What is the work of ethics in response both to the pandemic itself and to what anti-public health protests have shown to be the fragility of the legitimacy of medicine as a rationality of intervention based on scientific expertise? Three vignettes of moments in the pandemic, as I’ve experienced it in Alberta, Canada, lead to four realizations about where we are and the problems of moving on.

In the early days soon after we knew the virus was airborne, I was walking on a pathway near my home. Prominent signs advised walkers to maintain distance from each other. A group of boys who had been spending too much time indoors veered back and forth across the path, passing way too close to me. The adult who was with them smiled apologetically and said, “He doesn’t get the concept.” For humans, unlike viruses, everything depends on mens rea. No intent to harm, no fault, hence no harm done. Little did I know then how difficult the concept of a pandemic would be, for how many people.

Responses to COVID-19 lead me to reread W.H. Auden’s “Musée des Beaux Arts” (1940), which begins with the line that the Old Masters were never wrong about suffering; they knew “its human position.” In Breughel’s painting, Icarus falls from the sky, his wings melted by flying too close to the sun. Icarus occupies one human position, seeing whatever he can on his way downward. Auden’s greater interest is in the other humans whom the painting shows: a farmer goes about plowing his field, a dog scratches, a ship sails on. “How everything turns away,” Auden writes; while a boy falls from the sky, everyone else “has somewhere to get to.” The concept of disaster eludes them, especially what Icarus’s fall might show about their own human position.

The pandemic stopped people from getting to the somewhere they would otherwise have gone to; it locked them down. People didn’t like that. Ironically, protests took the form of creating more blockages to movement. A convoy of trucks blocked the central core of Ottawa for weeks. South of where I live, another convoy barricaded a major United States/Canadian border crossing. Hospitals were picketed; medical workers were advised not to wear uniforms on public transit, lest they be attacked. Credible threats continue to be made against the lives of the provincial Chief Medical Officer and her federal counterpart. Vaccination rates showed that most Albertans disagreed with these protests. And yet, as I write this report in September 2022, support for anti-public health protests was a prominent feature in the successful campaign of the recently elected leader of the federal Conservatives, the official parliamentary opposition.

What were the truck convoys protesting? A second vignette is a scene in a grocery store where I shop. A customer and an employee are talking. As I pass by, one of them objects to wearing a mask, opposing that to her “freedom.” The other, on cue, nods vigorously in agreement. I suppress a sociological urge to do some ad hoc interviewing and move as far away as I can get. They do have a concept, freedom, but to me it’s as distorted as the truckers responding to lockdowns by creating blockades of their own.

What does such “freedom” mean? My occasion to interview comes later. Near where I passed the child whose non-grasp of the concept apparently renders them outside viral contagion, I’m on a footpath where cycling is prohibited to protect a fragile area. A fellow rides by on his bike. At some personal risk, I point out the signs clearly showing no cycling. His response is to tell me that he was cycling here “long before the signs.” The history of modernity passes before my eyes, allowing me provisional sympathy with him. I see sixteenth century enclosure acts forcing people off what had been public grazing land, taking away what they had assumed to be their right. Even the privileged experienced an increasingly centralized state encroaching on their assumed entitlements. It’s so human to say, “but I used to be able to …”

My third vignette is of a concert last week, live streamed from Wrigley Field in Chicago; a massive gathering of people. Late in the show the singer talks about how much he and the band appreciate getting back to performing live music; the crowd responds enthusiastically. Icarus falling from the sky is relegated to a one-off occurrence, encapsulated in time past. There is no intimation that the pandemic was predictable, no interest in recognizing that the conditions that made it predictable have not changed. Auden and Breughel would not be surprised: everything turns away. Canadians have turned away from their initial indignation at the death rate in care homes for the elderly and at the conditions that residents of those homes were found to be living, when the army had to replace staff wiped out by COVID. Urgency has gradually given way to resignation. Rebuilding and staffing homes on the scale required is unthinkable.

Journalists have more than reported; they have witnessed. A newspaper report quotes a physician here in Calgary who “has treated many patients who have yelled and sworn at him, maintaining their false belief that COVID-19 isn’t real.” Then these patients have to be put on a ventilator. “There’s this moment,” the doctor says, “You see it in their eyes.” Then, some ask to be vaccinated. “It’s heartbreaking,” he says (Weeks 2022).

What is the concept that we should be getting, as we connect the dots of these vignettes? I offer four recognitions that might initiate a bioethics for pandemic times. These are by no means a programme for doing bioethics; rather, they suggest the conditions that future programmes have to respond to.

First, pandemic ethics begins with the recognition that COVID-19 is a symptom of a far more extensive and potentially disastrous climate emergency. Among those who call for bioethics to put environmental issues in the foreground of its agenda, David Schenck and Larry Churchill describe the pandemic as a “clinic in the interconnectedness of ethical problems, as well as the intertwining of the fates of nations and species” (2021, 508). That calls on us to reimagine Breughel’s painting, where instead of the one person falling from the sky and the others feeling secure, the farmer, the dog, and the ship are all falling but they can’t yet feel it. Each goes on asserting their freedom to pursue their lives with its purposes.

