16 March 2020
People who read my other blog know well that I am fixated on moral philosophy, see https://onetruenorthspace.blogspot.com and search the term philosophy. This morning as I was reading the Washington Post I came upon an article that was so drenched in issues of moral philosophy that I could not ignore writing about it. I am going to post the link here. I am not sure if this coronavirus article is free like some of them are. Still, for those of you with WaPo access it is worth the read, https://www.washingtonpost.com/health/2020/03/15/coronavirus-rationing-us/
If you can’t get to the article here is a quote from it that sort of sums up what the whole thing is about.
In the Chinese city of Wuhan, the epicenter of the novel coronavirus pandemic, doctors made life-or-death decisions last month when 1,000 people needed ventilators to support their breathing, but only 600 were available.
In Iran, where numerous high-level officials have been infected, doctors sought unsuccessfully to get the international community to lift sanctions so they could purchase more lifesaving machines.
And in northern Italy, doctors took the painful step last week of issuing guidelines for rationing ventilators and other essential medical equipment, prioritizing treatment for the young and others with the best chance of survival.
Such tough choices could well be ahead for the United States, a nation with limited hospital capacity and grim epidemiological projections estimating that as many as 40 to 60 percent of the country’s population of 327 million could eventually become infected.
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In an extreme outbreak, rationing would raise tortured questions: Should someone with a terminal cancer or serious heart disease get more or less priority? Should the CEO of a hospital or a health worker be able to jump the queue? What about pregnant women? How should prisoners or undocumented immigrants be considered? All things being equal, would a lottery or coin flip be an equitable approach?
Spiking U.S. coronavirus cases could force rationing decisions similar to those made in Italy, China, by Ariana Eunjung Cha (Emphasis added)
The science is that the novel coronavirus will grow at an exponential rate if we don’t follow the protocols for social distancing. My guess is that we’re are headed up that predicted exponential curve. Why? Well yesterday, as I walked through my neighborhood here in East Lansing, Michigan, I happened to walk by a park. Multiple families with young children were using the playground equipment, (equipment that could hold the virus for 10 days to two weeks). There were 13 or more people out there-four or five adults and a passel of virus vectoring kids. Nope, that isn’t social distancing. Photos posted on social media show the bar scene here is East Lansing has been rocking. Nope, that isn’t social distancing. Some cities are going ahead with St. Patrick’s Day parades and festivities. Nope that isn’t social distancing. Well, you will get the gist, Americans are not good at social distancing because we don’t like being told what to do. We are free and we have rights, dabgumit!
So, unless something changes damn quick in a couple of weeks, we are going to be facing a crush of demand on our ICU resources. There will not be enough ventilators to go around. At that point doctors and politicians (and probably insurance company CEOs), are going to be deciding who lives and who dies. Who gets to live is a question of moral philosophy. RATIONING VENTILATORS is the trolley problem in real life. No humor in it, no wiggle room, some people will live and others are going to die.
Some states have already codified the hierarchy, younger over older, healthier versus sicker. Others haven’t. In those states it may come down to who has the best insurance. Or it may come down to who has the closest relationship to the ER doctors in the community. Or it may come down to the people who are in better shape because they had good insurance over the course of their life, winning out over the poor who are in rougher shape because they had no such coverage. Seriously, in a couple of weeks we may be faced with the rationing of life and death health care.
The author of the article quotes Arthur Caplan, a bioethicist. The quote is, ““The public will accept triage and rationing if they understand the process, but if it’s secretive or looks like favoritism to politicians or the rich, they will not accept that — whatever the rules are.” I am not sure he is right.
There are a great number of disenfranchised people in this country. 40% of American’s per an ABC News post cannot withstand a $400 medical emergency. https://abcnews.go.com/US/10-americans-struggle-cover-400-emergency-expense-federal/story?id=63253846 Do we seriously believe that this 40% of Americans are going to sit idly by while grandma is shunted into a corner to die because she is 70 and has had two prior heart attacks? Are they going to accept the “this will benefit society as a whole”, argument for allowing their loved one to die with just a whimper? I am not sure, but as divided as we are right now as a people, I don’t think so.
What do we to do to face the question of triage/rationing? I don’t know. What I do know is that we had better factor this issue of moral philosophy into our daily mental reflections right now. Why? Because unless we change our ways, it will be the question we will all have face very, very soon. I am not sure, but given who we are as a people right now, the response could be very problematic.
If you want to understand the trolley problem itself here is a good article in the Atlantic, https://www.theatlantic.com/technology/archive/2015/10/trolley-problem-history-psychology-morality-driverless-cars/409732/ For those of you who know my future plans the picture on the Atlantic cover sure looks like Tram 28 in Lisboa.
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