Costs and Risk Imposition in a Pandemic
At midnight on 5 November 2020, England went into another national lockdown to deal with the sharply rising Covid-19 infection rate. This lockdown superseded a series of local lockdowns that have enveloped some regions for months on end. Until an effective Covid vaccine can be rolled out comprehensively, lockdowns seem destined to remain a primary instrument of policy, at least in the UK.
These bleak facts raise a number of important moral questions. What costs should we accept in order to reduce the transmission of Covid and minimize the deaths and long-term health complications that ensue from it? The longer we wait until we fully re-open the economy and allow ordinary life to resume, the greater the damage to our economic and social lives, and the more protracted the subordination of our personal liberties. But re-opening the economy and allowing people to come and go as they please will inevitably involve much higher levels of interactivity between us, and this may be very costly for some. The result will be an expected increase in the transmission rate of the virus, with lethal outcomes in some cases and long-term health complications in other cases.
It takes no special powers of advocacy to get anyone to see that this is a difficult and painful situation. What should our broad approach be as we attempt to plot a path out of it?
Different approaches have been suggested. Alec Walen and Bashshar Haydar (2020) think that what can be reasonably demanded of us depends on the costs we would have to bear, and on how long we would have to bear them. At the centre of their discussion is a variant of a famous thought experiment due to Peter Singer (1972). Imagine that I have saved up for a decade and bought a Bugatti for myself: it is to all intents and purposes irreplaceable, and my pride and joy. I now face the choice of whether to allow a boulder to roll into my Bugatti, thus destroying it, or else failing to prevent the boulder from crushing a child to death. However painful a loss this is to me, I should sacrifice the Bugatti and save the child: children’s lives must rank over my possessions, however precious they are to me.
This is a one-off case, but the news for me is about to get worse, because Singer is prepared to generalize the lesson. His favoured principle instructs each of us to sacrifice our resources in order to save lives up a point where we would risk losing just as much as those whom we are required to save. This is an extremely demanding picture of morality, but Singer thinks that it follows from honest reflection on the simple case he embarks from.
What costs should we accept in order to reduce the transmission of Covid and minimize the deaths and long-term health complications that ensue from it?
Walen and Haydar are not so sure. For them, there is a big difference between the level of sacrifice that may be appropriately demanded of us in one-off cases, or over short bursts of time in a designated emergency, and the long-term sacrifices that may become part of the ‘new normal’ in a world in which Covid infection remains a prevalent threat. It is one thing, they suggest, for morality to demand of me that I write off my Bugatti, but quite another thing if I am required to live like a church mouse on a permanent basis in order to save as many people as I can. I cannot be reasonably expected to sacrifice my life to morality in that way. At some point, my life would cease to be genuinely mine and become merely a handy resource for the production of morally good outcomes. As applied to the coronavirus crisis, Walen and Haydar think that there must be a limit to the sacrifices that can be reasonably demanded of us as the various lockdowns endure.
2. Killing versus Saving Lives
There are many questions that can be raised about this sort of anti-demandingness argument. But Helen Frowe has argued, in a direct response to them, that Walen and Haydar actually misidentify the main challenge. On Frowe’s view, it is not a matter of saving others from death, but of refraining from infecting them, with perhaps deadly results, in the first place. And this changes the moral arithmetic entirely.
Frowe sketches a pair of cases to explore the distinction she wishes to defend. In the first case (‘Case 1’), Alice would have to sacrifice her arm to save Betty from drowning. In the second case (‘Case 2’), Alice would have to kill Betty in order to escape from an attacker who will otherwise cut off her arm. It makes sense to maintain in both Case 1 and Case 2 that the choice facing Alice is between her arm and Betty’s life. But the intervening facts about agency are quite different, and this makes a difference to what Alice is permitted to do. Alice cannot inflict the harm of death on Betty to save her arm in Case 2, but she can permissibly refrain from saving Betty’s life to save her arm in Case 1. Frowe concludes that we should, in general, accept greater personal costs to ensure that we do not harm others than we should bear in order to save them from other dangers.
