Singapore recently witnessed a spike of new COVID-19 infections owing to the explosion of cases driven by the KTV cluster. A total of 252 cases (as of 8 August 2021) is now traceable back to the cluster and its growing size is stirring questions over the efficacy of contact tracing applications in curbing the virus spread.
The state’s approach so far has been to encourage patrons who cannot be identified by TraceTogether and SafeEntry data to voluntarily come forward for a COVID-19 test. The government’s sensitive handling of the cluster and the debates surrounding the value of personal privacy vis-a-vis public health offers an opportunity for us to consider questions of what we owe to each other, and the ethical conundrum that may arise from navigating these unprecedented times with a view to our social responsibilities.
Understanding responsibility: TraceTogether as a case study
The challenges that plague government efforts to trace down lounge patrons using TraceTogether data resurfaces concerns surrounding the utility and necessity of employing contact tracing applications. While the promised potential of apps such as TraceTogether is still debatable and pending further determination, a narrow emphasis on technology alone misses the bigger picture—how the quality and value of contact tracing technologies hinge on the cooperation of its users.
TraceTogether is a digital system implemented by the Singapore Government to facilitate the nation’s contact tracing efforts. It is available for download as a mobile application, but a physical token is also available for use. Both variations employ the same features and leverage Bluetooth technology to log when the devices of two users are in close proximity to each other. This anonymised data is then stored and kept dormant within the users’ phone or token. However, if a user subsequently tests positive for COVID-19, he will be asked to upload his app or token’s data which will be accessed by the authorities to identify close contacts of the infected individual. In essence, this decentralised approach preserves the user’s privacy as data collected is stored within the user’s device. On the flip side, unless individuals are getting themselves tested and then sharing their app’s data with contact tracers, authorities will not be able to trace exposure and alert potential patients. Furthermore, while TraceTogether is mandatory for entry into public venues, individuals can disable their Bluetooth function upon admission. While venue owners can theoretically perform checks and remove individuals for non-compliance to the rules, incessant checks are simply not realistic in areas of high footfall.
One can reasonably speculate that this is what has transpired with the KTV cluster, where exposed individuals are not volunteering information for fear of public censure, a desire for anonymity, and possible domestic and social consequences.
Doing good for others
The KTV debacle clearly demonstrates the blurring boundaries of private and public spheres of life during the pandemic, laying bare how interconnected our lives are and how private decisions taken at one’s self-interest have dire consequences for public health. Recognising this motivates our discussion on the idea of beneficence and how it can guide thinking about moral responsibility and help to reconcile the barrier between private choices and public lives.
The principle of beneficence obliges us to do good for others to protect and promote public health—it further suggests a moral obligation to act for the benefit of others to help them further their legitimate interests of staying healthy and safe in this pandemic. The duty is fulfilled through the prevention or removal of potential harms.
In the context of today’s health crisis, an argument from beneficenceprovides a simple guide to follow for two important stakeholders: the state in its handling of the pandemic, and individuals in their personal capacities. In this regard, we explore lessons from the KTV cluster through the lens of beneficence. We discuss the implications of the framework of “doing good for others” for the way we implement and deploy our control strategies for COVID-19, and stress the importance of foregrounding social responsibility so people act in accordance with the principle of beneficence. In addition, we extend beneficence to analyses of problems associated with social enforcement.
Aligning our control strategies to the principle of beneficence
The principle of beneficence prioritises the design and deployment of control strategies by the state for the good and benefit of humanity—in this instance, the implementation of control measures and technology for the protection and promotion of public health and wellbeing.
TraceTogether exemplifies this principle in its aim of conserving human and financial resources and reducing lockdown burdens shared by everyone, especially the vulnerable in society. While the technology has been made mandatory throughout most of Singapore since May 2021, proper use of the app falls on the initiative and earnest efforts of individuals. Put another way, if an individual fails to use the app (whether accidentally or intentionally) but somehow manages to gain entry and occupation into a venue, it is unclear what repercussions might follow (if any) if he is later caught for his omission.
The KTV cluster has thus forced us to confront the feasibility of current control strategies that rely heavily on individuals’ voluntariness. The case has made clear that individuals whose intention is to “game the system” will not be persuaded by a plea to social responsibility. These cases present a stumbling block in national contact tracing efforts that rely heavily on public buy-in and raise interesting questions about what else the state can realistically do to secure “completeness” in our contact tracing efforts.
One possibility is to tighten the control strategies adopted in certain high-risk settings where safe distancing and maximum occupancy protocols are challenged. This could take the form of stricter regulation at riskier venues, including tougher policing of private venue operators who knowingly fail or neglect to secure proper check-in records on entry. This can be secured via the imposition of enhanced fines or penalties in line with current social distancing laws. Individuals who deliberately evade contact tracing efforts at designated “high risk” venues should similarly be held accountable by way of fines or community service orders. Both the individual and the organisation should be held responsible for upholding the common good in the name of public health.
