Ethical and cognitive challenges in the COVID-19 emergency

Chiara Lucifora, Gustavo Cevolani


Abstract: The global emergency caused by the spread of COVID-19 raises critical challenges for individuals and communities on many different levels. In particular, politicians, scientists, physicians, and other professionals may face new ethical dilemmas and cognitive constraints as they make critical decisions in extraordinary circumstances. Philosophers and cognitive scientists have long analyzed and discussed such issues. An example is the debate on moral decision making in imaginary scenarios, such as the famous “Trolley Problem”. Similarly, dramatic and consequential decisions are realized daily in the current crisis. Focusing on Italy, we discuss the clinical ethical guidelines proposed by the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI), highlighting some crucial ethical and cognitive concerns surrounding emergency decision making in the current situation.

Keywords: Moral Dilemmas; Cognition; Rationality; Bias; Clinical Decision Making; COVID-19


Problemi etici e cognitivi nell’emergenza COVID-19

Riassunto: L’emergenza globale causata dal COVID-19 solleva problemi cruciali, sia per gli individui sia per le comunità, a molti livelli diversi. In particolare, politici, scienziati, medici e altri professionisti si trovano ad affrontare dilemmi etici e limitazioni cognitive legate a decisioni critiche in circostanze straordinarie. Sia i filosofi sia gli scienziati cognitivi hanno a lungo analizzato e discusso questi problemi. Un esempio è il dibattito sul ragionamento e le decisioni morali in scenari immaginari, come il famoso “problema del carrello”. Nella crisi attuale, dilemmi drammatici di questo tipo sono all’ordine del giorno. Concentrandoci sull’Italia, discutiamo le linee guida proposte dalla Società Italiana di Anestesiologia, Analgesia, Rianimazione e Terapia Intensiva (SIAARTI), evidenziando alcuni aspetti critici, sia etici sia cognitivi, del processo decisionale in una situazione di emergenza come quella attuale.

Parole chiave: Dilemmi morali; Cognizione; Razionalità; Bias; Decisioni cliniche; COVID-19

Parole chiave

COVID-19 emergency, ethical guidelines, moral reasoning, clinical decision-making, cognitive bias, Trolley dilemma

Full Text


Riferimenti bibliografici

AWAD, E., DSOUZA, S., KIM, R., SCHULZ, J., HENRICH, J., SHARIFF, A., BONNEFON, J.-F., RAHWAN, I. (2018). The moral machine experiment. In: «Nature», vol. DLXIII, n. 7729, pp. 59-64.

BONNEFON, J.F., SHARIFF, A., RAHWAN, I. (2016). The social dilemma of autonomous vehicles. In: «Science», vol. CCCLII, n. 6293, pp. 1573-1576.

CAVICCHI, I. (2020). Gli anestetisti-rianimatori alla prova, fallita, con l’etica medica. In: «Quotidiano Sanità», May 9th, online available at the URL:

CHU, Q., CORREA, R., HENRY, T.L., MCGREGOR, K.A., STOKLOSA, H., ROBINSON, L., JHA, S., ANNAMALAI, A., HSU, B.S., GUPTA, R., PATTON, D.U., MORENO-WALTON, L.A., BUTTS, C., CHAI, C., KUY, S.R. (2020). Reallocating ventilators during the COVID-19 pandemic: Is it ethical?. In: «Surgery», vol. CLXVIII, n. 3, pp. 388-391.

COZZOLI, M. (2020). A chi dare la precedenza? Riflessioni etiche sulle raccomandazioni della SIAARTI. In: «Quotidiano Sanità», May, 9th, online available at the URL:

CUSHMAN, F., YOUNG, L. (2011). Patterns of moral judgment derive from nonmoral psychological representations. In: «Cognitive Science», vol. XXXV, n. 6, pp. 1052-1075.

DARWALL, S. (ed.) (2003), Consequentialism, Blackwell, Oxford.

DARWALL, S. (ed.) (2003). Deontology, Blackwell, Oxford 2003.

EDMONDS, D. (2014). Would you kill the fat man? The trolley problem and what your answer tells us about right and wrong, Princeton University Press, Princeton.

FOOT, P. (1967). The problem of abortion and the doctrine of the double effect. In: «Oxford Review», vol. V, pp. 5-15.

GIGERENZER, G. (2008). Gut feelings: Short cuts to better decision making, Penguin, New York.

GREENE, J.D. (2013). Moral tribes: Emotion, reason, and the gap between us and them, Penguin, New York.

GREENE, J.D., SOMMERVILLE, R.B., NYS-TROM, L.E., DARLEY, J.M., COHEN, J.D. (2001). An fMRI investigation of emotional engagement in moral judgment. In: «Science», vol. CCXCIII, n. 5537, pp. 2105-2108.