Those purposes prominently involve calculated displaced destruction. Alberta’s prosperity is based on natural resource extraction, and although that sector has declined, it’s still central to both provincial self-image and GDP. Southern Alberta, where I and the oil executives live, remains insulated from the environmental effects; the massive, carcinogenic “tailing ponds” that are a by-product of extraction are up north, out of sight. Alberta thus participates in the economy of modernity that has always depended on resource extraction, whether those resources were silver or slaves, coal, or oil. The work of doing that extraction has always been hard, dirty, and often hazardous, and that difficulty and risk allowed people to feel they earned what they took. That sense of earning made it easier to cast a blind eye to the effects of those extractions on humans, their communities, and the earth itself. Modernity, while dependent on economic connectivity, has been a clinic in the denial of ethical interconnectedness in favour of seeing the fates of individuals, corporations, and nations as, in the preferred word of the moment, free.

Second, if getting the concept of a pandemic requires understanding it within a context of environmental crisis, the current organization of healthcare works against that understanding. In monetized healthcare, the clinic—contrary to Schenck and Churchill’s vision of interconnectedness—becomes the site of multiple disconnections. The health of each patient is disconnected into discrete body parts that are tested, examined, and intervened upon one at a time; individual health is disconnected from community health; and human species health is disconnected from environmental health. Patients take medications without awareness of the threatened ecosystems that produced the substances from which those drugs were synthesized.

The health-industrial complex depends on obscuring the interconnectedness that Schenck and Churchill want to focus awareness on. Thus when public health comes along and requires people’s awareness of their place in a collectivity, the response is that it’s an individual decision whether or not to comply: freedom as a slogan has its basis in a way of thinking that the organization of healthcare has reinforced. Responding to a pandemic as a responsible member of a collectivity and acting on behalf of others is not a concept that has resonance in people’s experience of healthcare.

Third, the pandemic occurs within a political context where language has been weaponized, to use journalists’ useful word. Freedom is the core example, but we can include words like justice and autonomy. The now antiquated ideal of ethical principles was that such words signified commonly held values; appealing to them would win people over. COVID-19 has crystallized how such words divide, as groups understand differently what principles call upon them to do. Justice to some means inclusion; to others, it legitimates exclusion in defence of a “way of life” that the group claims is threatened. Autonomy is understood as the right to divorce personal choice from any responsibility to collective interest. Not only principles but facts, including mortality rates, are either differently interpreted or else disregarded as another example of “fake news.” Language, instead of being a medium for reaching consensus, has become the currency of division.

Fourth, ethics interventions are difficult to imagine without agreement to participate in consultations that can tolerate disagreement because participants share rules of accountability to what constitutes a compelling argument. People have to agree to offer reasons for feeling as they do, and they have to agree to the possibility of being persuaded by others’ reasons. The social commentator Adam Gopnik offers a succinct summary of why this agreement no longer applies: “Searching for the source of anti-vaccine sentiment, one realizes that here, too, the search for rational argument is in vain, because having a rational argument would undermine the force of the anti-vax belief rather than assist it. The belief is an irrational affirmation of a mystical idea of autonomy” (Gopnik 2022, O1)

Too many people experience any demand for rational argument as an assault on identities that depend on group membership, and membership is affirmed by immediate response to slogans: no masks, no vaccinations, and freedom to say no to anything. All I see around me supports Gopnik’s conclusion that “self-interest is a much less reliable guide to human behaviour than identity and religious conviction.” Public health situates self-interest within community interest: it once seemed self-evident that in a situation of contagion, the interest of each was the interest of all. That self-evidence is gone. Neither the best epidemiological data nor the most traditionally accepted Enlightenment principles can appeal to those already committed.

How not to yield to despair? If perspective is part of the problem—each group locked within a perspective that views other groups as competitors at best and as enemies at worst—taking a different temporal perspective offers some refuge. Plagues and even extinctions have happened before; life survives, not as it did previously, but in forms those survivors can value. I imagine, a century from now, expanding equatorial regions that climate change makes inaccessible to humans. There, life will emerge in new shapes; what emerges may not be what I consider pretty, but my criteria won’t apply. On the fringes of those regions, in zones of human habitability, the children of those who survived the brutal struggles to occupy those zones will create new ways to live together.

We, collectively, may be Icarus falling, having flown too high, but how Auden’s Old Masters understood suffering is only part of a larger picture. I juxtapose it to the vision of the future presented 2500 years ago by Lao Tzu (2000) at the end of the Tao Te Ching: “Let the nations grow smaller and smaller and people fewer and fewer,” he wrote. “Let people knot ropes for notation again and never need anything more.” Humanity has come an immense distance since that was written, but now may be when Lao Tzu’s vision no longer seems regressive but brings hope. The footpath I described earlier, where no cycling is allowed, rings land where not that long ago there was a derelict farm house that had fallen into ill use by people with questionable purposes. The city tore it down and then, having no landscaping budget, left the ground to do what it will. Today, trees taller than I am fill in the area, which is dense with life. New beginnings find a way.