The COVID-19 pandemic has presented several ethical dilemmas. Which country, state or city should have first access to made-in-China masks? Stories abound that the United States paid cash three times the going price for masks ordered by France. If countries incrementally reopen, which stores or businesses should have priority? Children and schools? Which factories? And the list of tough ethical choices goes on. Officials from around the world are delicately balancing public health and business reopening.
One of the most urgent ethical choices in this period of scarce resources has been the use of ventilators for the hospitalized in intensive care. When asked about choosing between ventilators for the very old or younger patients, New York Governor Andrew Cuomo always refers to his 86-year-old mother Mathilda. “All lives are equal,” he says. On the other hand, Princeton ethicist Peter Singer refers to the 79-year-old average age of the dead in Italy to justify his choice of first saving the young.
Which should it be? As someone 73-years-old and more than sensitive to references to the virus as a Boomer Remover, I have obvious sympathies with Governor Cuomo. But Singer does have a point. His argument is that a 79-year-old may have perhaps three years left to live whereas a 40-year-old probably has 30 more years of life. In terms of the public good and general quality of life, Singer maintains that the 40-year-old should get the ventilator first. His preference for those with many potential years remaining is typical of his utilitarian rational positions. After all, shouldn’t we look after those who have the greatest chance to do the greatest good for the greatest number of people?
But what about Mathilda? (And me?) Are close relatives and friends willing to say that they’ll let her go in the general interest? The fact that doctors and hospitals may already be making this choice is a sticking point. Are they asking the immediate family? There are ethical experts working on some type of regulation of the question. But for the moment the general public has been left out of the discussion.
So medical experts and elected officials are making decisions for us. On this particular issue, life and death, shouldn’t we all be consulted? If Singer’s argument is about the greatest good for the greatest number and the general quality of life, shouldn’t the general public be allowed to express its opinion?
Beyond the question of who decides is the deeper question of rationality vs. emotions. Governor Cuomo loves his mother. (Don’t we all?) The difficulty of saying to a doctor, “Turn off the machine,” is compounded by the fact that severely ill patients have recovered. Does it help that turning off the machine to help someone else shows altruism? Is it emotionally sufficient to say that my act of altruism is helping someone else in terms of the general good?
Governor Cuomo’s devotion to his mother has never been in question. He issued an executive order called Mathilda’s Law with guidelines for vulnerable populations. It provides additional social distancing for people over the age of 70, people with underlying health conditions and people with compromised immune systems. Cuomo’s references to his mother as well as his COVID-19 positive brother Chris have significantly increased his popularity. The general public likes his emotional side.
But Professor Singer has the more rational argument. In terms of the general society, those of a certain age have few years left to live. And most of those years will not be productive for the general public. In fact, they will cost the general public huge sums of money for their upkeep in hospitals or old age homes.
So if the decision about the use of a ventilator comes down to the elderly or young, what should the doctors do? My first answer is that this is a public issue that needs some form of public discussion or decision making. If Singer’s argument is for the general good, then let the general public decide what is in its best interest.
And if that be the case, which I doubt, then I imagine the Mathilda/Cuomo argument will win. Rationality does not always run the world, if it ever has. Our emotional attachment to family is hard to let go. Cuomo’s references to his mother are very powerful. As they should be. Let’s leave it at that.