Who Breathes, Wins

C-19. It sounds like a far-right paramilitary group dedicated to expelling foreigners and purifying the race. The kind of people for whom the leap from deporting illegal aliens to euthanazing the disabled is more of a Sunday afternoon stroll. But Covid-19 is already forcing members of the medical profession in Italy to choose who lives and who dies – or, at least, who is given the greater chance of living. The virus is not one which kills as a matter of course, so the decision is not absolute, merely percentile. There is a nettle to grasp, however, and it needs to be grasped before those little sacks of formic acid get to the point where they still shatter in the middle. How, and under what conditions, can this decision be made?
An Australian Broadcasting Corporation (ABC) article online by Julian Savulescu and Dominic Wilkinson, both professors of medical ethics at Oxford (and also both involved in the care of children) seeks to address this very question. Allegedly.
The article poses the question ‘how should Australia ration a limited supply of ventilators?’ It then gives 5 possible answers:

1. Egalitarianism: equal access to all (effectively, first come, first saved)
2. Utilitarianism: the greatest good for the greatest number (or, use the resources in a way that saves the greatest number of people)
3. Contractualism: how would you want to be treated? (there is no real argument here)
4. Flatten the curve: restrict the public to limit peaks of demand (too late!)
5. Paternalism: do not cause more harm in trying to do good (or, it’s the best for you)

Each approach is flawed. They point this out.
Then, they stake their claim:

Doctors should make decisions about what risks are worth taking — but not in the name of the patient. Rather, in the name of all patients.
It is justice which should guide these decisions.
We simply don’t have enough ventilators and now we have to make ethical decisions about how they are allocated.
Unavoidably, there will be winners and losers. We have to take responsibility for making those decisions as ethically as possible.

Why thank you. But this is, philosophically speaking, horseshit.

Firstly, it’s all well and good talking about justice, but to then say that ‘justice’ is a ‘decision made by doctors in the name of all patients’ is, well, flawed might be a good start.
Justice is not about one sector of a population deciding on behalf of another, it is about a system deciding impartially for the good of society. It’s flawed, of course, but we’ve been working on it since Plato. It gets a bad rap when for most people ‘justice being done’ means ‘I got what I wanted’ but that’s life. The word justice is intoned here because it’s a BIG WORD and you shouldn’t argue with it (unless you disagree with what it tells you to do).
It all rather smacks of ‘Don’t worry your pretty little head about it. We know what’s best.’ To be fair, they ought to, as it’s their job, but don’t try and bamboozle us with big words. Just say ‘let us get on with it now and we can contemplate it later.’
As for ‘we have to make these decisions as ethically as possible,’ the same rules apply. Ethics are ‘the moral principles that govern our behaviour.’ Well, fellas, just whose ethics are you going to apply? You can’t just say ‘ethics’ and run away.
Think of the old conundrum: you see a burning building with two people trapped. You cannot save both. One of them is Nelson Mandela. What do you do?
Well? Ok. Firstly, who’s the other? Secondly, Nelson Mandela when? Before he was president of South Africa or a week before he died of old age? Thirdly, who am I? An Afrikaaner, AWB through and through or … you get the picture. Whose ethics?
The problem is that things are never black and white, never predictable, never certain.
Take me, for example. As a twelve-years diagnosed person with parkinson’s, I fit neatly into the UK government’s newly defined ‘vulnerable’ category (which doesn’t entitle me to any benefits, free presciptions, nada. Makes you wonder whether the DWP will assess us all to decide who has to stay inside for four months or who doesn’t get into an ICU). Kathryn Hearn wrote about this in the Guardian without saying much, unfortunately, but this category is one of those already being taken into account in Italy with regard to who gets the ventilator. Is that fair? More to the point, does this not rather suggest that my life is considered less valuable than someone else’s? If so, then surely the more disabled, the less valued you become? What about someone who’s a bit dim? Maybe kinda ugly? C-19’s manifesto writ large.
I’m not saying I have the answer, or even an answer, but I am saying we need to think very hard about the question – preferably when we have the leisure not simply to react. What sort of society do we truly want to live in? Simply saying ‘justice’ and ‘ethics’ but, like Pilate, not hanging around to hear the answer will not do.

And this, this is the kicker, the cat truly in the pigeon-loft … what kind of society makes veiled threats that ‘the vulnerable may have to be sacrificed for the greater good’ when it denies those same people rights over their own lives, namely, the right to die with dignity when they can bear life no longer?
This is a human rights issue, as Afua Hirsch has pointed out, though without delving particularly deeply – there are side-effects to everything. After all, when Mark Zuckerberg gets to define ‘right behaviour’ through his avowed and public decision to censor facebook, then we are in trouble.

How can it be good for anyone? There’s no justice here. Just them, and us. And neither of us know which is which.

2 thoughts on “Who Breathes, Wins

  1. Yep, the answer is not there. The Doctors in Italy have to act, as they will have to elsewhere. There is no point in attaching a moral philosophy to it. The human beast will say ‘oh yes, Utilitarianism is the way to go: the greatest good for the greatest number’ that way lies Eugenics and most of the -isms we endured in the last century, but that of course is not the big problem. Whichever ethical code you, I or Jo and Joanna Public decide always has an unsaid coda ‘except for when it comes to me or mine.’ My fingers are crossed for you, Pete. I wish we hadn’t had 12 years of austerity leading up to this moment, I wish we had a horse of a different colour in the lead… I wish… I wish…
    Good luck, and thanks for a terrific (in several senses) read.

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