From a technological standpoint and to remedy existing data gaps to ensure more comprehensive data coverage, the choice of technology deployed can also be tightened up for higher-risk environments. For instance, a modified version of TraceTogether preferring GPS technology can be made mandatory for use in riskier settings to complement current contact tracing initiatives. GPS tracking applications work by collecting a user’s location information to map the movement of that particular individual and other phones in the same area or time to identify potential exposures. This way, potential exposures can be identified not only by Bluetooth proximity data but also through location data. Regulation could similarly be introduced to govern individuals who deliberately fail to comply.
The design of such control strategies and their implementation on the basis of beneficence requires a reasonable expectation of public benefit outweighing their potential risks. The recommended measures are informed by the common good where risk mitigation and the promotion of public health are seen as the imperative, allowing us to transcend the problem of voluntariness and debates on individual choice. A case can also be made that these measures should be underpinned by legal obligation so as to ensure compliance, thereby safeguarding public health. We propose that the potential benefits to society in the longer term—including more positive health outcomes, a return to life “as per normal,” economic stability—justify temporary intrusion into the realm of individual choice. An appreciation for the principle of beneficence guarantees that this proportionate balance is achieved.
Despite justifications from the principle of beneficence, we recognise that heightened surveillance will inevitably and rightfully elicit privacy infringement concerns, a discussion harking back to the inception of the TraceTogether Programme and the ambiguous policies surrounding the governance of data collection. Recognising this, it is vital to regulate for another important outcome: user protection. The principle of beneficence can also help us understand why the law’s coercive function should be held in tension with its role in guaranteeing our rights against abuses of power. Laws that are appropriately designed to safeguard users’ data, privacy, and constitutional freedoms also serve the common good. They foster trust between citizens and authorities—leading also to better virus containment outcomes.
Beneficence, what we owe each other and denouncing blame
The principle of beneficence can be used to guide individual behaviour towards outcomes that are more socially responsible. One motivation to adhere to the principle of beneficence amidst the pandemic is that the individual’s interest is intertwined with that of the community—if a new normal and economic stability is to be achieved, it is in the individual’s interest to act in accordance with the common good. National efforts to counter the spread of the virus must similarly be supported by this understanding and this value of social responsibility must continue to be emphasised in Singapore’s official messaging. Indeed, government messages have consistently stressed the interconnectedness of individuals within a community, and the importance of acting responsibly to safeguard the health of others.
However, it is equally important to recognise that an overreliance on this narrative may result in vitriol directed at those seen as violating the terms of this social compact. Framing appropriate behaviour in terms of a responsibility to act in the interest of the common good might engender a strong desire for accountability and culpability when things go wrong. This has emerged strongly as acrimony at the community level when groups were perceived to flout safe distancing measures. The attribution of blame serves as a quick salve when frustrations and anxieties run high.
The principle of beneficence, however, also provides resources for resisting such practices. Blame acts against the common good because it often occurs along existing social fissures and entrenches pre-existing prejudices. For example, in Singapore, this plays out as the exacerbation of xenophobic and racist sentiments that predate the pandemic. This interaction between xenophobia and racism is witnessed in the rise of anti-Indian sentiments following the emergence of the B.1.617 variant.
Now, worries over the burgeoning KTV cluster have led to comments on the nationalities of the hostesses, pandering yet again to xenophobic and potentially classist discourse. Employing blame as a mechanism to enforce social responsibility can inadvertently further estrange marginalised populations, marring our endeavours to act collectively and imagine a common good for the benefit to all in society, which is fundamental to the concept of beneficence in pandemic times. To this end, beneficence can serve to refine official narratives that stress our responsibilities to one another—the encouragement of social responsibility by the state can foreground efforts to denounce blame and scapegoating as means of moral enforcement.
Conclusion
As João Nunes argues, “disease confronts societies with their limits.” Indeed, the dynamism demonstrated by the virus has placed strain on societies struggling to cope with the pandemic, demanding an ethical framework that recognises and accommodates the fluidity of this public health context. On one hand, the pandemic has made salient the fact that private choices made by any one individual can have dire impacts on the community and public health at large, amplifying the importance of reminding individuals to act for the good of others. On the other hand, the reality of the KTV debacle exemplifies the limitations of a system that relies on voluntariness. As a guide to official measures including how we design and implement COVID-19 surveillance strategies, beneficence encourages the prioritisation of the common good without neglecting individual rights to proper safeguards for data and privacy.
Yet, it is understandable that beneficence as a guide to individual responsibilities may come under scrutiny for facing similar issues with voluntariness—public buy-in is still fundamental and individuals must choose to act for the good of others. However, beneficence remains useful when navigating the quandary surrounding the issue of voluntariness—the idea that individual freedom of choice should be sacrificed for the common good. Rather than maintaining a dichotomous relationship between individual freedoms and the societal interests, beneficence postulates that individual interests are vested in the common good, encouraging the re-evaluation and recalibration of individual autonomy and choice toward decisions made for the benefit of society.