Theory at Work: Collaborating on Covid Ethics
Prof. Susan Wolf takes on a key public health role relating to resource allocation
When the World Health Organization declared sciences, litigating at a major firm, serving as associate for COVID-19 a global pandemic on March 11, 2020, major ethical and legal challenges became obvious. Cases were multiplying, hot spots were emerging with hospitals overwhelmed and personal protective equipment in short supply, and countries had begun restricting travel. As case counts climbed, concerns erupted over potential shortages of critical medical equipment, medications, space, and trained staff. The allocation questions were agonizing; if there were not enough ventilators, medications, or ICU beds, which patients should get priority?
Within two weeks, Susan Wolf and Debra DeBruin, both University of Minnesota professors and bioethics experts, had joined forces to develop and lead the Minnesota COVID Ethics Collaborative. Working with the Minnesota Department of Health (MDH), in partner- ship with the Minnesota Hospital Association, State Health Care Coordination Center, Minnesota Critical Care Working Group, and University, they convened a multidisciplinary group that grew to more than 70 people—clinicians, ethicists, lawyers, and public health experts from across the state who came together quickly and collegially, with a “sense of tremendous urgency” propelling them to fulfill a shared mission.
“You can’t do good ethics unless you have a solid grasp of what the real issues are,” Wolf says. “It’s been a crash course in ‘real time’ bioethics, in how you do public health ethics in the face of incomplete information, an evolving evidence base, and extremely high stakes. The issues we deal with are hybrid issues—scientific, biomedical, societal, ethical, and legal. They are that difficult, and that multifaceted.”
Over many months, MCEC developed multiple ethics frameworks that were vetted by the MDH Science Advisory Team, approved by MDH, and posted on its website. MCEC members created a framework for allocating supplies such as ventilators and treatments such as monoclonal antibody therapies. When the FDA authorized remdesivir for emergency use in 2020, they developed a distribution framework to guide allocation in the face of scarcity, subsequently adapting it as medical evidence and medication availability shifted. Another framework dealt with transitions between conventional, contingency, and crisis conditions in an emergency. “This is groundbreaking work that will be helpful beyond the COVID-19 pandemic,” Wolf says.
For Wolf, this was the natural culmination of a career spent bridging law, medicine, and bioethics. After studying how law approaches medicine and the life sciences, litigating at a major firm, serving as associate for law at a top U.S. bioethics think tank, and completing an ethics fellowship at Harvard, Wolf joined the University faculty in 1993; she holds both Law School and Medical School appointments. Her national service has included work for the National Institutes of Health; National Academies of Sciences, Engineering, and Medicine; and National Science Advisory Board on Biosecurity. All of this honed her skills and affinity for tackling the health and ethics issues that bombarded us when a novel coronavirus upended our world.
Wolf and DeBruin did not start from scratch. DeBruin had worked on two prior projects for MDH on pandemic ethics (focused on influenza) and crisis standards of care. “These public health challenges have a very long history,” Wolf notes, citing Minnesota’s past work on ethical, clinical, population, and legal issues as well as such federal legal precedents as Jacobson v. Massachusetts, the 1905 Supreme Court case that upheld state authority to mandate vaccination in a smallpox outbreak.
Yet, Wolf says, COVID-19 “caught many people off guard: the fact that it so rapidly became a pandemic; the sheer numbers in terms of morbidity, mortality, and now long-haul symptoms; the horrifying health disparities; and the need to protect public health while scrambling to understand a novel pathogen and new disease.” While co-leading MCEC, she also partnered with Professor Michael Osterholm at the University’s Center for Infectious Disease Research and Policy to offer webinars on “COVID Controversies” through the University-wide Consortium on Law and Values in Health, Environment & the Life Sciences, which she chairs. These events convened top national experts, reaching audiences around the world.
More work needs to be done. “What is striking about this pandemic is the range of approaches that different states have taken to issues like allocation,” Wolf says. Yet systematic comparisons are still scarce. “Research is needed to compare divergent approaches and determine which ones work best.”
Wolf continues to focus on issues at the intersection
of law, biomedicine, and bioethics, conducting federally funded research on genomics, bioengineering, and emerging neuroscience technologies. Her COVID-19 work is also ongoing, paving the way for responding to the next pandemic. Co-leading MCEC “has been a profound and lasting education in public health ethics in an emergency,” she says.
Cathy Madison is a Twin Cities-based freelance writer.