May 8, 2022

The role of scientific experts in making public policy has rarely been as controversial as it has been during the COVID-19 pandemic. From the first public health containment strategies to the development and rollout of the vaccines, governmental authorities have claimed to rely on the “science,” citing an array of scientists and physicians, most of whom were used to working in relative anonymity. Those experts—with Dr. Anthony Fauci as the prime example—have been alternately praised and vilified in a public discourse driven more by politics than science.

This Article focuses on the pandemic-related work of bioethicists, another category of once-anonymous experts who were suddenly thrust into the public eye. In early 2020, with COVID-19 cases overwhelming health care systems around the world, a raging debate erupted about the triage of patients and the rationing of care and equipment. Bioethicists were often drawn into this debate, sometimes by making real-time policy recommendations, and in other cases by influencing policy through background work. Both their specific recommendations and their longstanding operating principles came under attack from interested advocates and the general media.

This Article tracks the role of bioethics in shaping, first, triage and care-rationing policies and, later, the allocation of initially scarce vaccines. These Authors conclude that, viewed from the perspective of early 2022, bioethics has had little practical impact on the public health response to the COVID-19 pandemic. Early rationing strategies drew heavily on bioethics, but the recommended strategies were rarely—if ever—used. When this bioethics influence was discovered by various public constituencies, the response was overwhelmingly negative—and correct, in these Authors’ view. During the early vaccine rollout, strategies (and results) were tied much more closely to local politics than any principles of bioethics. This Article’s ultimate argument is that policy decisions in public health emergencies should be political, in the sense of made by democratically accountable officials who consult experts only for basic medical information.

Authors: John Conley & Arlene Davis


Volume 23, Issue 4