Should economics trump healthcare in responding to the COVID-19 pandemic

An Ethical Musings’ reader sent me these comments:

… which gets me to the question I’m struggling with. Saving lives is a worthy ethical objective. I’ve done my own math on “flattening the curve”, and slowing the spread of the virus could indeed save hundreds of thousands of lives (or more). Absent a vaccine, a large percentage of Americans will inevitably contract the virus even in a slowly spreading pandemic, but the healthcare system would have a chance at treating them as they present instead of the Italian scenario where people who could be saved by treatment are dying because no treatment is available. That’s the scenario where the mortality rate is 5-10% instead of the 1% that we’ve seen so far in the U.S.

On the other hand, shutting down the economy indefinitely has its own costs. Perhaps not life-and-death, but the costs are real in the sense of massive unemployment, loss of employer-provided benefits such as healthcare (a feedback loop?), etc. Also, is on 2009 the persons impacted early on were mainly the middle and upper classes, like myself. But in 2020 it’s the lower classes who are suffering first… and many of those are under 40, and they’re more likely to have small children in the home.

How do we optimally balance the needs of the medically vulnerable against the financial needs of those less medically vulnerable? This is becoming a political issue. There are “heartland” states that have relatively low infection rates. Most of them happen to be in the Republican camp, and most of the areas profoundly affected like NY are in the Democratic camp. That’s one aspect of the situation, but the pandemic also tends to oppose young people and old people everywhere. What sense do we make of these tradeoffs?

Below are my musings in response to those excellent questions. As always, comments are welcome.

First, the temptation to prioritize the wellbeing, whether physical health or economic, of one group over another group (e.g., heartland states over coastal states or young over the elderly) points to a weakness in utilitarian ethics. Seeking the greatest good for the greatest number inherently requires identifying not only potential benefits and costs, but also who will benefit or be harmed. In a worst-case hypothetical scenario, the benefits to the majority from enslaving a minority may, from the perspective of a utilitarian calculus, justify slavery. That morally abhorrent conclusion highlights the problems of entirely relying upon utilitarian ethics. Tens or hundreds of thousands of lives have tremendous moral weight. Any calculus about the value of resuming normal economic activity must therefore be heavily weighted in favor of public health safeguards.

In situations with well-defined limits, utilitarianism may prove ethically helpful, e.g., in a geographic area that has too few ventilators to save all persons suffering from COVID-19 related pneumonia, short-term triage that assigns ventilators to patients most likely to recover and with the longest life expectancies may be reasonable, presuming every effort is concurrently made to obtain more ventilators. Rationing based upon any set of socio-economic criteria disregards the equal worth of all persons and is thus unethical.

Second, the temptation to prioritize political or personal gain over the common good highlights the moral abyss of narcissism, whether personal or group narcissism. In a crisis, as in normal times, I want to live in a community, culture and society that values all persons equally. At times, I will benefit from this mutuality of reciprocal altruism; at times, I will pay a cost for this mutuality of reciprocal altruism. However, this mutuality constitutes the fabric that holds us together as a single community, the basis of human flourishing and the ethical imperative for having a strong social safety net, caring for the least among us.

In the present COVID-19 crisis, this mutuality offers guidance for shaping individual and community/state/national policy and programs. Following Maslow’s hierarchy of needs, health almost always is more important than economic or other types of wellbeing: unless a person is alive, food, shelter and money have no value. In short, lifesaving healthcare is priority number one. An informative exception to this generalization is the healthcare professional who risks his/her personal health for the common good.

After that clear top priority, prioritizing competing policies and programs that address various aspects of physical, social and economic wellbeing becomes much more complex and often unclear. Individuals and communities may have conflicting priorities. One consistent guideline for determining priorities is to protect the most vulnerable, our neighbors who face the greatest harm. Illustratively, the new federal law mandating two weeks of paid sick leave exempts companies with more than 500 employees. Yet, only 83% of the employees in those large companies currently have paid sick leave; those who do have paid sick leave often have only a week or less of paid sick leave per year. The law thus fails to protect some of the most vulnerable to the financial advantage of large corporations such as Amazon and Walmart. Similarly, any direct cash payments to individuals from the U.S. Treasury should go to all adults below a certain income level, not, as some in Congress have proposed, excluding those whose income is less than a few thousand per year.

Third, genuine federalism is better than one-size fits all. Genuine federalism – allowing states to set policies and establish policies – recognizes that COVID-19 may strike with different intensity along the coasts than in the heartland. Encouraging different policies and programs recognizes that little is known about the COVID-19 virus and essentially allows large scale experiments in the absence of evidence-based arguments to determine best case responses. As a matter of pragmatic ethics, science and not polls, claims about God's will, or private arrogance should determine public policy.