HAUSER, M., CUSHMAN, F., YOUNG, L., KANG, R., XING, J., MIKHAIL, J. (2007). A dissociation between moral judgments and justifications. In: «Mind & Language», vol. XXII, n. 1, pp. 1-21.

HILL, T. (2002). Human welfare and moral worth: Kantian perspectives, Oxford Uni-versity Press, Oxford/New York.

HOOKER, B. (2000). Ideal code, real world: A rule-consequentialist theory of morality, Oxford University Press, New York / Oxford.

HUANG, K., BERNHARD, R., BARAK-CORREN, N., BAZERMAN, M., GREENE, J.D. (2020). Veil-of-Ignorance reasoning favors allocating resources to younger pa-tients during the COVID-19 crisis, pre-print, doi: 10.31234/

KAHNEMAN, D. (2011). Thinking, fast and slow, MacMillan, Basingstoke.

KAHNEMAN, D., SLOVIC, P., TVERSKY, A. (eds.) (1982), Judgment under uncertainty: Heuristics and biases, Cambridge University Press, Cambridge / New York.

KANT, I. (1993). Grounding for the metaphysics of morals (1785), translated by J.W. ELLINGTON, Hackett, Indianapolis.

MORI, M. (2020). Le raccomandazioni degli anestetisti e la fine dell’uguaglianza ippo-cratica. In: «Quotidiano Sanità», May 13th, online available at the URL:

RANSOHOFF, K.J. (2011). Patients on the trolley track: The moral cognition of medical practitioners and public health professionals, Doctoral Dissertation, Harvard University.

REDELMEIER, D.A., SHAFIR, E. (1995). Medical decision making in situations that offer multiple alternatives. In: «JAMA», vol. CCLXXIII, n. 4, pp. 302-305.

ROMERO-RIVAS, C., RODRÍGUEZ-CUADRADO, S. (2020). Moral decision making and mental health during the COVID-19 pandemic, preprint, doi: 10.31234/

ROYZMAN, E.B., BARON, J. (2002). The pref-erence for indirect harm. In: «Social Justice Research», vol. XV, n. 2, pp. 165-184.

SCHEIDEGGER, D., FUMEAUX, T., HURST, S., SALATHÉ, M. (2020). Covid-19-Pandemic. Intensive care medicine: Triage in case of bottlenecks, Swiss Academy of Medical Sciences, online available at the URL:

SHAFIR, E., SIMONSON, I., TVERSKY, A. (1993). Reason-based choice. In: «Cogni-tion», vol. XLIX, n. 1-2, pp. 11-36.

SOMMAGGIO, P., MARCHIONI, S. (2020). Tragic choice in the time of pandemic. In: «BioLaw Journal», vol. II, pp. 453-458.

THALER, R.H., SUNSTEIN, C.R. (2009). Nudge: Improving decisions about health, wealth, and happiness, Penguin, New York.

THOMSON, J.J. (1976). Killing, letting die, and the trolley problem. In: «The Monist», vol. LIX, n. 2, pp. 204-217.

TVERSKY, A., SHAFIR, E. (1992). Choice under conflict: The dynamics of deferred decision. In: «Psychological Science», vol. III, n. 6, pp. 358-361.

VERGANO, M., BERTOLINI, G., GIANNINI, A., GRISTINA, G., LIVIGNI, S., MISTRALETTI, G., PETRINI, F., SIAARTI (2020). Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances, available at

VON NEUMANN, J., MORGESTERN, O. (1944). Theory of games and economic behaviour, Princenton University Press, Princeton.

WALDMANN, M.R., DIETERICH, J.H. (2007). Throwing a bomb on a person versus throwing a person on a bomb: Intervention myopia in moral intuitions. In: «Psychological Science», vol. XVIII, n. 3, pp. 247-253.

ZHOU, F., YU, T., DU, R. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. In: «The Lancet», CCCXCV, n. 10229, pp. 1054-1062.


Copyright (c) 2020 Chiara Lucifora, Gustavo Cevolani

URLdella licenza:

Rivista internazionale di Filosofia e Psicologia - ISSN: 2039-4667 (print) - E-ISSN: 2239-2629 (online)

Registrazione al Tribunale di Milano n. 634 del 26-11-2010 - Direttore Responsabile: Aurelia Delfino

Web provider Aruba spa - Loc. Palazzetto, 4 - 52011 Bibbiena (AR) - P.IVA 01573850516 - C.F. e R.I./AR 04552920482

Licenza Creative Commons
Dove non diversamente specificato, i contenuti di Rivista Internazionale di Filosofia e Psicologia sono distribuiti con Licenza Creative Commons Attribuzione 4.0 Internazionale.