What is often presented as a binary 'jobs versus lives' choice in debates on the appropriate response for the Covid-19 pandemic is anything but. It's really a moral choice, although both sides can often present it as a conflict between their competing expertise. However, as a society, we appear incapable of having these debates in public in a reasonable manner.
There is no shortage of people pushing their opinions on the right response to Covid-19 that New Zealand should follow. We've been in a hard lockdown for just over three weeks (4 days to go until the initial end date given), and the government is likely to ease out slowly from the end of next week. Our Prime Minister told us last week that 'level three' would still have many of the restrictions on freedom of movement and activity in our current 'level four'.
An economist in yesterday's paper described the government's approach so far as a
"...least-regret strategy based on the assumption that people may get their jobs back, but lost lives cannot be recovered. This approach is favoured in extreme uncertainty where there are irreversible outcomes." 1
I thought that was a pretty good description of the choices the government had made.
The world is probably going into a deep recession whichever way our government chooses to respond. However, there have been some insistent voices that are pushing for the faster easing of restrictions because the economic and social costs of a deep recession are too high, as though that largely hinges on the actions of our government. On the other hand, their critics claim the proponents of easing are willing to sacrifice people for jobs and to protect the economy, and an understanding of the science shows us the correct way to proceed.
This misrepresents the true nature of the debate. This is, at its heart, a debate about values and morals and the right way to act in certain situations, which both medicine and economics can inform but not rule on. We shouldn't shy away from a debate about the relative value of people's lives compared with the long-term impact of decisions on our society, economy and communities. Within that debate, there's nothing inherently wrong with advancing the sort of utilitarian moral argument some of these people are making. You can choose to accept it or not. But critics of the lockdown don't present it that way because it looks too hard-hearted and most people reject that sort of analysis.
They present it as some well-founded judgement based on specialist knowledge and expertise that gives them insights that normal people don't have. Or on logic. Or the conservative's traditional refuge, 'common sense'. They fudge it to make it look as though they aren't making that comparison because they know that when it comes to people's lives, explicit utilitarian arguments and tradeoffs can offend many people.
We make utilitarian moral decisions all the time, even if we don't think we do. Governments certainly do and many of their policies are based on some interpretation of it. In health funding in New Zealand, the drug-buying agency Pharmac gets good deals with manufacturers by driving hard bargains on behalf of our state-funded health system. It also has to ration access to the most expensive drugs in order to maximise the benefit it can get for the greatest number of people from the budget it gets from the government. It's been the target of well-run campaigns by doctors and cancer support groups to get funding for some very expensive drugs. These campaigns have been emotional and the media have willingly featured individuals who would die in a short while without the drugs — many of them will die soon anyway, even with the drugs, but their lives could be extended by months or possibly a year or so.
However, many people will accept that the greater good is served by letting some people die sooner than they might so that a larger number of people can get a greater benefit from Pharmac's limited funding. That's a blunt way of saying it, but these are the trade offs we make, even if we feel uncomfortable with them.
When we are faced with a serious and sudden crisis that we think we might have a chance of influencing, we tend to go for moral absolutes, such as 'You can't put a price on a life.' Of course, we do put a price on a life, often implicitly and sometimes explicitly, as the Pharmac example shows. But, that's a situation we've become used to. A global pandemic caused by an unknown and unpredictable agent that could kill millions of people in a few weeks or months is not something we have had time to become used to, so we react strongly and tend to take morally absolute positions on it. Our humanity and compassion drives us to take drastic action — the 'least regret' strategy mentioned earlier.
"Tradeoffs involving health, mortality and money are uncomfortable to discuss, but it's the reality of public health." 2
The medical experts advising the government are also taking a moral stance on this, even if they don't necessarily present it as that. They also justify their stance on the basis of their expertise and on the science of the disease. But, there are a lot of value judgements that underpin their practice, e.g. 'do what ever is possible using the resources you have to save someone's life'. Things have to be pretty bad before doctors triage incoming patients and decide which ones they will try to save and which ones they will let die (although doctors in Italy had to do this because they didn't have enough equipment to treat everyone).
I don't have a problem with people making these utilitarian moral arguments about which decisions will cause the least harm, even though I would reject their conclusions to ease restrictions at this stage in the pandemic. However, the negative reaction to a proposal earlier this week to reduce the lockdown was swift and strong, and you would have to be brave or stupid or both to advance it at this time. The people making the proposal could have presented a better argument, but they didn't, and it was never going to fly with a government that has such strong public support for its approach. It's a shame that we aren't able to have deep discussions about these important matters of principle, even when we're in the midst of a crisis. The channels we have for doing so — the news media and social media — don't encourage it, or even make it possible. And, sadly, I'm not confident we will be able to have a public debate on them even after the crisis is over.