Protecting affiliation during pandemic crises: a capabilities approach for public health ethical deliberation

Abstract During the COVID-19 pandemic, non-pharmaceutical interventions that affected people's ability to access and maintain social relationships, which philosopher Martha Nussbaum calls “affiliation”, were implemented. However, the WHO has reported that no measures to actively protect social relationships have been put in place. Furthermore, existing pandemic ethical frameworks do not explicitly specify affiliation protection as a relevant ethical consideration. Subsequently, the main aim of this work is to justify why pandemic public health ethical deliberation should aim at protecting people's capability of affiliation, and to present Nussbaum's “capabilities approach” as a suitable theory to support this endeavour. First, we discuss the contributions of the capabilities approach to the ethics of public health, specifically in the context of pandemics. Second, we argue how affiliation informs the core public health ethical principles of respect for individual freedom and equity. This paper provides an original normative account, as (1) it recognises the irreplaceable role of personal relationships, by contrast to other accounts that favour primarily online or non-human interactions, and (2) it builds a conceptual understanding of their role in public health ethics, paving the way for the integration of health and affiliation in future pandemic deliberation.