Two more particular lessons follow from Frowe’s discussion. First, the slogan used by the UK government during the early part of the Covid pandemic (‘Stay Home, Protect the NHS, Save Lives’) was misleading. We were, and are, staying at home primarily in order to ensure that we do not infect and perhaps kill others. Second, the accumulated costs that we should be expected to put up for the duration of the lockdown (and its aftermath) are considerably higher than they would be if our only concern was to save lives. We can presumptively expect, on moral grounds, to be required to sacrifice more in order not to kill others than we would in order simply to save them from dangers for which we were not responsible.
3. Reciprocal Risks and Waiver
There are other dimensions of risk imposition that make a difference to the moral arithmetic, but which Frowe does not address. One of these is concerned with the reciprocal nature of the threat. When it comes to the likelihood of infection, each of us poses a risk to others, and others pose a risk to us. (I ignore those who have already been infected and have acquired immunity. I am also going to assume that those people who know that they are infectious should isolate themselves from the community.) We therefore stand in a reciprocal relationship with each other: everyone is basically a threat to everyone else.
This is a situation that to some degree resembles the ‘state of nature’, or the social world in the absence of political authority, which Thomas Hobbes speculates about in grisly detail in his Leviathan. For Hobbes, the mutual and reciprocal nature of the threat should teach each individual that everyone is in the same boat, and impress upon them that there are common benefits to be gained by an alteration in their attitudes to each other and an adherence to common rules. (They do need, however, an all-powerful enforcer to make them live up to all they might be.) But there are also things we can learn, nearer to home, about the management of the Covid crisis.
Another pair of cases allows us to explore the difference made by reciprocal threat-making. The first of these (‘Case 3’) is an asymmetrical case: Alice and Betty both know that Alice is free of infection, but neither of them knows whether Betty is infected. In venturing into her company, Betty poses a risk to Alice’s health, a risk to which Alice was not previously exposed. Now perhaps, as it turns out, Betty does not infect Alice, either because she is not infectious after all, or because she is infectious, but Alice remains luckily uninfected as a result of their proximity. If that is so, Betty’s proximity to Alice has not harmed her. Does it follow that Betty has not wronged Alice? No. Betty can wrong Alice by exposing her to the risk of being harmed by Betty, even if, as in Case 3, the risk does not eventuate in actual harm. For all Betty knew, she might have been infectious, and so she might have infected Alice, and so there is a definite sense in which Betty has exposed Alice to the risk of harm.
In the second case (‘Case 4’), neither of Alice or Betty knows who is infected: as far as Alice is concerned, she might be infectious, and therefore infect Betty, or Betty might be infected, and therefore infect Alice. Betty is similarly ignorant of who is infectious. In Case 4, as far as Alice is concerned, she risks infecting Betty, but Alice also runs the risk of being infected by Betty. And exactly the same goes for Betty: she risks infecting Alice, but she also runs the risk of being infected by Alice. Each of them sees themselves both as a potential victim but also as a potential threat.
If I am wronging you and am also being wronged by you, and you are wronging me and are also being wronged by me, then it will turn out — subject to the satisfaction of some further conditions — that neither of us is wronging the other.
Of course, if Alice is an actual threat, in virtue of being infectious already, then she is not a potential victim. It is too late for that. But the same goes for Betty: if she is an actual threat, in virtue of being infectious already, then it is too late for her to be a potential victim. An epistemic symmetry between them still exists: as far as each of them is aware, there is a chance of Alice infecting Betty, and there is a chance of Betty infecting Alice. If Alice is wronging Betty, then Betty is also wronging Alice, and for the same reasons.
