Moral, self-interested, and social motivation each predict compliance with social distancing rules: utilitarianism is an indirect positive predictor.

BACKGROUND: Social distancing rules have proven to be essential in reducing the spread of COVID-19. However, we can optimise these rules if we identify factors which predict compliance. Thus, in this study we investigated whether compliance with distancing rules is predicted by whether an individual is motivated by moral, self-interested, or social reasons. We also investigated the impact of an individual's utilitarian orientation both on compliance itself and on reasons for compliance. METHODS: Our sample consisted of 301 participants recruited from four US states - California, Oregon, Mississippi, and Alabama - who completed an anonymous online survey. Six vignettes describing hypothetical social distancing rules were developed for the study. Participants indicated (i) how likely they were to violate each hypothetical distancing rule, (ii) how morally wrong violating each rule would be, (iii) how much risk of contracting COVID-19 they would tolerate in order to violate each rule, and (iv) how much social condemnation they would tolerate in order to violate each rule. Based on these responses, we gauged each participant's overall degree of compliance with social distancing rules as well as the extent to which each participant's compliance is motivated by moral, self-interested, and social reasons. We also measured other variables that could affect compliance including personality, level of religiosity, and inclination to engage in utilitarian reasoning. Multiple regression and exploratory structural equation modelling were used to determine predictors of compliance with social distancing rules. RESULTS: We found that moral, self-interested, and social motivation each positively predicted compliance, with self-interested motivation being the strongest predictor. Furthermore, utilitarian orientation indirectly predicted compliance, with moral, self-interested, and social motivation as positive mediating factors. No controlled covariates (personality factors, religiosity, political orientation, or other background variables) predicted compliance. CONCLUSION: These findings have implications not only for the design of social distancing rules but also for efforts to ensure vaccine uptake. Governments need to consider how to harness moral, self-interested, and social motivation to promote compliance, perhaps by co-opting utilitarian reasoning, which positively influences these motivational forces.

Contextualizing sacrificial dilemmas within Covid-19 for the study of moral judgment.

"Sacrificial dilemmas" are the scenarios typically used to study moral judgment and human morality. However, these dilemmas have been criticized regarding their lack of ecological validity. The COVID-19 pandemic offers a relevant context to further examine individuals' moral judgment and choice of action with more realistic sacrificial dilemmas. Using this context, the purpose of the present study is to investigate how moral responses are influenced by the contextualization of the dilemma (i.e., contextualized or not within the Covid-19 pandemic). By comparing two versions of one dilemma, Experiment 1 revealed that the more realistic version (the one contextualized within the Covid-19 pandemic) did not elicit more utilitarian responses than the less realistic version (the one not contextualized within the Covid-19 pandemic). In Experiment 2, we examined more specifically whether both the perceived realism of the dilemma and the plausibility of a utilitarian action influence moral responses. Results confirmed that the contextualization of the dilemma does not make any difference in moral responses. However, the plausibility of an action appears to exert an influence on the choice of action. Indeed, participants were more inclined to choose the utilitarian action in the plausible action versions than in the implausible action versions of the dilemma. Overall, these results shed light on the importance for future research of using mundane and dramatic realistic dilemmas displaying full information regarding a sacrificial action and its consequences.

Mitigating and managing COVID-19 conspiratorial beliefs.

BACKGROUND/AIM: Belief in COVID-19 related conspiracy theories is a widespread and consequential problem that healthcare leaders need to confront. In this article, we draw on insights from social psychology and organisational behaviour to offer evidence-based advice that healthcare leaders can use to reduce the spread of conspiratorial beliefs and ameliorate their negative effects, both during the current pandemic and beyond. CONCLUSION: Leaders can effectively combat conspiratorial beliefs by intervening early and bolstering people's sense of control. Leaders can also address some of the problematic behaviours that result from conspiratorial beliefs by introducing incentives and mandates (e.g., vaccine mandates). However, because of the limitations of incentives and mandates, we suggest that leaders complement these techniques with interventions that leverage the power of social norms and increase people's connections to others.

Systemising triage: COVID-19 guidelines and their underlying theories of distributive justice.

The COVID-19 pandemic has been overwhelming public health-care systems around the world. With demand exceeding the availability of medical resources in several regions, hospitals have been forced to invoke triage. To ensure that this difficult task proceeds in a fair and organised manner, governments scrambled experts to draft triage guidelines under enormous time pressure. Although there are similarities between the documents, they vary considerably in how much weight their respective authors place on the different criteria that they propose. Since most of the recommendations do not come with ethical justifications, analysing them requires that one traces back these criteria to their underlying theories of distributive justice. In the literature, COVID-19 triage has been portrayed as a value conflict solely between utilitarian and egalitarian elements. While these two accounts are indeed the main antipodes, I shall show that in fact all four classic theories of distributive justice are involved: utilitarianism, egalitarianism, libertarianism, and communitarianism. Detecting these in the documents and classifying the suggested criteria accordingly enables one to understand the balancing between the different approaches to distributive justice-which is crucial for both managing the current pandemic and in preparation for the next global health crisis.

