Re-starting the US economy "even if that costs lives"

“In the middle of April, reports began to emerge that Donald Trump — and the state governors who support him — would be relaxing COVID-19 restrictions in an attempt to re-start the US economy. One of the arguments deployed was that keeping the economy in hibernation costs more in the order of lives lost than the virus ever would. In other words, better to open up the economy and risk further infections than to shut it down at the risk of unemployment and poverty, and the health implications that are aligned with these — including death…

“There are two strains of this debate which — though no doubt appealing for good reasons and perhaps well-intended — should, on closer analysis, be rejected. The first undertakes the kind of cost-benefit analysis I’ve associated with Trump, and argues that the right path becomes clear on the basis of a crude calculation of lives saved versus lost. The second attributes to proponents of either ‘side’ an intent to take lives in pursuit of their goal. This grenade doesn’t belong to anyone in particular — it has been thrown at those whose focus is on limiting the spread of the virus and those who wish to wear the risk of infection and open up the economy, alike. These ways of thinking bring to mind a thought experiment known as ‘the trolley problem,’ which was recently popularized on the Netflix series The Good Place.

“Imagine a tram hurtling down a track without a driver. Five people are tied to the track some way ahead. If nothing happens, the tram will kill them. However, you are standing next to a lever which, if pulled, will lead the tram onto a side track. Unfortunately, there’s one person tied to that track. Do you let the tram run by and kill five? Or switch it and kill one?

“The moral philosopher Philippa Foot designed this thought experiment in order to test how different ethical frameworks would approach the conundrum it presents — which has, at first glance, some resonance with our current moment. Five lives or one?

“Most people choose to pull the lever: better to save five and lose one. But it’s foolish and unhelpful to deploy this kind of thinking as we find our way out of lockdown. It devalues lives by allocating dollar figures to the worth of individuals in order to support its calculus, typically pitting the strong against the weak, and leading to disturbing outcomes for the elderly, the disabled, and the sick. If the person you love most is the one whose life is sacrificed, would you be satisfied with this calculation?

“There’s a variation of the experiment in which the choice doesn’t involve a lever, but a large man. Would you push him in front of the tram to stop it, sacrificing his life, but saving five in the process? A thoroughgoing consequentialist would: what matters is the outcome, not the action. But many choose not to push the man, even if they pulled the lever. In so doing, they reveal that they adhere to a duty never to directly and intentionally take a life, no matter how it might affect the cost-benefit analysis. Most in our community subscribe to this commitment.

“No one I’ve come across intends actively to harm people in order to see the community protected from COVID-19 or the economy reopen, though it’s become popular to accuse political leaders and advocates on both sides of doing precisely this. I think that’s both uncharitable and inaccurate.

“A more fruitful avenue for analysis comes into view when we consider our current predicament using a very old tool for ethics: the principle of double-effect (PDE). This principle recognizes that sometimes good or morally neutral actions can precipitate negative consequences, and it provides a way of assessing whether one should still commit to those actions even though their negative consequences are foreseen.

“Imagine, for example, a political leader explaining: ‘I plan to place the nation I lead in lockdown to prevent the spread of COVID-19 and save lives (an unambiguously good action), but foresee that this will have negative effects in other areas: jobs, mental health, etc., which may also cost lives (a negative consequence).’

“The same kinds of questions arise when I consider the trolley problem. Is it ethical to choose these courses of action, knowing full well that there will be negative outcomes? PDE offers four ‘tests’ to help clarify one’s thinking:

1. Is the action itself good, or morally neutral? (Pulling a lever to save five people is morally good, whereas pushing a man in front of a tram is not.)
2. Does the negative outcome follow on from the good or morally neutral action? (This protects against using evil means to achieve good consequences — I cannot commit murder, even to save the five.)
3. Is the intention of the acting agent for the good? (If I pull the lever because I want to kill the one person tied to that track, then my action isn’t ethical — even if the consequences look better on the balance sheet.)
4. Is the negative outcome proportionate to the good achieved? (Saving five lives is, on balance, proportionate to losing one — as tragic as this is.)

“Preventing the spread of COVID-19 through lockdown measures, even foreseeing dire consequences to the economy, passes PDE’s tests. One only needs to glance at the data from countries which have not taken these measures with the same seriousness to see this. But there are three reasons that a radical relaxing of restrictions — as seems to be on track in parts of the United States — in favor of stimulating the economy, while anticipating the consequences of a greater number of infections, do not pass the same tests. Considering these carefully might help to chart a more just and creative way out of our current predicament.

“First, reactivating the economy is not an unambiguously good, or even neutral, action. We should not forget that baked into [the U.S.] economy, for example, are significant injustices. These have been exacerbated by COVID-19, but they were there all along. We should remember, for instance, that those deemed ‘essential workers’ are some of the most poorly paid in our country, who have placed themselves at risk during this lockdown, and that an increase in economic activity will also lead to increased risk of infection for them…

“We should also remember that key aspects of our economy rest on supply chains riddled with poor working conditions and modern forms of slavery… Is pushing for the reanimation of ‘business as usual’ in this regard really a good thing?

“Second, there is an unambiguous link between the rate of COVID-19 infection, health burden, and death. The link between economic shut down and health impact, including suicide rate and death, is not as simple. To be clear: there is a relationship — no one is denying that. But the link is a long-term one: there is distance and time between cause and effect, which allows for different kinds of actions along the way to mitigate against negative outcomes…

“But the distance between contracting COVID-19 and dying is much shorter, and the end result is irreversible. It’s as if the trolley problem was changed, and the five are much, much further down the track than the one. In such a case, we shouldn’t pull the lever because we have the benefit of time and distance to stop the tram or free the people in some other way.

“This leads to the third point, which I think is the most significant. Whenever I teach using the trolley problem, those in the room always come up with innovative solutions: pulling the lever half-way and derailing the tram; running really fast after pulling the level to untie the one; or jumping in front of the tram themselves. This derails the thought experiment and the teaching moment is lost — sometimes I even place rules on it (you can only choose one or the other) to avoid this. But still, people rebel and use their creativity to come up with new responses.

“Faced with the choice between easing restrictions to stimulate the economy and keeping them in place to prevent the spread of COVID-19, I suggest we engage this same spirit of rebellion. Let’s reject the either/or boundary. Let’s commit to the unambiguously good goal of preventing the spread of disease. And instead of restarting an economy that requires sacrifice to survive, let’s dream up a new way of organizing our finances that doesn’t need the principle of double-effect: one that truly serves the good of all.

“I know, I know. This sounds like another impossible demand from a well-intentioned person who really doesn’t know how it all works. How could we possibly effect such change? …In society more broadly, housing was provided to the homeless; the potentially unemployed were kept in their jobs through massive government subsidies; airline staff were redeployed in supermarkets; gin distilleries were making hand sanitizer, and the list goes on. None of these things seemed possible at the beginning of March. So perhaps the real dreamers are those imagining that things can be re-booted and be the same, even if that costs lives. That sounds to me like a nightmare. We can do better” (Patheos). 

Daniel Fleming leads ethics and formation for St. Vincent’s Health Australia. He is also a Visiting Fellow of the Law, Health and Justice Research Centre at the University of Technology, Sydney.