Prof. Fatima Alvarez-Castillo is the former Dean of University of the Philippines Manila, and a gender and equity specialist.
Before the COVID-19 pandemic, almost one fourth of Filipino families lived below the poverty line. Over half of Filipinos considered themselves food insecure. About 17 million lived in slums, many in shanties, in one small room where whole families sleep, eat and stay together.
The public health care system suffered from major inadequacies. Medical services and drugs were beyond the reach of millions. Before the pandemic, many died without being seen by a doctor. When the COVID-19 pandemic struck, the situation worsened considerably.
We were among the worst hit by the pandemic in the Southeast Asian region. About 10 million Filipinos lost their jobs. The number of unemployed and hungry soared.
The government decree to stay indoors was horrific for those living in shanties. Orders to social distance and isolate the sick were impossible under these conditions. Domestic violence increased victimizing mostly women and children. Hospitals turned away patients as they were already overflowing. Some patients died outside while waiting for a bed.
Stigma was suffered by those who had symptoms and also by their families. Hospital workers were attacked in communities for fear of carrying the disease. Hundreds of thousands hid their symptoms, afraid of stigma and job loss. While many eagerly waited for a vaccine, there was also widespread distrust. Misinformation and disinformation about the virus, the disease, the vaccines, was rampant through various platforms especially in social media.
Empathy, solidarity and care
Amidst this dismal situation, we learned of acts of empathy, solidarity and care. As the government appeared incapable of effectively responding to the pandemic, people organised donation drives for health care workers. Cash, hot breakfasts, rice and grocery items were distributed by anonymous donors to poor households. Volunteers ferried health care workers and construction workers to and from work, free of charge. Professionals volunteered psychological services.
These are only a few of the many examples of acts of empathy and solidarity which are key elements in the ethics of care.
Ethics of care is an ethical theory that views empathy, care and compassion as moral values, equal to the ‘logical’ rules and rationalities in historical moral theories. It is a feminist approach to ethics that challenges the Western cultural views that these values are ‘lesser than’, as they are associated with femininity and womanhood.
A key tenet in the ethics of care is that caring is a universal human attribute basic to humans. It is a response to a perceived need. The carer considers the viewpoint of the cared-for and formulates a response that provides the best opportunities to help them. Context is important to avoid slipping into abstraction.
The moral imperative in the ethics of care goes beyond legal responsibilities. It urges us to act even where it may be uncomfortable to do so. Acting morally means more than the passive idea of “do no harm”. Doing the right thing means acting to make the world a better place for those who have been excluded and marginalized. The ethics of care is a relational ethics, a framework that includes many non-Western ethical approaches such as Chinese Confucian ethics and the African ethics of Ubuntu.
In social science research, the ethics of care has great potential.
COVID-19 Social science research in the Philippines
In 2021, the Filipino government funded social science research whose findings would be used to encourage public participation in the government’s COVID-19 vaccination programme. This involved surveying households in local communities. Although the study was approved by an accredited research ethics committee and complied with ethical requirements, I identified two main challenges.
Firstly, the reliability of the study. In the community with the highest number of positive cases, there was a much higher refusal rate to participate in the study compared to the two communities with lower number of cases. At the same time, of those taking part in the study, only 2% admitted having been exposed to a person with a COVID-19 infection and only 2.2% answered that they experienced signs and symptoms of COVID 19. There is reason to doubt the truthfulness of this data given the high infection rates. If one had a traumatic experience with COVID-19 — as many had — being directly asked in a survey about the illness could trigger distress.
A wall of remembrance to pandemic victims (Ryomaandres, CC BY-SA 4.0, via Wikimedia Commons)
Secondly, trust in researchers. There was significant distrust of the study and the researchers amongst community members. The field interviewers were summoned to the local government chief after he received reports of people asking suspicious questions about COVID-19 and vaccines. Hence, the study’s aims must have been unclear. It is common among social science researchers to consider survey research as quite benign in terms of risk of harm. In the context of a public health emergency in a setting like the Philippines, any social science research is pregnant with ethical dilemmas and hurdles.
An ethics-of-care approach would have encouraged genuinely participatory and caring community consultations on every aspect of the research, including risks like stigma and distress. My hypothesis is that this would have improved the results of the study and also the mistrust in researchers. There is a need to care for mental health. Social science research works best in safe spaces, where care is given and received.
Advances in social science methodologies note that caring engagement of researchers with study participants in fact sharpens scientific rigour while enhancing ethical vigour.
Important groundwork toward mainstreaming care ethics in research has been undertaken in our sister project TRUST, by creating a code of conduct centred on the values of fairness, respect, care and honesty.
Some may object and argue in situations like a global pandemic, the ethics of care is impractical, slower and expensive.
Let me revert to the acts of solidarity, empathy and care of countless people in my country and elsewhere around the world during COVID-19. Probably these acts made it possible for countless lives to be saved. May I end with this: it is perhaps in the direst, most difficult moments of human existence that we must invest in more solidarity, empathy and care. In the long term this may be the only way to survive.