We read two articles, one by a philosopher and the other by an economist, about how to think about some of the ethical issues raised by the current pandemic.
The three things that are most pressing are:
How to weigh the costs of shutting down society against the costs of letting the epidemic spread.
How to distribute a scarce medical resource like a ventilator.
Whether we should give priority to people who are younger.
Kamm criticizes the suggestion that aggregated small costs spread over large numbers of people can outweigh a large cost to a smaller number of people. For instance, suppose that two things are true:
But for the lockdown to slow the spread of the epidemic, the unemployment rate would not have gone up.
The high unemployment rate due to the lockdown cost 40 million of people a year of life.
Suppose both points are granted. Kamm denies that we should weigh this 40 million life years against the thousands of lives that would be lost if the pandemic were allowed to spread more rapidly. She thinks that we should instead proceed with what she calls pairwise comparisons.
Here is how that works. Make two lists. One one, put everyone who would be made worse off by having a lockdown ranked from those hurt the most to those hurt the least. On the other, put everyone who would be made worse off by not having a lockdown, again ranked from those hurt the most to those hurt the least. Presumably the people on the first list are those who are unemployed and the people on the second list are those who die from COVID-19.
Now put the two lists side by side and compare the people at the top (those hurt the most by either alternative). Choose the policy that avoids the larger harm. If the harms are equal, move down to the second position on both lists. And so on. That’s pairwise comparison.
This method has some uses. For instance, we can use it to explain why it makes sense to save a larger number of people rather than a smaller number in a disaster.
But Prof. Brown made a strong criticism of it. She said that if you used this method to compare policies that would reduce the risk of death to policies that would enhance the quality of life, you would always wind up opting for the ones that reduce the risk of death, no matter how small, and wind up never doing anything to enhance the quality of life, no matter how large.
She prefers the economist’s approach of trying to determine the value of a statistical life and then using that value to determine whether a policy aimed at saving life is worth pursuing.
Lilly asked whether this didn’t involve aggregation of the sort that Kamm criticized. After all, the social decision is going to favor the lesser benefits experienced by a large number of people over the lives of a smaller number of people. That sounds like aggregation!
I said that the idea was that the tradeoff between saving lives and enhancing the quality of life reflects the choices that the individuals concerned would make. The idea is that if you didn’t know whether you would benefit from, say, schools or stiffer guardrails, which would you choose to spend money on? The odds that you will drive over the edge of the road without guardrails are very small and the odds that you will be ignorant, poor, and sad without decent schools are very high. If you were given the choice, you would probably opt for the schools. So it’s not “we piled up the costs on each side and this pile is bigger than that one.” It’s “this is what you would have chosen if it were possible to put the choice to you.”
To be clear, I’m saying that’s the argument. I’m not saying that it wins the day. That’s up to you to decide. I think it’s reasonable to interpret this method either way.
First, Jordan was right to say that the remarks on comparing young and old lives are among the most interesting parts of Kamm’s piece. I whooshed on that in my introduction. Here’s a quickie recap.
Kamm contrasts two different reasons for giving preference to the young against the old.
It’s more efficient: a medical intervention saves more life years when it is given to a younger person than it does when it is given to an older person, generally speaking.
It’s more fair: the older person has already had the years of life that the younger person would lose.
Kamm prefers the second argument.
Emily thought that Kamm’s argument that wearing a mask is a matter of respect rather than love deserved a better presentation than I gave it. She said that what Kamm is saying is that it’s a matter of duty rather than something that depends on how you feel about other people. I concede the point.
Finally, I have to question the first assumption from the argument about unemployment. The economy is going to suffer if there is a highly contagious epidemic. The point of a lockdown is to control the epidemic so people will be willing to resume normal social and economic life. If we let a highly contagious disease run rampant, most people aren’t going to want to leave the house and that’s going to hurt everything including the economy. (But enough will to keep it circulating; it’s the worst of both worlds.) For that reason, I’m dubious about the suggestion that unemployment would have been significantly better without the lockdown.
There was much more in our discussion and I’m skipping Page’s interesting remarks about Rawls. But I’m going to have to hang it up here.