How We Reason About Covid Tradeoffs

The Covid-19 pandemic has presented ugly tradeoffs between life and livelihood, and even between life and life. We don’t know the number of deaths that will result from unemployment, poverty, and social isolation over the next several years, but we know they are occurring, along with untold misery for millions more.

With fall looming, two difficult tradeoffs must be addressed: whether and how to open schools, and whether and how to play sports. Returning to normal would almost certainly contribute to the spread of the virus, increasing the risk of death for the most vulnerable. But halting these activities would incur serious economic, public health, and psychological costs. State governors, who have become major decision-makers in the pandemic, are each striking their own balance: California’s Gavin Newsom has ordered most schools in the state to close for the fall, while Texas’s Greg Abbott has left decisions in the hands of school boards.

How many deaths from the virus should we accept, and at what cost? We have an intuitive sense that the hundreds of daily deaths that states like New York were seeing at the peak of the outbreak are too many. But if we’re honest, we know that the acceptable number of deaths cannot reasonably be zero, although we have an understandable aversion to specifying just what the number is. Unsurprisingly, it seems that no public leader will offer one, although universities have had to think this question through in concrete terms. The University of Texas listed a hypothetical death of a student — apparently not a faculty or staff member — as a trigger for converting all operations online.

Yet as vexing as these ethical questions are, and as staggering in magnitude, they are different only in degree, not in kind, from other forms of risk that we deal with and accept under normal circumstances. How we answer these questions says something about what kind of society we are. Tradeoffs are more, not less, difficult because of our commitment, however inconsistent and imperfect, to the sanctity of life. Perhaps a fuller appreciation of that commitment can help us to navigate with poise and steadfastness the challenges we now face.

How do we evaluate tradeoffs that pit life against life, or life against broader costs to human flourishing?

We have heard different evaluations from public officials and commentators. New York Governor Andrew Cuomo said in early May that “the cost of a human life is priceless, period. Our reopening plan doesn’t have a tradeoff.” Texas Lieutenant Governor Dan Patrick appeared to take the opposite position in April, when he infamously said that many grandparents, including himself, were willing to die to keep the economy open: “There are more important things than living, and that’s saving this country for my children and grandchildren and saving this country for all of us.”

Part of the problem is plain uncertainty: We simply don’t know very well what the tangible costs of either the lockdowns or the pandemic will be. But there are deeper moral reasons to be dubious of reasoning by some utilitarian calculus, or with the absolutism of Cuomo.

In a 2012 essay in First Things, Robert George identifies the principle of “respect for the human person” as the first pillar of a decent society. He writes that the institutions, beliefs, and practices of a decent society should

be such that every member of the human family — irrespective of race, sex, or ethnicity, to be sure, but also and equally irrespective of age, size, stage of development, or condition of dependency — is treated as a person — that is, as a subject bearing profound, inherent, and equal worth and dignity.

This view, which we might call a dignitarian one, introduces considerable constraints on policy and our evaluation of tradeoffs. Consider how it would contrast with a utilitarian framework for the pandemic. If we knew the dimensions of the tradeoff — if we were certain about, say, the economic costs of continuing the shutdown compared to those of letting the virus spread unchecked — the tradeoff would be easy for a utilitarian to evaluate. In a New York Times panel discussion, ethicist Peter Singer argues that overall wellbeing is the value to be maximized: “We need to think about this in the context of the well-being of the community as a whole.” The implication he draws is that, even at the cost of more lives, lockdowns and restrictions should end quickly because they are harming overall wellbeing.

For a utilitarian, the only problem is missing data. Singer asks: “How many years of life were lost?” and cites an economist’s estimate that people who died in Italy lost on average three years. If we had all the relevant figures on lives lost, life-years lost, harms caused, and shifts in benefits and burdens that would occur as a result of each possible course of action, we could run this all through what utilitarians call a “felicific calculus” and choose the course of action that maximized human wellbeing. In this calculus, each unit of wellbeing counts, but some people have more wellbeing to gain or lose, and everyone’s is thrown together into a big wellbeing pot. The best policy maximizes the volume of that pot.

The dignitarian, on the other hand, is obliged to respect the dignity of each person as an individual, not as a contributor to a sum of total wellbeing.

