Guest column by Rev. Deb Conklin
Last week a friend shared an article on Sweden’s decision – from the beginning – to limit the level of physical distancing that it requires of its people. Sweden, in contrast to most other countries, chose to maintain most social and economic activities, with some moderate distancing practices. As a result, they’ve had a markedly higher rate of people being infected.
In fact, Dr. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, believes that Stockholm has just about reached the goal of herd immunity. Herd immunity is considered achieved when 60 percent of the population has acquired immunity. (I will leave aside for now the issue of declaring herd immunity achieved when we don’t even know what constitutes immunity to this particular virus.) This article raised yet a new set of questions for me about what constitutes a moral response (for political leaders) to this virus.
The main ethical debate in the U.S., up until now, has been the conflict between the lives (arguably) saved by a virtual shut down of the economy, and the economic costs of shutting down. This debate pits lives (and damaged health from the virus) against jobs and financial losses. Sweden’s approach involved a decision about how many lives one can sacrifice to achieve herd immunity quickly. While that, in effect, is also about shutting down the economy or not, the moral considerations are somewhat different. It is framed more as who’s lives can be sacrificed in order to ‘save’ many more lives.
I have been considering the ethical dilemmas posed by this virus from the beginning. It is an area that has long interested me. The study of ethics was part of each of my three academic degrees: Philosophy, Law, and Ministry. Most ethical systems deal with Rules and Principles and hard questions – often real dilemmas. The basic structure is that there are Rules and Principles. Rules are specific guides that one either follows or violates. “Don’t murder” is a Rule that most moral systems adopt. Principles are more generalized guides that have relative weight, and help me decide when a Rule needs to be broken. Principles are not followed or broken, they are weighted against each other, and give me a systematic approach to applying/living with Rules in an ethical way. Principles are what justifies the Rules and choices about following them. “Life is sacred” is one of my Principles.
Some of my seminary classmates will remember some heated ‘discussions’ in our Ethics class as the professor tried to insist that Principles are also either followed or broken. He was just wrong. Principles are what help you find an ethical answer to the hard questions or dilemmas. If you (he did) treat Principles just like Rules, then you don’t really have Principles at all. You just have more Rules. Over the years I have developed (and continue to amend) a personal ethical system. I believe it serves me well. But, I find myself frustrated to be living in a world in which ethical reasoning has become a lost skill.
The world is increasingly becoming deeply (and mostly unconsciously) utilitarian – as long as it gets the result I’ve decided I want, it is justified. It is possible to construct a moral ethical system using the Principle of Utility. But that requires a whole set of Principles that define what results I pursue. As long as those results are ethical, one can have an ethical utilitarian system. That is not what I see being practiced in our culture. Instead, the utility Principle as it is currently applied is becoming increasingly immoral.
One of the most glaring examples of this in international politics (at least prior to the current U.S. president) was George W. Bush’s decision to invade Iraq in 2003 – Iraq II. Bush and Cheney had decided that an invasion of Iraq was required – in other words, they wanted to do it. So whatever lies were needed, whatever betrayals of allies were required, were justified as long as they led to invading Iraq. The current pandemic presents leaders with significant ethical quandaries. (Any such pandemic does, but this one is the biggest such challenge we’ve encountered in decades – at least since the flu epidemic in the early Twentieth Century.) And I am deeply disturbed by the extent to which the debate is a (mostly) thoughtless utilitarian one.
I try to apply an analysis from my ethical Principles. Among them:
- Life is sacred.
- There are few values more important than life – specifically a ‘high quality’ life.
- Wealth itself is morally neutral.
- And there are almost no values that are less important than the accumulation of wealth.
Thus, for me, the answer to the debate in the U.S. has been pretty clear. I choose life and health over money. While that is stated simplistically, it is not a simplistic analysis. Yes, many people are suffering from the economic collapse. However, that damage would have been easy to mitigate had our federal government had the moral integrity to pass bills that provided the necessary funding to assist people and small business owners to weather this challenge. But allowing the virus to rage through the population would clearly have meant overwhelming our already inadequate system for providing health care.
No one has (seriously) disputed that the shut down has saved many lives. So my Principles – that value life over wealth accumulation – lead me to support the decision to order significant physical distancing. Sweden’s approach, while probably motivated primarily by economic considerations, does offer a different, and challenging ethical dilemma. Sweden’s health care system has shown itself to be quite capable of handling the numbers of people infected. So, flattening the curve was not a consideration. Instead, there are a different set of questions raised. And those are (at least for me) a new set of questions.
So far, most debates have been about deaths. But what about the permanent cardio-pulmonary damage that COVID-19 does to some people? As the mother of someone who’s been taking corticosteroids for asthma since she was 12, I am highly aware of this issue. Any ethical analysis must count more than just deaths as casualties. It must also count diminished quality of life.
During the polio epidemics of the Twentieth Century, many lived – but with serious permanent effects. Some people who lived paid a very high price in the time it took to develop a polio vaccine. Those were just as much casualties as those who died.
Some of the questions that Sweden’s approach raise for me: How many casualties are acceptable to achieve herd immunity? (Assuming, for this argument, that getting the virus and surviving does grant immunity.) Does the moral calculus change for high population areas in which health care resources were/could have been overwhelmed without the shut downs (Italy)?
In the U.S., the stated goal was never to stop the virus – which was considered unrealistic. The stated goal was just to flatten the curve to accommodate our inadequate health care delivery system. Would our calculus have been different, if we had been willing to invest in the comprehensive health care that Swedes enjoy? These are only a few of the many questions.
Yes, I have generalized and simplified very complex and difficult questions. I do not claim that I have THE correct answer. My goal is simply to invite us to have the debate on a more thoughtful level. I want to challenge people to ask themselves the deeper ethical questions. Is it ever ethical to sacrifice the lives or health of some people for financial benefits of others? Is it ethical to significantly curtail everyone’s freedom in order to save the lives and health of a relatively small number of people? Who is morally entitled to make those choices? What moral Principles help you answer those questions? And, when you identify the Principles that are inherent in your answer, how comfortable are you with realizing that those are your Principles?
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