Hi everyone – I’ll get back to the promised series of posts soon! But this is too important to wait…
My PhD thesis was concerned with moral (and to a lesser extent) religious thought, and its effect on our decision making. Especially as decisions between what we want now, and what we might want later on are concerned. G K Chesterton (writer and poet) argued that ‘a man (or woman) must be sure of his (her) morality, because there’ll come a time when they must suffer for it’. Put another way, you don’t really know if you have a moral code until it is costing you something.
I’d like to elucidate the moral case for staying home, with all the disadvantages and stresses of social distancing versus, well not doing that. Staying the social distance course will cost us economically, and the cost will not be inconsiderable. People who are on the margins, will suffer economically, and many who are otherwise well off may very well suffer a notable decrease in their circumstances. Others who are lucky otherwise, will have to go without their sports, booze, favourite activities and even their toilet paper. Single people and teens won’t get to date, or socialise, and this will be particularly hard for people who don’t live with a family. And if we do this right, it will be some weeks, maybe months. The psychological cost will also be considerable I suspect. So that’s no joke and I do not seek to minimise it.
I have heard people say there is no choice but to do this. But of course, there is. There is a case for ignoring all that and going on with your lives, and that argument is being made in political circles in the US and I suspect, more subtly elsewhere. An argument to let the virus spread. There’s seems to be absolutely no disagreement that social distancing, staying home and not going out any more than is absolutely necessary will save lives. Conversely, failing to do so will kill people. We’re all agreed on that point.
Let’s examine the argument through two lenses. The utilitarian view, versus the deontological view. In the first view, the position that results in the most good for the most people is the right choice. In the second, there are the right things to do, which are obligatory, things that are permissible (not obligatory), and things that are forbidden to do, and these moral rules are ‘universal’. It’s never OK to deliberately harm a child or let someone die if you could save them; would be good examples of a deontological position. Studies in the neurobiology of morality seem to indicate that most people’s attitudes tend to be a bit of a hybrid between utilitarianism and deontology. When these two positions collide, we have a moral dilemma. I will argue this COVID-19 crisis is for many people providing such a dilemma (and that by the way is no sin), and it is well worth stating it clearly. If ever reason was required, give us increase of it now.
If we argue the utilitarian view, we need, above all else, to be accurate in our predictions about what will result from each choice. Social distancing will result in economic upheavals and restrictions not experienced since the last world war. Maybe not as bad, but it won’t be easy. This point seems to be pretty uncontroversial. The argument for doing it anyway is similarly uncontroversial. Slowing the rate of infection down enough so that when (or even better if) our hospital systems becomes completely overwhelmed by the demand for intensive care beds, ventilators and the exigencies of barrier nursing to prevent infection spreading and disabling our medical staff, the period of saturation won’t be as severe or protracted, primarily because our medical systems will have had critical time to bolster their arsenals of equipment, mobilise and train staff and prepare. This, simply put, means that more people out of the 5-15% of patients who may require critical care will be saved from death because they will have much better chance of getting the care they have a right, in a civil society, to have provided to them. Oh all right, in talking about rights I am getting into deontological matters, but humor me. How many lives would be saved? Well, in Australia estimates are in the tens of thousands. Worldwide, estimates range from hundreds of thousands, to millions of human lives. Which human lives? The COVID19 infection does not exclusively kill the elderly, that much is uncontroversial as well, but overwhelmingly, it is those over 70 years, and those who are already suffer some chronic illness who are most likely to require critical care.
Recently, in White House press conferences and in conversations in offices to which I have been privy (I’m sorry to report), it has been proposed that these life-saving measures (isolation, social distancing etc) will produce results that are far worse than the deaths of millions of people; who are after all mostly the sick, poor and the elderly. In particular, that there will be more suicides – of people who are not poor, sick or elderly, as a result of economic deprivation, than lives lost to viral infections. This is a claim, a prediction, that can, and should be, considered empirically. This claim takes as a given that in times of war, or natural disaster, there is a drastic and sustained increase in suicides in the affected populations. The second assumption, that the lives of the elderly, the poor or the chronically ill are not as valuable as the lives that may be lost to suicide, has been made explicitly by at least one politician in the United States. Let’s look at the first claim about suicides increasing.