How does the dignitarian deal with tradeoffs that pit life against life? How do we respect the profound and equal worth of each person when we know that, whatever we do, some people will suffer or die so that others might live and flourish?

In a tradeoff that directly pits a life against a life, there is no dignitarian calculus to help us decide. In that case, a commitment to a dignitarian view forces us to confront the tradeoff instead of taking an easy way out. My life as a thirty-something in good health is not of more value than that of an octogenarian who smokes. One outcome of this view is that it encourages an ethic of sacrifice, or at least regard for others.

What about the question of how to balance the risk of death for some against generalized costs to society? This is the kind of tradeoff we see when we ask whether and how to reopen schools or play football. At what point, if any, do generalized costs to the wellbeing of the members of a society outweigh the imperative to preserve life?

Some conservative voices seem to echo the utilitarian view. Philosophy professor Robert C. Koons, writing in Public Discourse, invokes Thomas Aquinas’s “order of charity” — that is, a ranking of who most ought to receive our love — to argue that “the primary aim of any political community must be its own common good.” Deaths, while harmful to the common good, “would not represent a catastrophic loss, so long as the community were able to sustain its social existence.”

Koons’s argument privileges the wellbeing of the community, even at the expense of particular individuals’ lives. Isn’t that effectively the same as Singer’s utilitarian view? Shouldn’t a dignitarian, on the contrary, aim to maximize lives preserved?

On the dignity principle, since every life is of profound worth, all else being equal, more lives saved is indeed better. If the only choice is whether to save more or fewer lives, the dignitarian should plainly opt for more.

But only rarely is all else equal. Consider what would happen if we applied the policy principle “maximize lives preserved” consistently in other areas. This would suggest bans or tighter restrictions on all kinds of products and activities that cause death. Ninety-three thousand people die of alcohol-related causes each year in the United States, 480,000 of cigarette smoking, and 32,000 in car accidents.

Furthermore, researchers have found that overall mortality actually decreased in the wake of the Great Depression of the 1930s and the Great Recession around 2008 — yes, decreased. One likely explanation is that people were participating in less activity. In other words, economic stagnation may save some lives, but at a cost we would hardly wish to continually pay.

Part of respecting human dignity is respecting legitimate freedom, freedom to participate in the activities of life. Normal life comes with risk, and so respecting human dignity means accepting some risk of death. We do not take the car from the driver or the cigarette from the smoker just on the ordinary chance that this might save his life. We can debate the boundaries of legitimate freedom and dignified treatment, but an unbounded principle of maximizing lives preserved would surely encroach on the legitimate freedom of each person.

Respecting human dignity, of course, is not just about protecting individual freedom. It also means spending resources in ways that provide for humane treatment. We should, for instance, spend what is required to ensure that prison inmates are treated humanely and decently. That is true even if we might save more lives by redirecting much of that money to, say, public health.

Contrary to our initial instinct, then, a life-maximizing principle cannot be the dignitarian policy formula. While impolitic and surely arguable as applied to the pandemic lockdowns, Lt. Governor Patrick’s statement that there are things more important than living is plainly true.

Of course, we must identify more carefully the sense in which it is true that some things are more important than living. The things more important are the maintenance of those institutions and activities essential to the common good of a society. The common good, as Pope John XXIII wrote in his 1961 encyclical Mater et Magistra, refers to “all those social conditions which favor the full development of human personality.” This includes respect for individual rights, just arbitration of competing interests, and social peace. It relates to the totality of conditions in which human beings live well together, the “flourishing of the whole community,” in Robert Koons’s wording.

This is not the utilitarian calculus that tries to maximize the total amount of everyone’s wellbeing. Instead, each person’s good is integrally connected to the common good. As John XXIII wrote in another encyclical, “every single citizen has the right to share” in the common good, and so “every civil authority must strive to promote the common good in the interest of all, without favoring any individual citizen or category of citizen.”

For the dignitarian, the generalized costs of life-saving efforts should factor in to the determination of the best policy, because they affect the totality of conditions in which human beings live together, and thus affect the common good. Regulators, medical providers, and policymakers use calculations based on the dollar value of an individual life to understand when life-saving efforts become counterproductive. As political science professor James R. Rogers explains in a Law & Liberty article, these calculations are based on the average economic value people implicitly place on life, as demonstrated by choices involving risk.