[COVID-19 pandemic: the "trolley problem" to explain allocation of scarce resources]. / Pandémie de COVID-19 : le « dilemme du tramway ¼ pour expliquer l'allocation des ressources rares.

INTRODUCTION: The SARS-CoV-2 virus that appeared in December 2019 in the city of Wuhan in China spread rapidly. Severe forms of this virus infection cause acute respiratory distress syndromes (ARDS) requiring hospitalization of affected patients in intensive care units (IUCs), providing mechanical ventilation. The capacity of ICUs in the countries most affected by this health crisis quickly became overwhelmed, forcing healthcare providers to choose the patients who would benefit from care. Managing the overload of a healthcare system is the role of disaster medicine, for which one of the principles is the triage of patients according to their severity. Having to choose between patients means choosing a statement between deontology (judging the morality of an action according to its intention) and utilitarianism (judging the morality of an action by its consequences). AIM: The aims of this article are, through the analysis of the trolley problem, to understand and justify the process of allocation of scarce resources found in the guidelines used in the context of the COVID-19 pandemic. RESULTS: The analysis of the trolley problem allows us to understand in what way our choices are utilitarian or deontological. Saving as many lives as possible", as advocated in the guidelines, is utilitarian. CONCLUSIONS: These answers will provide a better understanding of all of the different ways of allocating scare resources according to the deontological or utilitarian approach, especially the one found in the disaster medicine guidelines.

Triage in Times of COVID-19: A Moral Dilemma.

We present evidence from choice experiments on hypothetical triage decisions in a pandemic. Respondents have to decide who out of two patients gets ventilation. Patients are described in terms of attributes such as short-term survival chance, long-term life expectancy, and their current ventilation status. Attributes are derived from the ethical discourse among experts regarding triage guidelines during the COVID-19 pandemic and differ in the extent to which they are salient from a utilitarian or deontological perspective. Empirically, we find that although nonexperts agree with experts in prioritizing utilitarian attributes in triage decisions, nonexperts also consider the adherence to the norm of wearing face masks as particularly relevant. Furthermore, our study supports Greene and colleagues' dual-process model of moral judgment; we find that utilitarian attributes are more decisive for respondents with a greater inclination toward utilitarianism and for respondents with a greater tendency toward reflection.

Using moral foundations in government communication to reduce vaccine hesitancy.

Having a vaccine available does not necessarily imply that it will be used. Indeed, uptake rates for existing vaccines against infectious diseases have been fluctuating in recent years. Literature suggests that vaccine hesitancy may be grounded in deeply rooted intuitions or values, which can be modelled using Moral Foundations Theory (MFT). We examine the respective prominence of the MFT dimensions in government communication regarding childhood vaccinations and explore its effect on parents' vaccine hesitancy. We measure the MFT dimension loading of the vaccination information brochures from the Dutch National Institute for Public Health and the Environment (RIVM) between 2011-2019 and connect this information with the electronic national immunisation register to investigate if the use of moral foundations in government communication has a measurable effect on vaccination uptake. We find the largest positive effect for the dimensions Authority/Subversion and Liberty/Oppression and suggestive evidence in favour of a small positive effect for Purity/Degradation. Conversely, Loyalty/Betrayal actually has a negative effect on vaccination rates. For the dimension Harm/Care, we find no significant effect. While Purity/Degradation and Harm/Care appear to be the two most frequently used moral foundations by RIVM, these dimensions have in fact no or only a minor effect on parents' vaccine hesitancy. Reducing the use of these moral foundations may be the first step towards optimising government communication in this context. Instead, formulations activating the moral foundations Authority/Subversion and Liberty/Oppression appear to have positive effects on vaccination uptake.

Reduced utilitarian willingness to violate personal rights during the COVID-19 pandemic.