This is not at all the ‘no-brainer’ it appears to be. Theoretically, sociologist Emile Durkheim addressed his studies to this question quite some time ago. He suggested that when a population is at war, there is an increased sense of belonging or integration with one’s group, and also and increased sense of purpose. Later, psychologists would find that purpose and a sense of being needed, as well a sense of belonging are indeed protective against psychological distress and hopelessness. In addition, there is a certain perspective taking that goes on which tends to mitigate psychological distress as well. The data are mixed when it comes to natural disasters such as earthquakes or bushfires. Certainly, mental illness is increased, largely as a function of post-traumatic stress in responders, but in the population as a whole there is little reliable evidence of increased and sustained incidence of suicide. That PTSD was a driver of later mental illness should give us pause here, to consider the traumatic impact of letting this disease runs its course on frontline medical staff. The psychological impact on frontline medical staff is likely to be worse in the business as usual scenario, where medical resources are overwhelmed and helpers are forced to watch people die (and choose who dies) when they might otherwise have been saved. This is already the case in Spain and Italy, and I suspect the impact on medical staff will be terrible.
War and natural disaster have deleterious psychological effects, that’s not in dispute. Quarantine also can have psychological effects. A review of the evidence concerning psychological effects of quarantine was published just this week in the medical journal The Lancet. Evidence for deleterious psychological effects were detected, frustration, anger, and anxiety with respect to one’s own health were among them. Effects were made worse by pre-existing mental health issues, social stigma for health workers, and a sense of compulsion without adequate explanation or appeals to the goodwill and altruism of the internee. The study also found that giving full information, alleviating boredom and communicating the public service aspects of the quarantine could mitigate some of these effects. The review also found health care workers were most at risk of post-trauma symptoms and for this reason deserve particular care (Brooks, et al. 2020). No suicides were recorded. None, out of around ten thousand people who were quarantines across 24 studies. The assertion that economic difficulty and social isolation will result in hundreds of thousands (or millions) of suicides has no basis in theory or evidence, is a bit of political casuistry and does not merit inclusion in any utilitarian argument for ‘business as usual’.
The other side of the utilitarian argument is the unexamined assumption that the resumption of economic activity is feasible if the virus is allowed to infect the population unchecked. Sadly, it appears this experiment has been conducted in Italy, Spain, and there appears to be even greater danger of such an experiment being conducted deliberately in the United States. In the United States the situation is being put very baldly; there is no need for me to imply what has been made explicit. That is, that the elderly should be prepared to die to prevent harm to the US economy. Curiously, the Lieutenant Governor and the President aren’t really volunteering. With their official positions, they would get one of the respirators – but I digress. So, what would the sacrifice of all that wisdom, life experience not to mention unpaid child care, this casual human sacrifice by viral lottery buy us?
Not as much as its proponents, like Lieutenant Governor Dan Patrick would have us believe. The US population is near to 330 million. Epidemiological estimates of an unchecked spread of the virus in question indicate up to 60% of the population would be infected, of which 80% will have mild symptoms (or none). Sounds great? Well, that means 39.6 million Americans will get sick, many of them very sick. Of those, at a case fatality rate of 1 – 2%, between 2 and 4 million people would die. How does an economy thrive with that many people unable to work, medical care unavailable for months (for any illness or injury, not just COVID19), and up to 4 million grieving families? This is to say nothing of the fact that those elders also support, to a great extent, the workforce participation of their families by providing free and flexible childcare. A 2015 study revealed many grandparents were committed to the ongoing and demanding care of their grandchildren, incurring costs and considerable sacrifices so their families could perform paid work. Most grandparents took on this role to enable their children and children-in-law – mostly mothers – to remain engaged in the labour market. In their absence, participation in the labour market falls further still as this vital but economically invisible work is decimated.
Taking the second claim, that the elderly lives, set against the economic and personal prosperity of their country and younger generations should be regarded, and regard themselves, as expendable. This argument has been made before, only it was forcibly applied to communists, gypsies, homosexuals, the disabled and you guessed it, Jews. This argument didn’t pop out of the ground, it grew out of an acceptance that individuals were in a very real sense the property of the State, and that the State had a right to decide which lives were more valuable and which people, as hard as the decision was, just had to be extirpated to insure the greatness of the nation. Whether more good could be delivered to more people as a result of giving a State that kind of power over individuals right to care and life, is an experiment that has been conducted in North Korea, Stalinist Russia, Germany in the middle of the Twentieth Century. It doesn’t stack up on pragmatic, utilitarian grounds. I doubt very much that is the form of democracy Thomas’ Paine & Jefferson, Samuel Adams, and Ben Franklin had in mind. One’s right to live large if they work hard is fine, but it doesn’t trump our elders right to live.
In sum, the utilitarian argument, the options are to pay an economic price, a steep one, and save hundreds of thousands, hopefully millions of lives. Or sacrifice millions of lives and pay an economic price, a steep one at that. On purely utilitarian grounds the case for staying home, and slowing the spread of the virus, wins. It is the solution that delivers the greatest good for the greatest number of people.