The purpose of such a figure is not to put a price tag on the intrinsic worth of a human life. It also cannot make decisions for us, as it does not fully account for qualitative factors we must consider when treating each person with due respect. For example, there is a qualitative difference between a death caused by voluntary smoking and an involuntary death from Covid-19. Rather, the purpose is to understand the justifiable costs of life-saving efforts. There are always costs, which in turn affect others’ lives and the social conditions that affect us all. We routinely spend hundreds of thousands or millions of dollars to save one life, but we could not justify the suffering that would be caused to so many others by sacrificing, say, a tenth of our whole economy.

The importance of the common good does not detract from the importance of preserving life; these two are integrally related. The dignitarian tries to preserve life, even at significant cost to others. People with greater need due to weakness or vulnerability justly demand not less care, as in a utilitarian framework, but extra regard and aid from those who are stronger and less vulnerable. Enduring hardship, pain, and struggle, or even sacrificing our own lives to preserve the lives of others, can be ennobling. Indeed, that should follow from the communitarian logic Patrick and Koons appeal to — the same logic by which a police officer, soldier, or just a good neighbor may choose to sacrifice his or her life for the lives and flourishing of others. By the same logic, those of us who are less vulnerable to the virus should be willing to endure hardship to preserve the lives of the more vulnerable among us.

Dignitarians insist on the traditional notion that life is sacred and every individual life has profound worth. The dignitarian refuses to accept gains in quality of life in return for a diminishment in the respect due to each person. The diginitarian tries to protect life, with special care for the vulnerable.

But dignitarians also acknowledge that death is natural and that risk of death is part of life. Efforts to preserve life can diminish a community’s capacity to sustain conditions fostering due respect for each human person, and so simply counting lives preserved does not determine the best policy.

In terms of welfare economics, the dignitarian principle would probably come closest to some of the ideas of political philosopher John Rawls, who argued for social arrangements or policies that would yield the best possible outcome for a society’s least well off. Bloomberg writer John Authers has suggested that many governments’ responses to the pandemic have attempted to enact this principle, which has deep religious roots: “Some religious leaders have approached the awful dilemmas presented by the coronavirus just as Rawls would, by taking treatment of the worst off as the criterion for social action.” Of course, even this principle may be inconclusive if there are different sets of “worst-off” people whom different courses of action would affect differently — as is the case with our pandemic options.

While a dignitarian ethic does not provide a formula for action, it does suggest a balanced approach to risk management. It suggests doing everything possible to keep institutions operating, even at some risk of death to some members of the community. But a dignitarian approach is far from the devil-may-care, caution-is-cowardice mindset some have expressed. Life is precious, and some costs are worth bearing to preserve it. There is no way to simply shrug through this muddle; rather, muddling through is the dignitarian way.

We can see the need for this kind of nuance in decisions about whether and how to open schools. Moving everything online would probably save the most lives in the short term, but there would be serious costs. There would be costs to parents who must sacrifice work to educate their children at home, and to grandparents who may be called on to provide extra help with children. And in a July Atlantic article offering guidelines for reopening schools, three former federal officials argue that in-person instruction and interaction with adults is an important contributor to children’s growth and development. Loss of that kind of interaction can be detrimental, particularly for low-income students. Those should be significant factors in our decisions. In-person schooling contributes to the flourishing of all members of our society.

These considerations suggest trying to open schools while accommodating vulnerable students, teachers, and staff. Adjusting operations and taking some precautions, while allowing our social institutions to function and serve the needs of children and families as much as possible, seems the best way forward. There are alternatives, too: co-op arrangements that some parents and districts are exploring.

Sports present a similar situation. Football may not seem as direct a contributor to critical social institutions — though, having been raised in Austin, Texas, and now living near College Station, I know many people who would argue otherwise — but employment is, and football supports employment. Trying to play, perhaps at reduced stadium capacity, would seem prudent.

To be sure, high rates of death from Covid-19 would be costlier than forgoing these activities, but saving one life is also not worth just any cost. We will have to navigate this disease as we do other risks, negotiating an acceptable risk level. It will not be astronomical, but it will not be zero.

Yielding no simple formula, the dignity principle forces us to consider the full reality of the difficult tradeoffs in front of us. In this, it has a certain air of the tragic. Yet it is also ennobling, pointing us toward a vision of society that renders due respect to each and every person, a vision worth pursuing as best we can.