learned, they will engage us collectively. Everything possible must be done to ensure that Covid-19 does not contaminate our democratic life, when, on the contrary, it should sharpen its significance.
That is why the other urgent need is to envisage national consultation, particularly on the means of escaping from confinement, on the use of tests and the conditions for their implementation, on measures to support situations that expose people to social and economic vulnerability, and on the anticipation of the measures that are essential for the prevention of a future epidemic episode or any other health crisis.
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Overcoming Covid-19 and rebuilding our social model will only be possible if the principle of trust is at the heart of public action. Everyone must be recognised in their capacity to contribute to the arbitration of collective choices for which they will have to assume responsibility in their commitments. Consultation will be all the more intense and contributive because many of us are eager to share our thoughts, to go even further in their solidarity initiatives, and to contribute as democrats to the common good.
Emmanuel Hirsch, Professor of Medical Ethics, Faculty of Medicine - President of the Council for Research Ethics and Scientific Integrity of the University of Paris-Saclay
Director of the Ethics Area of the Île-de-France Region