(Most of this article Summarized by Theodore Warnakulasuriya is adopted from the Daniel P. Sulmasy who is the André Hellegers Professor of Biomedical Ethics in the Departments of Medicine and Philosophy and Acting Director of the Kennedy Institute of Ethics, Georgetown University, Washington)
As we know different countries have shown different responses to treating people who are affected by a monstrous coronavirus. I like to share the thoughts of a leading American philosopher and bioethicist and what he has to say about and how he looks at the unexamined assumptions that underlie different public policy approaches to the COVID-19 pandemic.
It is frightening to see that this monster infects young and old, rich and poor, politicians and labourers, the able-bodied and the disabled, people of every nation and race. According to the statistics given by World Meter, 210 Countries and Territories around the world have reported a total of the coronavirus COVID-19 that originated from Wuhan,China, and a death toll of 145,551 deaths. Latest figures show 146,841 people have died so far from the coronavirus COVID-19 outbreak as of April 17, 2020, 04:48 GMT. There are currently 2,183,148 confirmed cases in 210 countries and territories . The fatality rate is still being assessed.
It is well known that the Coronavirus have different effects on different people – older persons and those with diabetes or heart conditions fare worse. Mercifully, children do not seem to become so sick. But no one who has not been infected is immune.
This is a pandemic, affecting everyone, and so cities, nations, and the world must respond collectively to the threat. And everyone agrees that, in deciding how best to respond to the pandemic, we must consider the common good. But what is “the common good we are talking about? In other words, there are four different ways of thinking about the common good, which we might call utilitarian, liberal, authoritarian, and holistic. By listening and watching the news, it seems that societies and governments are not aware of their implicit understanding of where the common good lies. But under pressure, the underlying ethical stances emerge and form public policy. How the responses to the pandemic are framed and put to action reveal which notion of the common good underlies them.
The most common responses to COVID-19, especially in the English-speaking world, have been driven by a utilitarian notion of the common good. For the school of utilitarians, the common good is the sum of the good of each individual. Individuals are treated as isolated cells of pleasure and pain, or preferences, or interests, or utility. One tallies up the expected good for each individual and that sum is the common good. Neither the means to achieve that good nor the distribution of that good across the population or among particular groups really matters. Utilitarians love to contemplate rationing because they think it proves their case. But according to him, it shows their true colours.
FOR EXAMPLE, in the face of a surge of patients infected with COVID-19, Spain has issued guidelines asking doctors to consider “social worth” in deciding who gets a ventilator. Various US guidelines have called for mandatory age cut-offs, and/or exclusion of the mentally retarded or demented. More subtly, some of these guidelines ration by “life-years”. While claiming to be non-discriminatory and fair, rationing by life-years bakes discrimination into the scheme. Maximising life-years is a classic utilitarian idea that reflects their view of the common good. As all of us are aware It doesn’t take more than a moment’s reflection to recognise that the elderly have fewer life-years and that someone with Down’s syndrome can be expected to have a shorter life expectancy as well. Under the veneer of rationality and fair-mindedness lies a formula that pits the young and able-bodied against the elderly, the disabled, and those already on the margins of society.
The notion of the common good embedded in political liberalism (and especially neo-liberalism) also finds expression in a number of reactions to the pandemic. The liberal view of the common good is narrow – it is no more than those things that we all must hold in common in order to survive. Our common good consists merely of what all of us need to have a shot at flourishing – air, water, safety and security, and a minimal set of regulations to keep us from chaos.
Everything else is left to nature and the free marketplace of money, goods, and ideas. It is this notion of the common good that leads some to argue that our response to the pandemic should minimise, as much as possible, the disruption of individual freedom, everyday life, and the economy. In the end, on this view, just as markets occasionally must undergo a correction, so nature may be issuing a correction. We might even end up better off.
WHILE WE HAVE a duty to try to save lives and slow the spread of the infection, we can’t ruin the economy in the process. And given that those most afflicted are elderly and sickly, the losses would be tolerable. The neo-liberal view is that an obligatory lockdown to address COVID-19 is a disproportionate and unjust intervention of the state into the lives of free citizens. Millions of people have (or will) lose their jobs as a result.
In the long run, argue the neo-liberals, the impact of the impulse to save more lives might be worse than letting nature take its course by permitting the virus to spread widely enough to provide us with population-level immunity. This sense of the common good seems too narrow; too mean-spirited.
The third notion of the common good might be described as authoritarian. On this view, the common good is identified with the state, or the proletariat, or the people (das Volk), as something above the individual. Persons are regarded as servants of a common good that supersedes them and their particular personal goods and rights. This is how things played out in China, for example. At first, the emerging epidemic was ignored as detracting from the reputation of the state and its “glorious people”. Then, when things got out of hand, the state reacted with enormous force.
The city of Wuhan was shut down by the police and the army. The nation’s extensive system of personal surveillance was called into service, using security cameras, facial recognition software, and GPS tracking to locate and isolate infected individuals and to identify and quarantine contacts. The engines of state-sponsored manufacturing were marshalled to produce needed medical equipment. Now China is selling that medical equipment to more recently afflicted countries under the guise of relief, but motivated, certainly, by the potential financial and propaganda gains. The authoritarian approach seems to have contained the virus, but at a cost in terms of freedom and respect for individual dignity that is too high.
The fourth understanding of the common good is that it is more than the sum of the parts and more than the necessary goods we share in common. The common good is greater than the good of any individual, but not something that exists above or apart from the individual. On this holistic view of the common good, the good of the individual is, in part, constituted by the good of the whole. And the good of each individual is always, in turn, respected as integral to the common good. This is the traditional Catholic view, but it can also be found in the ideas of a number of philosophers.
HOW WOULD the popular understanding of the common good, suggested by most of World religions inform public policy and the rationing of ventilators? With respect to public health measures such as lockdowns, it would prioritise the saving of concrete lives now over the need to keep the economy growing. We matter to each other – all of us. Yes, stock investments have been depleted and many people, particularly in service-oriented economies, have lost their jobs. Yet we know that when this passes the economy will recover. In the meantime, as individuals and as governments, we have responsibilities to help those most affected by the economic fallout.
We should carry out our public health response by rallying people’s sense of the holistic common good and not by trampling on rights and freedoms. When this is over, we have an obligation to find out how we can accomplish effective public health measures without stalling the economy. There will be another pandemic. We need to be better prepared. Above all, we should realise that the best stimulus for the economy will be the end of COVID-19.
WE SHOULD certainly do everything in our power to avoid the rationing of life-saving medical equipment, but if it comes to it we should not triage in ways that are discriminatory or exacerbate existing inequalities in our society. We should allocate resources based on simple, objective, fair, medical criteria: need, prognosis, and effectiveness. Does the patient need the resource? Is the patient going to live more than a few months anyway? Will the treatment be effective in helping the patient recover? Age and pre-existing medical conditions will certainly be part of such estimations, but we should not establish criteria that automatically exclude people on the basis of age or disability. We should not be deceived by more subtle forms of discrimination baked into formulas such as “maximising life-years”.
On the holistic, view, that all of us need to promote the elderly, the disabled, and the marginalised are part of us, and we are part of them. This virus does not make calculations based on “social worth”. And neither should we?