For most of human history matters of life and death lay almost entirely outside the material world. Saving a life at any cost feels to most of us like a moral imperative, but the astonishing leaps forward in science and technology that define the modern world push our values to their breaking point.
Modern medicine along with its incalculable benefits also raised end-of-life questions our ancestors never had to ask. If the difference between dying at 90 or 95 is a life savings that could be left to one’s children, do we spend it? Until recently these questions weren’t even acknowledged in polite company. This is a case of technology evolving faster than our cultural values. Catching up only happens through many people honestly struggling with difficult questions.
The COVID-19 pandemic presents us with this kind of choice but on a global scale. The ability to forecast a pandemic and the institutions capable of a coordinated response are things we still struggle to understand scientifically. But that newness also raises moral questions we find deeply uncomfortable to face.
Spend more, sacrifice more, disrupt and damage society more, and save more lives. When New York Governor Andrew Cuomo said any efforts at shutdown and distancing were worth it to save just one life, it came from a place of human decency. Suggesting otherwise is chastised as putting the economy ahead of human lives.
Adam Smith taught us that moral sentiments emerge from the bottom up rather than being handed down from on high. Were the questions raised by our response to COVID-19 an aberration, we might not need to ask as many hard questions. But the truth is these questions are all around us and honestly recognizing them is uncomfortable but overdue.
The Movie That Won’t Stop Playing
Consider the following debate:
Group A forecasts major human tragedy that can only be addressed by vastly expensive or transformative changes to society. The choice is often presented as binary–maximum change versus fiddling while Rome burns. What a coincidence that what we must do often resembles politically controversial ideas already favored by Group A.
Group B doesn’t like those changes and sees through the all-or-nothing mentality but is reluctant to directly push back at the understandably uncomfortable life-or-death issues. Instead they allege Group A’s forecast, whether by honest mistake or manipulation, is wrong. We lack the moral vocabulary to look at the issue as anything but all-or-nothing, and assail each other’s intentions instead.
This dynamic, rather than being new, has poisoned a generation of public debates. Climate change, gun control, surveillance of U.S. citizens, torture of high-value terror suspects, preemptive wars, and at least to some extent the more recent populist friction points on both the left and right fall victim to this tension.
Most people have likely found themselves in both groups on different issues. When faced with complex uncertain problems with moral components, we find shelter in the place where our worldview makes us most comfortable. All of us.
Rules Destroy, People Redeem
What about our currently ticking clock? We must understand that economic harm itself does lead to loss of life and suffering, as many have made clear. This must be part of our discussion, but not all of it. Take the following not as a proposal but as an invitation to think differently, something we seem to do less and less.
We suspect most people will experience COVID-19 not that differently from a nasty flu, but were it to rip through the population all at once, the strain on hospital resources from the still-large number of people whose lives likely would need saving would create its own unspeakable tragedy. The enormous costs in this formulation are in the service of the laudable goal of actually letting our medical system save the lives it can.
But maybe some of the cruelty in what we face is the almost subliminal collectivization we project on the problem. No two lives are the same and most of the people at risk are very old or very sick. We shy away from these ideas because we think they imply the need for some horrible rule that people over a certain age should be denied care, or other doomed efforts from the top to micromanage us out of the problem. Count me among the people who think such engineering destroys more of a society than it builds.
What if every American over the age of 18 were sent a sticker in the mail? What they did with it was a confidential matter for themselves and their loved ones, though on a more general level a topic of conversation for the country. Putting that sticker on the back of one’s drivers license would entail a commitment if the worst should happen, meaning they get the virus and home care isn’t going well. They’d commit to go to the back of the line for hospitals, ventilators, the resources we worry about being strained. Or they don’t. It’s their choice, we don’t pressure, we don’t keep track.
How many of the people most vulnerable, in something not all that different from a living will, would make that hard but movingly generous choice? My guess is it would be enough people to substantially reduce that strain (allowing for substantially less closures and distancing). And while a dictated rule from the top might destroy a society, such an act, made by individuals who choose, might be a moment of redemption.
We’ve developed extraordinary capabilities to save lives, but these capabilities create new choices. Attacking each others’ intentions is safer. This is easily the most difficult article I’ve ever written, but breaking old patterns is hard. I hope I’ve asked hard questions I can’t answer in a compassionate way.