Now, in the deontological sense, the whole discussion of who will or won’t succumb is a grossly immoral one. To quote Jon Donne from the time of the Black Plague, ‘No man is an island entire unto itself’, when someone dies we are all diminished. A piece of us is lost, a piece of the collective wisdom. It is–intuitively—not permissible to take an action that results in foreseeable and avoidable deaths unless doing so avoids even more deaths, and even then, opinions vary. This argument is easily illustrated by the trolley problem – which all first year philosophy students encounter. In some United States legal jurisdictions letting people die when you could help them is an offence, this may be referred to as depraved indifference, or a violation of a Duty to Act, and people have been successfully prosecuted in the grounds they possessed the means to save lives but were indifferent to taking the necessary action. At a global, national, regional and individual level, indifference to the death of others because of our own fear of penury is a moral cowardice, a lack of civic fortitude. It is no vice, and even sensible to be afraid. But to deny our fear and instead call it ‘social darwinism’, or ‘economic sense’, and sacrifice perhaps millions of others to our desire for economic security is deserving and in time will attract, nothing but the cold contempt of those who will view us in the unforgiving light of history. On the other hand, we could, not only medically, economically and socially, but morally rise to the challenge – and accept certain hardship (hardship we will not avoid by economic cowardice anyway) to save as many of our own as we can.
Putting it a little more poetically, I was sitting in the shade of a lovely pear tree I planted a decade ago this morning, a tree I watered, protected and propped up against the wind. Now it protects me from the sun and wind as I sit in its lee. The generation with all the power now, are we not the pear tree, and haven’t our elders and our vulnerable the right to our protection? Even if it costs us five years of relative penury? Many cultures, ours included, have to some extent the assumption that our elders are entitled to our protection, because they have earned it sure, but also because of their store of wisdom history and knowledge are valuable. All human life is valuable, and deserves to be fought for.
Dr Victor Frankl remarked in bleak times how rare people with a genuinely deep, guiding morality, that persisted even when it cost them personally, were in Auschwitz. I suspect a very confronting feature of crises like this is we get an unclouded view of who and what we are, and I am not sure we’ll all like what we see. This will be over one day, and what will we think of each other, ourselves, and our unspoken contract as a people, if we let people die, who we, by our collective efforts could have saved? Every single person who dies when they might have been saved by our small sacrifices, will diminish us as a people. Not just during the pandemic, but for a generation. We will not look at one another the same way ever again, knowing that when it comes to the wages of others, or my life, my sorry carcass may be summarily tossed onto an economic bonfire that was never going to be extinguished by my demise in any case. While we are prepared to let people die so we can make our country ‘great’, no country, no community, no family can be great. If the last century taught us anything, it taught us that surely. I really hope as a people we can retain a greater sense of our own dignity than that.
Make no mistake, even with our best efforts, many loved people will die. We will lose a great deal economically as well. But hopefully we won’t lose the hope that we would fight as hard to save members of our community, as we hope they would fight for us if the position were reversed; and reversed it they very well might be.
But if we can say, in whatever mess we are in when this pandemic passes, that everyone stayed home rather than going on ‘holiday isolation’ to our favourite resort town because we feel entitled to, if we took the financial strain voluntarily, and did more than was asked of us, if we checking on our neighbours daily and helped them, supported others to stay home and halt the spread of this disease, I believe the authors of the Lancet article are quite right; afterwards the psychological healing will be that much faster, and the inevitable losses will be that much easier for those who remain – to bear.
Stay home. Work for your community that has provided for you. Cop a bit of humble time now so we may feel pride to go with our losses later. Whether you subscribe to the utilitarian view, or the deontological view that ‘what is right is always right’, you and I have a moral obligation to do all we can to stop the spread of this virus, and save lives.
Either way, we’re in for economic difficulty, and loss. A very likely reduction in many peoples’ circumstances. Lives will be lost. How many will be decided by you and I, this week. Let’s not lose our self-respect as a people as well.
“No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.”
John Donne (Poet, 17th Century).
Brooks, S. K. et al. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912 – 920 Retrieved March 26, 2020, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext.
O’Malley, P. (1975). SUICIDE AND WAR: A Case Study and Theoretical Appraisal. The British Journal of Criminology, 15(4), 348-359. Retrieved March 26, 2020, from http://www.jstor.org/stable/23636204
Hamilton, M, & Jenkins, B. (2015). Grandparent childcare and labour market participation in Australia (SPRC Report 14/2015). Melbourne: National Seniors Australia 2015.