The COVID-19 pandemic poses many real-world moral dilemmas, which can pit the needs and rights of the many against the needs and rights of the few. We investigated moral judgments in the context of the contemporary global crisis among older adults, who are at greatest personal risk from the pandemic. We hypothesized that during this pandemic, individuals would give fewer utilitarian responses to hypothetical dilemmas, accompanied by higher levels of confidence and emotion elicitation. Our pre-registered analysis (https://osf.io/g2wtp) involved two waves of data collection, before (2014) and during (2020) the COVID-19 pandemic, regarding three categories of moral dilemmas (personal rights, agent-centered permissions, and special obligations). While utilitarian responses considered across all categories of dilemma did not differ, participants during the 2020 wave gave fewer utilitarian responses to dilemmas involving personal rights; that is, they were less willing to violate the personal rights of others to produce the best overall outcomes.

Surgery during COVID-19 crisis conditions: can we protect our ethical integrity against the odds?

COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.

Deontological or Utilitarian? An Eternal Ethical Dilemma in Outbreak.

Both deontological ethics and utilitarian ethics are important theories that affect decision making in medical and health care. However, it has been challenging to reach a balance between these two ethical theories. When there is a conflict between these two ethical principles in the medical context, the conflict must be addressed in order to reach an appropriate solution for patients and others involved. To demonstrate decisions made in terms of deontological ethics and utilitarian ethics, the study will use the film Outbreak as example to further understand these two ethics in relation to epidemiology and public health. The paper will also analyze film scenarios to examine how deontological ethics and utilitarian ethics are involved and strike a balance with different pearspectives to reach an appropriate public health solution. To reach more just solutions, it is essential to determine how to make wise decisions by balancing deontological ethics and utilitarian ethics. However, the decision-making process is complicated because any solution must consider not only medical ethics but also political, environmental, and military issues. In order to reach an appropriate public health decision, those involved should be inclined toward empathy and contemplate things from different ethical perspectives to deal with ethical/moral dilemmas and create greater beneficence and justice for patients and humanity at large.

Ruthless Utilitarianism? COVID-19 State Triage Protocols May Subject Patients to Racial Discrimination and Providers to Legal Liability.

As the coronavirus pandemic intensified, many communities in the United States experienced shortages of ventilators, intensive care beds, and other medical supplies and treatments. Currently, there is no single national response to provide guidance on allocation of scarce health care resources. Accordingly, states have formulated various "triage protocols" to prioritize those who will receive care and those who may not have the same access to health care services when the population demand exceeds the supply. Triage protocols address general concepts of "fairness" under accepted medical ethics rules and the consensus is that limited medical resources "should be allocated to do the greatest good for the greatest number of people."1 The actual utility of this utilitarian ethics approach is questionable, however, leaving many questions about what is "fair" unanswered. Saving as many people as possible during a health care crisis is a laudable goal but not at the expense of ignoring patients's legal rights, which are not suspended during the crisis. This Article examines the triage protocols from six states to determine whose rights are being recognized and whose rights are being denied, answering the pivotal question: If there is potential for disparate impact of facially neutral state triage protocols against Black Americans and other ethnic groups, is this legally actionable discrimination? This may be a case of first impression for the courts to resolve."[B]lack Americans are 3.5 times more likely to die of COVID-19 than [W]hite Americans … . Latinx people are almost twice as likely to die of the disease, compared with [W]hite people." 2 "Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism … . HHS is committed to leaving no one behind during an emergency, and this guidance is designed to help health care providers meet that goal." - Roger Severino, Office of Civil Rights Director, U.S. Department of Health and Human Services. 3.

Trolleys, triage and Covid-19: the role of psychological realism in sacrificial dilemmas.

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people's moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did not stem from period change in moral attitudes relative to pre-pandemic levels-but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas-and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people's robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas.

COVID-19. Effect of Moral Messages to Persuade the Population to Stay at Home in Spain, Chile, and Colombia.

Analyze whether the content of three moral messages (deontological, ethical utilitarianism, ethical virtue) and a control message differentially affect the probability of engaging in four behaviors: Washing their hands, participating in public gatherings, staying at home/avoiding social contact, and forwarding the message to inform more people. In our study, the sender of the message is a university professor. These variables are measured in terms of their behavioral intentions and others' behavioral intentions (beliefs about others' behavior). Randomized Controlled Trial. Our study includes the analysis of the possible moderating effect of the country of residence (Spain n = 1,122, Chile n = 1,107, and Colombia n = 1,433). The message with content referring to ethical virtue and staying at home obtains statistically significant lower scores on the probability of carrying out public health behaviors and sharing the message received. Regarding beliefs about the behavior of others, the message of ethical virtue has the same negative effect, but only on the likelihood of other people washing their hands, staying at home, and sharing the public health message. Institutional messages aimed at promoting public health behaviors are necessary in a pandemic situation. Our recommendation is to use deontological and utilitarian, or non-moral, content.

Moral uncertainty: A case study of Covid-19.

