Making life-saving decisions in a pandemic

The COVID-19 pandemic has thrown a spotlight on the question of how the people at the top -- those in charge of companies and public organizations -- should allocate scarce resources in the face of life-threatening situations.  

So it is important to reflect on how best to do that. I would like to suggest three ways to do it:  two ways that are widely applied but fundamentally flawed, and one that is not so well known but can actually be applied successfully by ordinary mortals.

None of this is original. Philosopher Robert Koons described them recently in an issue of First Things.  But originality is not usually a virtue in ethical reasoning, and in what follows, I'll try to show why.

In the 1700s, the Enlightenment thinkers Adam Smith and David Hume devised what Koons calls a "difference-making" way of coming up with moral decisions.  

The way this process works is best described by an example.  To properly assess an action or even the lack of an action, you must figure out the net difference it makes to the entire world.  Koons uses the example of a homicidal maniac who, if left to himself, is bound to go out and kill three people.  Suppose you know about this maniac: you can either do nothing, or choose to kill him.  If you do nothing, three people die; if you kill him, only one person dies.  Other things being equal, the world is a better place if fewer people die, so the logic of difference-making says you must kill him.

That's an extreme example, but it vividly illustrates the rational basis of two popular ways of making moral decisions involving public health.  Let's start with the commonly-heard statement that every human life is of infinite value.  

Few would dare to argue openly with that contention, yet if you try to use it as a guide for practical action, you run into a dilemma.  Even something as simple as your driving a car to the grocery store exposes other people to some low but non-zero chance of being killed by your vehicle.  If you take the infinite value of human life seriously, you will never drive anywhere, because infinity times (whatever small chance there is of running over someone fatally) is still infinity.

Extreme measures may not be helpful!

Koons calls one way of dealing with this dilemma "sentimentalism."  He's not talking about people who watch mushy movies, but the fact that the sentimentalist, in the meaning he uses, abandons logic for emotion and settles for life more or less as it is, but feels bad whenever anybody dies.  Such people exist in a constant state of deploring the world's failure to live up to the ideal that every human life is of infinite worth, but otherwise derive little moral guidance from that principle in practice.

The more hard-headed among us say: "Look, we can't act on infinities, so if we put a finite but large value on human life, at least we can get somewhere."

Applying the difference-making idea to human lives valued at, say, a million dollars, allows you to make calculations and cost-benefit trade-offs.  Engineers, for instance, are familiar with technical trade-offs, so many engineers find this method of moral decision-making quite attractive.  But one of many problems with this approach is that it requires one to take a "view from nowhere":  there are no boundaries to the differences a given decision makes, other than the world itself.  Again, if we try to be truly logically consistent, calculating all the differences a given life-or-death decision makes is practically impossible.

At this point Koons calls Aristotle and St Thomas Aquinas to the rescue.  Operating under the umbrella of the classical virtue called prudence, Koons asks a given person in a given specific set of circumstances to judge the worthiness of a particular choice facing him or her.  He sets out for things that make a human act of choice worthy:  

  1. whether the human is applying rational thinking to the act, rather than random chance or instinct
  2. what the essential nature of the act is
  3. what the purpose or end of the act is, and
  4. what circumstances are relevant to the act.

Weighing up alternatives

Unlike the difference-making approach, which imposes the impossible burden of near-omniscience on the decider, judging the worthiness of an action doesn't ask the person making the decision to know everything.  You simply take what you know about yourself, the kind of act you're contemplating, what you're trying to accomplish, and any other relevant facts, and then make up your mind.

In this process, some decisions are easy.  Should I kill an innocent person, a child, say?  Item two says no, killing innocent people is always wrong. 

Here's another situation Koons uses, but with an example drawn from my personal experience.  You walk outside your building past a bicycle owned by a person you really hate (call him Mr SOB) and would like to see out of the way.  You notice that someone who hates Mr SOB even more than you do has quietly disconnected the bike's brake cables, so that unless Mr SOB checks his brakes before he gets on his bike, he will ride out into the street with no brakes and quite possibly get killed.  

If you decide to say or do nothing, you have not committed any explicit act; you have simply refrained from doing anything.  But item three says your intentions in refraining were evil ones:  you hope the guy will get killed on his bike.  In this case, not doing anything is a morally wrong act, and you are obliged to warn him of the danger. 

A United Nations response

And in less extreme cases, such as when public officials decide how to trade off lockdown restrictions versus spending money on vaccines or public assistance, the same four principles can guide even politicians (!) to make decisions that do not require them to be all-knowing, but do ask them to apply generally accepted moral principles in a practical and judicial way.

Of course, judiciousness and prudence are not evenly distributed virtues, and some people will be better at moral decision-making than others.  But when we look into the fundamental assumptions behind the decision-making process, we see that the difference-making approach has fatal flaws, while the traditional virtue-based approach using prudential judgment can be applied successfully by any individual with a good will and enough intelligence to use it.


Join Mercator today for free and get our latest news and analysis

Buck internet censorship and get the news you may not get anywhere else, delivered right to your inbox. It's free and your info is safe with us, we will never share or sell your personal data.

Be the first to comment

Please check your e-mail for a link to activate your account.