Covid 19: A moral dilemma for society
We must be clear about exactly what alternative we are choosing
Pedestrians in Dublin. Lockdown will save lives: that is undeniable. For anyone concerned about losing a loved one to Covid-19, this may seem like the only salient fact. However, as a society, if we decide to pull the lever and to save these lives, we must be clear about what exactly the alternative we are choosing is. Photograph: Paul Faith/Getty Images
The question of whether Ireland should go into a stricter lockdown has been centre stage for the past week. Those in favour of raising the level of restrictions argue that placing further restrictions on movement will break the spread of transmission, saving lives and sparing many from a long and trying illness.
Those against further restrictions argue that the harm inflicted on others through the negative consequences of a harsher lockdown outweigh the benefits of slowing the spread of the virus.
This choice, that we are facing as a society, can be viewed as an example of the “trolley car problem”. The trolley car problem is a thought experiment in philosophy designed to test theories of moral decision-making.
Imagine that you are the conductor on a runaway trolley car. The brakes on the car have failed and you have no way to stop it. You can see on the track ahead of you five people who are not aware of the oncoming trolley. If the trolley keeps going, all of them will die.
However, just before the trolley will hit the five people there is a diverging track, on which just one person is standing. You can pull a lever to change the track, meaning the trolley car will hit the lone person and not the five. The question is, do you pull the lever?
Most people, when faced with this thought experiment, say they would pull the lever. Killing one person to save five, all things being equal, seems like the obvious solution. Only someone who subscribes to a rules-based moral code and thinks that making the active decision to kill someone is never morally permissible regardless of the consequences of inaction, would be likely to demur.
Understanding the pandemic in these terms, it would seem like we have a strong justification for a stricter lockdown. In this view, the five people on the track represent all of the people who will be harmed by Covid-19 if we do not act. The individual on the other track represents the people who will be harmed from the side-effects of lockdown. While this harm is regrettable, we save more people by imposing the lockdown than by not.
The problem with this line of reasoning is that moral decision-making in real life is never as straightforward as in an imaginary thought experiment. In the trolley car problem, it is assumed that you have perfect knowledge of the situation. In real life, this is never the case.
In fact, there are a number of uncertainties that seriously complicate the solving of the real-life pandemic trolley problem. The first question is, how many people are “standing on the track” in front of us? That is, how many people are expected to die or suffer serious harm from Covid-19 if we do not act?
This is, obviously, a difficult question to answer. However, we are in a better position to do so today than we were back in March, when lockdown was first introduced and the facts were more uncertain.
There are still serious unknowns about the virus, including its possible long-term effects, but we have a better idea now about how deadly it is and about how it moves through a population. We have some basis on which to estimate its impact.
The second, and much trickier problem in applying the trolley car logic in the case of Covid-19, is to calculate how many people are standing on the other track. What are the costs of introducing a stricter lockdown? If you decide to pull the lever on the trolley car, you had better be sure that there are not 10 more people standing just out of sight down the track.
There are some harms we can predict here. We can estimate broadly what the immediate economic cost of a lockdown will be. We are also becoming aware of some of the other harms created by lockdown.
It was reported last week, for example, that many patients missed check-ups for cervical cancer due to concerns over Covid-19. How many patients with undiagnosed chronic conditions have also missed check-ups that might have caught the problem early? We can also ask about second order effects, such as how the suicide rate is likely to be affected by an economic downturn resulting from lockdown.
There are also harms that may be more difficult to predict. What will be the long-term economic effects of moving large parts of the population to remote working? Will it, for example, accelerate the off-shoring of high-skilled jobs by large companies? Will there be a long-term impact of a lockdown on the mental health of young children, whose lives have been sharply curtailed by the various lockdowns?
The point here is not to argue for or against lockdown. It is rather to illustrate that real-life moral decision-making is complicated and messy. In the real life trolley problem, we are not facing a straightforward choice between saving one versus saving five lives: the true consequences are extremely unclear. To present it as obvious that we should choose one option or the other is likely to miss the complexity of the situation.
Lockdown will save lives: that is undeniable. For anyone concerned about losing a loved one to Covid-19, this may seem like the only salient fact.
However, as a society, if we decide to pull the lever and to save these lives, we must be clear about what exactly the alternative we are choosing is. This means broadening the conversation we are having as a society to talk about these other questions.
The decisions we make today in response to the pandemic raise a variety of questions, and not all of these can be answered by infectious disease specialists alone.
These are the questions that we, as a society, must engage with. We cannot outsource our moral decision-making to Nphet, or the Cabinet or anyone else. Each one of us has a stake in the decision of whether or not to pull the lever on the trolley car. Conor McGlynn is public affairs consultant with Red Flag Consulting and will be taking up a research position at the Wilson Center in Washington in the new Year