During the training for D-Day, one historian recounts that 5,440 died in live fire drills, amphibious landing exercises and flight training compared with around 4,414 who actually died at Normandy. The question we’ll never know the answer to is whether those 5,440 deaths affected the number of those who died in the invasion. Did they die in vain? Were their deaths critical in making adjustments so the death toll in the invasion was lower than it would have been? There’s no way to know.
But . . . General Eisenhower had to make the call that killing men in training was a necessary trade-off. One who might have disagreed was General Patton who famously said “A good plan violently executed now is better than a perfect plan executed next week.”
It should come as no surprise that the ethics of pandemics has been widely considered. Let’s have a look a bit from the CDC
The Ethics Subcommittee of the Advisory Committee to the Director for Centers for Disease Control and Prevention published a report addressing ethical issues in pandemic influenza, including the rationing of scarce resources. It advocates for an ethical justification of rationing based on balancing the goal of providing the greatest good for the greatest number with considerations of justice (in particular, issues of equity and fairness), respect for persons and non-maleficence. The report specifically rejects distribution based on first-come, first-served, arguing that it is not truly a fair procedure. In addition, although the report advocates for prioritizing workers key to maintaining the societal and healthcare infrastructure, it rejects prioritization of groups based on other social factors (e.g., race or ethnicity). The guidance does not include age in its list of examples of discriminatory social categories.
What strikes me is the lack of “what’s the best thing for the country?” and I’m pretty sure that’s what President Trump is wrestling with right now.
If I were him, I’d be asking simple questions like “if we lost 50% of the people over 60 to this virus, what would that do to the economy?” One potential reality is that Medicare and Social Security payments would drop dramatically. The death of someone who is 65 years old probably has a better financial impact on the country due to the likely elimination of 20 or so years of Medicare and Social Security payments.
It’s pretty horrible to contemplate which is why “balancing the goal of providing the greatest good for the greatest number with considerations of justice” sounds so much better but provides absolutely nothing that’s actionable. In addition, one person’s greater good is another person’s evil which is what lies at the heart of all of this.
Is the economy the right measure for deciding who lives and who dies in a pandemic? Not entirely but it is a measure that must be strongly considered. It is certainly, in my view, not ethical to save everyone we can save by all means and resources necessary if it puts us back into the Dark Ages.
When the President tweeted:
WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!
— Donald J. Trump (@realDonaldTrump) March 23, 2020
he was no doubt wrestling with this exact ethical situation. If I were to guess, based on everything I’ve seen so far, after all the deep thinking that’s gone on relating to ethics and pandemics since the H1N1 pandemic, I suspect the totality of advice he’s getting is “we dunno.” The good news is that we have a president who will make a decisive decision and that will be good enough for me.