What is one of the most difficult tasks of a doctor in dealing with the pandemic? I say, it is the dreadful morality choice the doctor ought to make while saving someone at the cost of the other. This has been an intrinsic moral dilemma for centuries of human civilisation. Even as we begin, it is imperative to make one thing clear at the start: societies have scare resources. As a result of resource-constraint, the doctors are forced to ration ventilators, life-saving drugs, dialysis machines and the staff qualified to operate them.
Rationing ventilators has become a new normal in a world grappling with COVID-19. The hospitals get to decide which patient should receive access to mechanical ventilation and other medical procedures. Such an exercise often decides the fate of patients. It is excruciating to think of doctors making moral decisions of which patient gets to live and who dies.
Moral dilemmas are as antique as the medicinal practices themselves. However, in times of crisis, these dilemmas become more evident, unique and urgent. Thus, it is essential to take a look at the concept of morality and the dilemmas that we grapple with in our daily lives. We, humans, inherently belong to one of the two schools of moral philosophy: Millsean utilitarianism and Kantian deontology.
Utilitarian Philosophy and Physicians
Utilitarianism, often also known as consequentialism, was articulated by 19th-century philosopher Jeremy Bentham and popularized by John Stuart Mill. In 1776, in his work, A Fragment on Government, Bentham invoked what he defined as a “fundamental axiom, it is the greatest happiness of the greatest number that is the measure of right and wrong.” Benthamite utilitarianism surmises on “ends justify the means” morality.
Immanuel Kant wrote Groundwork of the Metaphysic of Morals in 1785. He argued that in order for one to act in a morally right way, one must act from duty. Kant argued that it is not the consequences of actions that make them right or wrong, but the motives that enabled the action. He concludes what truly good is: “Nothing in the world – indeed nothing even beyond the world – can possibly be conceived which could be called good without qualification except goodwill.”
Deontology is a normative ethical theory that defines, as Kant had propounded, the morality of an action should be based on whether that action itself is right or wrong and not on what it achieves. Kant notes that a person has goodwill when he “acts out of respect for the moral law.” And that there are certain universal moral laws that are the guiding principle behind the ethical behaviour known as the “categorical imperative.” Deontological philosophy argues that it is “the means that justify the ends.” One of the most influential deontological works in recent times comes from Harvard philosopher John Rawls, in his work, A Theory of Justice propounds a social-contract based on the “veil of ignorance.”
In this essay, I argue that humans are not consistently inclined to a singular school of morality, they shift their goalposts based on circumstances they are encountered with. Let me illustrate this with two ethical dilemmas:
Imagine you are a doctor, and there are five patients in dire need of transplants to live. And each of them will require a different part of the human body. In the next ward, a healthy patient with a mild headache is unconscious due to a dosage of a drug. So, would you kill the healthy patient and harvest his organs to save five lives? Most of us will utterly reject the idea of killing a healthy person. In here, no matter what the consequence of the action is, it is morally wrong to kill a healthy human. Here, we are all Kantians.
Let us now imagine that there is a limited supply of a life-saving drug. Six people will certainly die if they are not treated with the drug. But, one patient requires all of the drugs if he were to survive. But, the other five would require only one-fifth of it. What would you, as a doctor, do in this scenario? Many of us would administer the drug to the five patients as it would fetch the maximum utility. At this point, we are consequentialists.
John Taurek and Numbers
John Taurek, in 1977, in a paper titled “Should the Numbers Count?” presented the above scenario and argued against the general notion of saving five patients than one. To Prof. Taurek, numbers don’t matter. He responds:
“Here are six human beings. I can empathize with each of them. I would not like to see any of them die. But I cannot save everyone. Why not give each person an equal chance to survive? Perhaps I could flip a coin. Heads, I give my drug to these five. Tails, I give it to this one. In this way, I give each of the six persons a fifty-fifty chance of surviving.”
Prof. Taurek adds, “I cannot see how or why the mere addition of numbers should change anything.” However, it becomes evident that Taurek underestimates the number-game a little too much. What if, the calculation was one life against a hundred, a thousand, or a million? Would numbers still not matter? One of the most compelling critiques came from Derek Parfit. In his article “Innumerate Ethics”, Parfit argues that equality meant giving equal consideration to each person’s life, rather than equalising their chances of survival. Parfit wrote, “We should save more people” as each person counts for his life and more people count for more.
Morality and COVID-19
There are two schools of thought within medical departments about the action plan about the virus. One school of thought preaches that the resources must aim at guaranteeing intensive treatment to patients with a higher chance of survival. It privileges the “higher life expectancy” over those with less chance of survival. In other words, relatively young patients with health problems are prioritized over the elderly and sick.
Another school, deontological ethics, prioritises the elderly and sick over those who are less likely to be affected by the virus. Since the death-rate of the older population is high, the preachers of deontology believe that with proper care and treatment they are reducing the number of deaths. They argue that patients with lower risk are more likely to survive without proper medical treatment, but that is not true in the case of elderly people.
Even as we learn to live with the virus, there is a grave challenge to the inherent human-beliefs more than ever. John Authers, a leading business editor, wrote, “The pandemic is also a test of the strength of the ideas humans choose to help them form moral judgements and guide personal and social behaviour.”
The crisis challenges our abilities to justify what is right and what is wrong. More so, it questions our ability to interpret the purpose of human existence. The estranged society as it exists is its next target. It is at this point, we realise that humans are a product of unequal resource privileges, where one’s garbage is another’s gold. The constant fear engulfing our lives about the known and unknown strangers that might infect us with the virus.
The privilege of justifying our ability to quarantine the population – rich, and poor alike; at times, enabling the poor to toil for their livelihood and battle the virus; telling the destitute, elderly and sick that it is the time for you to sacrifice yourselves for the benefit of the larger society; spewing hatred in the name of primetime news; watching the migrant women walk a thousand miles with babies wrapped around their shoulders; enabling the labourers to sleep on the railway track even as the train passes over them.
The virus shows us the world we have created – gravely unequal and subtly cruel. It is the marvellous creation of thousands of years of humanity’s obsession with greed and competition. Coronavirus has challenged the ability of humans to protect human society. Vulnerability has become the cornerstone of today’s world. In the post-COVID-19 world, humans ought to become human first, only then humanity will thrive. It is time to rethink and reconceptualise an equal and just society.
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