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Eusebius McKaiser: How do we decide whose lives matter most?

COMMENT

It is entirely possible that when we say, “Two more people died from Covid-19 and both were over the ages of 60” or “A man in his thirties died from Covid-19. He had several comorbidities including hypertension, diabetes and obesity”, we are merely reporting facts. Furthermore, if there is any agenda, you might say it is a defensible one: to calm the general population in a time of the pandemic by conveying (truthfully) a possible pattern among those who succumb to Covid-19. In other words, the public can know to not panic too much (which is not to say we shouldn’t be careful) if you are not in one of the risk groups.

I get all of that, and in a lot of governments’ communications around the world I think something like this is the motive for denoting comorbidities and the ages of those who died.

But something bothers me (and this is not a hard argument, but a thought floating for several weeks now). I know “subtext” can be as vague as “tone”, so when we talk about the subtext in communication we really often should simply say, “This is how, on a personal level, I hear you…” “Subtext” isn’t necessarily objective.

With this torturous qualification out of the way, it feels like we sometimes imply that the deaths of old people or people who had chronic diseases and various comorbidities are less of a tragedy than if a healthy or a young person were to die.

In one of my favourite radio interviews during this pandemic thus far, with brilliant Wits University professor Shabir Madhi, who did a really admirable job of explaining the rationale for why Sweden had approached the pandemic as it did. I challenged his brute utilitarian reasoning — effectively that mostly old people would be at risk and not younger people if we sent kids to school sooner, thereby implying that, over the long term, it is better for society’s societal-level survival to get that process done sooner rather than later so we do not also suffer other public health (not economic) disasters that come with a strict level 5 lockdown.

Something about his reasoning was coherent but seemed to me off-key, morally. And it struck me as obvious. That he did not recognise, implicit in his reasoning, any kind of intrinsic value attaching to the lives of old people or people with comorbidities. The subtext was that it would be a bonus to save as many of these categories of citizens as possible but that we must, at a policy level, bite the bullet and ask what is in the systemic interest of an entire population that wants to endure across time.

But if I am a 70-year-old citizen, with inherent dignity and rights to healthcare, quite apart from moral claims against the state to treat me decently, and equally, then why should my fragile embodiment be seen, without my consent too, as disposable?

The same goes for people with comorbidities. If someone is 30, has a chronic lung condition and diabetes, why should we imply in our trade-off calculations that that person’s life should obviously be deprioritised when it comes to thinking through the pros and cons of various responses to the pandemic?

Here, by the way, we are no longer talking pure science or pure maths. We are now making value judgments that all citizens can legitimately have a view on and debate publicly. Yet this debate has not been centered much publicly. We have, along the way so far, talked a little bit about medical ethics and the choices faced by the individual healthcare worker needing to decide in real time who to allocate scarce resources to. For one thing, many doctors I have spoken to feel uncomfortable about this heavy ethical burden even as the pandemic compels them to make a call anyway. They often do, so tough medical ethical calls aren’t invented this year. But even medical ethics should be opened up for wider public debate, because answers to ethical and moral questions are not the exclusive business of doctors or nurses or even public healthcare experts to settle. It would be useful for all of us to become a bit more literate in ethical reasoning, and to enter these tough debates, and in fact to help take some of the burden off overworked healthcare workers by ensuring that codes that get developed by hospitals and professional medical bodies reflect public moral sentiment that is based on well-framed public debate.

Here moral philosophers can be of enormous help. Obviously not all philosophers have the skill or the inclination to transpose academic expertise into popular discourse (without loss of complexity), but an attempt should be made. Otherwise all the moral philosophy seminars we did and papers we wrote would be purely academic, and that would be a shame. (As an aside, I think there are enough experts who can do this, and the media — especially producers — need to work a bit harder to think about what discussions to create that are not already being had, and to think more carefully, based on better content research, about who to give media access to.)

Lastly, the wider policy questions about how to respond to the pandemic and “which lives matter most” are not quite the same — although there is a relationship — as the situation-specific ethical calls doctors are compelled to make in the ward. By this I mean that the kind of discussion Professor Madhi opened up brilliantly on my show (regardless of whether you agree with where he ended his analysis or not) is a discussion the public should be invited to enter, even if that requires first empowering laypeople to have the language and the frameworks, and the understanding of the normative issues, to join the discussions productively.

What we have instead are way too many secret decisions being made that affect you and me, and generations to come, profoundly. We do not know what models the government is using to inform lockdown decisions. We do not know (therefore) the assumptions built into those models (assumptions that are not merely mathematical but simultaneously value judgments deceptively expressed as “objective” numbers). We do not know the thinking of the government on how to adjudicate the trade-offs, with radical structural and existential consequences, between equally unsatisfying strategies.

Which brings me back to the beginning. If we do not treat citizens as adults, and openly and carefully frame and invite debate about every aspect of our response to the pandemic, you might find your mother or your lover dead because a statistician or director general or doctor close to the president took a gut decision about whose lives matter (most).

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Eusebius McKaiser
Eusebius McKaiser
Eusebius McKaiser is a political and social analyst at the Wits Centre for Ethics. He is also a popular radio talk show host, a top international debate coach, a master of ceremonies and a public speaker of note. He loves nothing more than a good argument, having been both former National South African Debate Champion and the 2011 World Masters Debate Champion. His analytic articles and columns have been widely published in South African newspapers and the New York Times. McKaiser has studied law and philosophy. He taught philosophy in South Africa and England.

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