Cancer in the time of coronavirus

We are forcing doctors to play god because no one prepared properly for this crisis. As I battle cancer, this pandemic has left me without treatment and I do not know what will happen next.

Doctors across the world are making life and death decisions about who they treat, including in Italy; Robert Phillips argues it didn't have to be this way (Photo: Getty Images)
Doctors across the world are making life and death decisions about who they treat, including in Italy; Robert Phillips argues it didn't have to be this way (Photo: Getty Images)

Long before the Coronavirus crisis, I had come to terms with dying.

As a Stage 4 cancer patient, it’s something you need to do: find fortitude and calm amid excruciating uncertainty; use the moment to truly understand yourself and others.

It appears that journalist George Alagiah experienced a similar journey. Cancer gave him “an edge” when he contracted COVID-19. I get it. A dear friend, a Buddhist, helped me appreciate that death, whenever it comes, is a natural part of the cycle of life. George has maybe received similar counsel.

COVID-19 notwithstanding, I intend to hang around for a few years more. Even my wise Buddhist friend admires my determination to fight.

Medics tell me I’ve been “chemo responsive” (good) and “look great”. After 16 months, 18 rounds of chemotherapy and 25 doses of radiotherapy, I was “strong” and “stable”. Tumours were “under control”. My latest chemo break started in February, to be reassessed last week for any “return to growth” and possible treatment restart.

That’s not going to happen now, and I’m not sure what comes next.

‘I no longer feel special’

Scans and treatment are cancelled for the foreseeable future. Relative risks are too high: from either contracting the virus with “underlying health conditions”; or suppressing my immune system, making me vulnerable elsewhere. Explained in these terms it makes sense. I’m playing Health Russian Roulette.

The stark reality is that should I fall seriously ill, I may not qualify for a ventilator. With the National Health Service under incredible strain, other lives would take priority. This is what I’ve learned in patches of communication – snatched “stay put” messages with my wonderful doctor and oncologist, fighting to help others.

I no longer feel special, in the way that cancer patients are meant to feel special. No one, understandably, is making a fuss of me – I’m just another potential death-number among a tsunami of others. I’ve never been one for tea and tissues, cakes and sympathy, anyway. 

I am working full throttle. True friends and loved ones understand and remain supportive.

The numbers aren’t pretty. I was potentially one of 16,000 people who die in the UK every year from bowel cancer. Now, I’m one of 20,000-30,000 who the virus might take – perhaps one of 1.5 million if the pandemic hits really hard. And that’s not counting the others that are “let go” elsewhere, while COVID-19 consumes everyone’s attention. Like them, I’m no longer a name; just a number.

“Every law is an evil, for every law is an infraction of liberty”, wrote the utilitarian philosopher Jeremy Bentham, in defence of the principle of the greater good. “And I repeat that government has but a choice of evils.” Thus in medicine, too, Bentham observed. 

I am hugely sympathetic to my consultants and all medics – Hippocratically committed to preservation of life – suddenly faced with such moral dilemma: their choice of evils.

Could better preparation have avoided a scenario where doctors are forced to play god? (Christ the Redeemer statue, Rio de Janeiro, on Easter day. © Getty Images)

On the ‘trolley track’

Fans of The Good Place understand the trolley problem, first articulated 50 years ago by philosopher Phillipa Foot. With a runaway tram, does the driver divert to kill one person in order to save more? To do so would be to follow the utilitarian path: the protection of the many for the greater good. The trolley problem raises questions of moral rights and wrongs and our participation in them: the choices we make.

Critically, in the abstract, it may be OK to kill one person for the greater good – but judgements change dramatically when that one person happens to be your husband or wife; father or mother; son, daughter or friend.

That’s me, on the trolley track. I’m not a number – not one of 16,000 or 1.5 million. I am Robert: a father, husband, brother and son. That’s what keeps my spirit alive. The statistics may help the moral judgements of others but they annoy the fuck out of me.

I don’t much care for five-year survival rates, nor am I bothered by data sets of a zillion others. I try not to look on the web for this stuff. This is my future and my fight. To paraphrase my inspirational friend, Uncharted author Margaret Heffernan, I refuse to bow to the “propaganda of inevitability”.

Doctors playing god

There is, though, something more vital at play. It has significant implications for government and public policy. It simply did not need to be like this. We are forcing doctors to play god because no one prepared properly.

We may not know exactly when pandemics will surface but that doesn’t mean we cannot be ready. The time to prepare for a crisis is absolutely not when that crisis hits – whether it’s plane crash or plague. Anyone trained, like me, in crisis management knows this.

There’s no excuse not to have sufficient reserves of ventilators or masks, nor the preparedness to make testing kits and activate test centres at scale. For those currently denied access to clinicians or hospitals, there’s no reason why there shouldn’t have been a plan for secure, hygienic establishments for those undergoing treatment for non-COVID life-threatening conditions. That’s what proper crisis planning is about. Government and public health planners have failed Britain miserably.

Society’s misplaced obsession with cost-cutting, managerialism and ruthless efficiency is a huge part of the problem. 

“Just in time” planning – touted by a generation of management consultants – is why we don’t have the requisite Personal Protection Equipment; “spare” capacity in hospitals; even supplies of hand sanitiser.

We are living with the consequence of societal hubris and blind belief that such a moment would never come. But come, it always does. We cannot predict the future, but we can certainly prepare for it.

I’m not going anywhere yet, physically or metaphorically. Compassion and, in my case, Jewish atheist prayers are with those on the frontline and with loved ones who are sick and dying. It is a tragedy of immeasurable proportion. But medics are being forced to make painful moral choices that could have been averted with better planning, less complacency and more imagination from those who lead them. This is the essential morality tale for now.

Robert Phillips is the founder of Jericho Chambers, former EMEA president and chief executive of Edelman, and author of Trust Me, PR is Dead

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