Ethics and Re-Opening

Here is a proposal by an author you know well for approaching the problem of re-opening given that all options entail highly undesirable consequences.  It may be right or wrong, but it does at least lay out clear principles.

There is no option that does not entail extra deaths. Medical professionals seem to think that we will experience thousands, perhaps even tens of thousands of extra deaths if we re-open quickly. The UN has produced two reports lately on the effects of the shut down, one of which says that hundreds of thousands of extra children will die of starvation; the other of which says that over a hundred million people will be pushed to the edge of starvation by the economic lockdowns.

So we have to choose between dark roads. That's the problem the model tries to address.


David Foster said...

In addition to the ethical questions, there are also real scientific and practical issues outstanding. Some scientists believe that by extending shelter-in-place, we are delaying the development of herd immunity...I was talking with an immunologist just yesterday who is basically of this persuasion.

Also, reopening vs non-reopening is not binary, there are many granular aspects to it. For example, one could argue that as long as the NYC subways are running, that city is in fact Open, regardless of how many restrictions are put on day-to-day life and employment. A subway car with many passengers who are strangers to one another...some of whom are bad actors and sociopaths who will not abide by mask wearing or any other surely a more effective venue for transmission of coronavirus than is a small gathering of friends at someone's home.

Grim said...

The piece intentionally avoids the scientific and medical questions, because the author is not an expert in the fields of science and medicine -- though of course an interested observer. You're right, of course, that those questions are of paramount importance, but the piece is focused on the ethics.

I think your second paragraph contains many excellent points. NYC may be getting all the harm of being open, along with all the harm of being closed. Meanwhile in this county there hasn't been a new case in weeks, and there were never more than five confirmed cases anyway. We could open up even if the effect were to double those numbers, because we have 9 ICU beds in the county (and the second wave wouldn't all need one anyway).

Elise said...

I find this a very helpful framework precisely because it makes quite clear that we do not have the information necessary to be sure we are making the proportionate choice. To use the factory example in the essay, assume that we do know the factory is using unfree labor and we do know it is producing war materiel but we do not know exactly what kind of materiel, nor do we know how many laborers work each shift. The factory may be making nuclear weapons or it may be making helmets; there may be 50 workers per shift or 50,000. Given that level of knowledge, we cannot know which choice is the proportionate one.

As far as I can tell, that's the situation we are in with the tradeoffs involved in continuing the shutdown versus re-opening. We do not know how many people will die if we re-open; we do not know how many people will die if we stay shut. Additionally, we do not know how much non-fatal suffering each alternative will entail. Further, we will not know this for a long period of time, if ever. Today New Zealand seems to be doing well in terms of COVID-19 deaths while Sweden appears to be doing badly. But 6 months from now, New Zealand may find it has done worse than Sweden, simply over a longer period of time. The same time problems exist with regard to death and suffering from non-COVID causes, such as poverty, malnutrition, depression, anxiety, etc.

Given this lack of information and having agreed that all options are discriminate, either (any) choice can be justified and will have to be made on grounds other than knowledge of the likely outcomes. It seems to me this means it is a very good thing that different countries and different States are trying different approaches. Each group of people, country, State, town, must simply do the best it can in a situation where the objective best cannot possibly be known. As Meg says in Jo’s Boys when deciding to take a particular action:

'I don't see but I must, and “leave the consequences to the Lord”, as Marmee used to say when she had to decide, and only saw a step of the road.