BACKGROUND: Most writing about uncertainty in healthcare has addressed empirical uncertainty - that is, resulting from insufficient or conflicting facts. OBJECTIVE: To consider moral uncertainty by exploring how different theories apply to a single clinical case. METHOD: In this philosophical reflection, I briefly acknowledge empirical uncertainty before introducing and exploring the topic of moral uncertainty - defined as the question of what to do when we do not know what (morally) to do-using a case study of my own mother's deterioration and death from Covid-19. RESULTS: I identify and apply a number of philosophical theories relevant to managing moral uncertainty, including utilitarianism, deontology, practical rationality and feminist philosophy. CONCLUSION: Different moral theories lead to different conclusions about the best course of action in situations of moral uncertainty. PRACTICE IMPLICATIONS: Detailed analysis and close reading of a single case can provide insights into how to act in morally complex situations, but learning is in the form of enriched understanding, not formulaic rules.

Moral dilemmas and trust in leaders during a global health crisis.

Trust in leaders is central to citizen compliance with public policies. One potential determinant of trust is how leaders resolve conflicts between utilitarian and non-utilitarian ethical principles in moral dilemmas. Past research suggests that utilitarian responses to dilemmas can both erode and enhance trust in leaders: sacrificing some people to save many others ('instrumental harm') reduces trust, while maximizing the welfare of everyone equally ('impartial beneficence') may increase trust. In a multi-site experiment spanning 22 countries on six continents, participants (N = 23,929) completed self-report (N = 17,591) and behavioural (N = 12,638) measures of trust in leaders who endorsed utilitarian or non-utilitarian principles in dilemmas concerning the COVID-19 pandemic. Across both the self-report and behavioural measures, endorsement of instrumental harm decreased trust, while endorsement of impartial beneficence increased trust. These results show how support for different ethical principles can impact trust in leaders, and inform effective public communication during times of global crisis. PROTOCOL REGISTRATION STATEMENT: The Stage 1 protocol for this Registered Report was accepted in principle on 13 November 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.13247315.v1 .

Journalistic ethics and Covid-19: an analysis of deontological codes / Ética periodística y Covid-19: análisis de contenido de los códigos deontológicos / Ética jornalística e Covid-19: análise de conteúdo de códigos deontológicos

Esta investigación realiza un análisis de contenido de 103 códigos de ética periodística de todo el mundo para comprobar su adaptación a las circunstancias derivadas de la pandemia Covid-1٩. A partir de siete recomendaciones formuladas por la Ethical Journalism Network (EJN), se analiza su presencia o ausencia en los códigos. Los resultados muestran una presencia desigual de los principios y diferencias importantes entre los códigos. Ninguno de ellos comprende las siete recomendaciones y solo uno asume seis de ellas. Por el contrario, 17 códigos contienen únicamente una recomendación y dos de ellos no recogen ninguna. Se concluye que las recomendaciones de la EJN más presentes en los códigos se relacionan con principios muy asentados en la ética periodística que dependen habitualmente de la fecha de actualización. Se propone incorporar secciones específicas sobre salud a los códigos. (AU)

This article presents the results of a content analysis of 103 journalistic codes of ethics throughout the world conducted to test the adaptation of these codes to Covid-19 pandemic. Based on seven recommendations formulated by the Ethical Journalism Network (EJN), we analyze the presence or absence of each principle. The findings show an uneven presence of the principles and important differences across the codes. None of the codes cover the seven recommendations and just one addressed six of them. In contrast, 17 codes contain only one recommendation and two do not contain any. The EJN recommendations that are most present in the codes address well-established principles in journalistic ethics. The year of the latest update of the code is also a determining factor. Specific sections on health should be incorporated into the codes. (AU)

Esse artigo desenvolve uma análise de conteúdo de 103 códigos jornalísticos de ética em todo o mundo para testar sua adaptação às circunstâncias da Covid-19. Com base nas sete recomendações formuladas pela Ethical Journalism Network (EJN), analisa a presença ou ausência de cada princípio. Os resultados mostram uma presença desigual de princípios e importantes diferenças entre os códigos. Nenhum deles entende as sete recomendações e apenas uma assume seis delas. Em contraste, 17 códigos contêm apenas uma recomendação e dois deles não contêm nenhum. Conclui-se que as recomendações da EJN mais presentes nos códigos dizem respeito a princípios muito estabelecidos na ética jornalística. O ano da última atualização do código também se torna um fator determinante. Propõe-se incorporar seções específicas de saúde nos códigos. (AU)

Ethics of selective restriction of liberty in a pandemic.

Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation-that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option-fails to adequately accommodate the complexity of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options.