We can enlarge these two-person cases such as Case 3 and Case 4 in order to encompass our ordinary activities involving interaction with lots of other people, thus moving to genuinely collective cases. In these cases, is each of us wronging everyone else? It is hard to see why that should be so, if it would be also true to say that each of us is being wronged by everyone else. It is tempting to affirm that, under certain conditions, these presumptive wrongs basically cancel out, or neutralize each other. If I am wronging you and am also being wronged by you, and you are wronging me and are also being wronged by me, then it will turn out—subject to the satisfaction of some further conditions—that neither of us is wronging the other.
What would have to be true for these annulment conditions to obtain? I think the answer is roughly this: we would all have to agree, either implicitly or explicitly, to run a moderate risk of being infected in order to resume a recognizable life. When the relevant conditions obtain, we will have waived our right not to be in the vicinity of an infected person by taking a chance that we will get lucky. I will waive my right not to be infected by you whenever I am in proximity to you just in case you waive your right not to be infected by me whenever you are in proximity to me.
When the relevant conditions obtain, we will have waived our right not to be in the vicinity of an infected person by taking a chance that we will get lucky.
Frowe herself lists examples of risky collective activities, such as driving, cycling, and horse-riding. What could make these activities permissible, given that they either risk harming others or else risk potentially depriving others of scarce medical resources if the risks turn out badly for these drivers, cyclists, and riders? The answer must have something to do with the fact that we all accept these risks, and all benefit from reciprocal risk-sharing. Now not everyone is actually going to have the desire or opportunity to ride horses, climb mountains, or go cycling. But all of us have an interest in at least having the option of participating in these moderately risky activities, actual participation in which will then be determined by opportunity and personal preference. We do not want to wrap ourselves in cotton wool and fearfully stay at home. Since that is so, we agree to inhabit a moderately risky world. We hope for the best, plan for the worst, and in the meantime do our best to live recognizably human lives, pursuing recognizably human activities.
4. The Conditions for Waiver
To secure in full the conditions for the waiver model I have described, other things would need to be in place.
First, since the mechanism for waiver depends on agreement, in either an explicit or (much more likely) an implicit form, we would be required to ensure that this agreement must in some robust sense count as an unforced one. Requiring some people to bear risks for the comfort of the rest of us, and threatening them with joblessness unless they shoulder those risks, is unlikely to pass this test. This does not mean that everyone has to face exactly the same risks and collect the same benefits in the post-lockdown world. But we would need to avoid situations in which some are visibly exploited for the benefit of others through the lack of better alternatives.
Second, we would need some sort of medical safety net: we would need assurance that there was sufficient capacity to treat us if we became infected and required medical intervention.
Third, we would need to add safety features to the average social environment where distortions in the meaning or the significance of the activity could be avoided, or where physical intimacy was not essential to our interactions: social distancing where practicable, hand sanitisers, mask-wearing, and so on.
Fourth, we would need to take measures to ensure that those people who are at especially high risk can shield themselves from infection. These people are not in a position to reap the benefits of a resumed social life, because the costs of infection would be too high for them. We should not force them to venture into risky environments out of concern that they will otherwise starve or face serious disadvantage. (They might face serious disadvantages through prolonged isolation, of course, but these social costs are unavoidable. We should also permit these people to take their chances and hope for the best if they find isolation intolerable.)
If and when these conditions were in place, however, it would no longer be the case as we went about our daily business that one of the risks we were running was that of manslaughter. We might still be the cause of other people’s dying, but our victims will not have been infected as a result of their exposure to a risk that they had a compelling interest in avoiding.
Frowe, H. "Is staying at home really about ‘saving lives’?’". CapX. 14 May 2020.
Haydar, B. and Walen, A. "The ethics of a pandemic are not those of a ‘new normal’’. CapX. 12 May 2020.
Hobbes, T. Leviathan. 1651.
Singer, P. "Famine, Affluence, and Morality". Philosophy & Public Affairs 1 (1972): 229-243.
Disclaimer: Any views or opinions expressed on The Public Ethics Blog are solely those of the post author(s) and not The Stockholm Centre for the Ethics of War and Peace, Stockholm University, the Wallenberg Foundation, or the staff of those organisations.