How do we figure out the best way to handle the current crisis of the Corona virus? Let’s look at two extreme options. The first is to close everything except critical business until we are 100% sure the virus has exhausted itself. The second is to reopen everything and let nature take its course. Neither is an acceptable answer. In the first case, while sounding plausible, does not consider 2d,3d or .4th order effects of an economic and social downturn. These range from an increase in spousal abuse, increased alcoholism or just a large segment of the population dropping into poverty which increase the problem of malnutrition and other problems too numerous to mention. In the second case we are condemning a portion of the population to sickness and in some cases death. For transparencies sake I will let you know I am in at least three of the high-risk categories.
Admittedly there are several other choices, but the question is how you arrive at the correct answer if you are in charge, and keep in mind we are speaking of the person who must make the decision. We must separate the emotional charges that are being made that it is strictly economics over elderly. We must also understand that we are nowhere close to having to make this decision.
While over the years several books and publications have come out on how decisions are or should be made, there does not seem to be one single answer. One commonality is that for every action or decision there will be some form of consequence. To begin I will look at the classic thought experiment in ethics known as the Trolley problem. To save you from looking it up the Google version is:
The trolley problem: should you pull the lever to divert the runaway trolley onto the sidetrack?
The trolley problem is a thought experiment in ethics. It is generally considered to represent a classic clash between two schools of moral thought, utilitarianism and deontological ethics. The general form of the problem is this:
There is a runaway trolley barreling down the railway tracks. Ahead, on the tracks, there are five people tied up and unable to move. The trolley is headed straight for them. You are standing some distance off in the train yard, next to a lever. If you pull this lever, the trolley will switch to a different set of tracks. However, you notice that there is one person on the sidetrack. You have two options:
- Do nothing and allow the trolley to kill the five people on the main track.
- Pull the lever, diverting the trolley onto the sidetrack where it will kill one person.
Which is the more ethical option? Or, more simply: What is the right thing to do?
To make this more complicated there is a version were the lone person is your son (daughter, parent or spouse).
If the question was simply between economics and life it would be an easier answer. As we have said above there are other consequences in an economic downturn that weigh in.
A more real-life consideration is to look at the concept of triage, we’re in a crisis and with limited resources decisions must be made based on:
- Those who are likely to live, regardless of what care they receive.
- Those who are unlikely to live, regardless of what care they receive.
- Those for whom immediate care might make a positive difference in outcome.
We can always look to history to see what other have done. It is being said that we have never faced a crisis of this magnitude in recent history. This is only true if you confine recent history to the last 3½ years. Getting past the hyperbole we can come up with several examples, none exactly match today but since we are looking to make a decision they act as a guide.
The US has seen a number of epidemics and pandemics is recent years and has reacted to each with degrees of difference and similarity. One thing that appears to be consistent in our reaction is isolation. The next was rushed vaccine development and of course constant updates to the public. In the days of widespread smallpox, we also saw quarantines of houses and families. Today we are self quarantining. In other words what is happening today is what has been done in the past.
Increased requirements for protective gear such as masks and gloves have caused a strain on the system as has the need for ventilators. What sort of decisions should have been made for these. In the 2009 H1N1 pandemic 100,000,000 N95 masks were used but never replaced. Had they been we may or may not have solved the current crisis since there is an expiration date on them. Ventilators are needed. The government did indeed see a need and had over the years placed orders for up to 40000 units. While the contracts were canceled by the manufactures for different reasons the numbers, had they been delivered, would have been insufficient. New Your alone has called for 30000 units, leaving 10000 for the rest of the country had the government stockpiled them.
How then should the decision-making process work? We can look to history and try to decide based on what was done in the past, which was done today but based on the differences and extent of this pandemic from those in the immediate past actions were missed. We could have insured resources were available, but we see that there is a shelf-life on items so how many to buy and when to replace becomes problematic. Without a crystal ball the number of items to purchase and store becomes an imposable task. Based than on limited resources who gets what and when comes down to what? Is it a medical decision of who is most likely to survive and just make the rest comfortable? This last brings us to the ethics of decision, how do you decide where the trolley goes.
In the end someone must decide and it is not always easy or straight forward. It is easy to criticize the person who must make it and to say they are wrong, if you are not the person making the decision. Monday morning quarterbacking is a time-honored tradition in America, but for now let’s stop and hope/pray that we get through this soon.