Ireland has gone into lockdown to try and minimise the number of deaths caused by Covid-19. In coming to this decision, the Government has decided that, for now anyway, the good of the lockdown outweighs any possible harms that might result.
Obviously, we do not shut down society each year to try and minimise the number of deaths caused by the latest winter flu. We decide then that the number of lives that might be saved is not worth the price of effectively shutting down society. Here, we have weighed things differently.
Every policy has costs, not simply in economic terms but also from the point of view of human relationships, mental health, civic liberties (including religious freedom), etc. We are hearing about an increase in domestic violence. How many marriages might end in divorce due to the lockdown? Will depression (and maybe suicide) eventually soar? Recessions and financial ruin are associated with an increase in the overall mortality rate. How many could die as a result of growing hospital waiting lists and people avoiding A&E at the present time?
Catholic social teaching requires us to try and find the common good at all times by keeping different goods in balance, weighing them against each other, and deciding which are most important and which less important, and how the different weight we attach to each can change as circumstances change.
We will be asking a number of Catholic moral theologians and philosophers in the coming days to weigh up the goods to be considered in arriving at a suitable public policy at a time like this. We will bring them to you as we receive them.
Weighing goods and bads?
By John Murray
It seems obvious that in this current crisis, and indeed more generally in political, professional, and personal life, we need to weigh up the goods and bads involved in the options we face for choice. Isn’t such weighing up required if we are to be rational and scientific and fair?
However, it is impossible to know all the goods and bads in the diverse options that we face when we have to make a choice. You simply can’t work out accurately all the consequences. For example, it is impossible for us to know accurately just how many direct and indirect bad effects the current Covid19 lock down will cause into the future. It is even more difficult to work out what the effects would have been if we had adopted some other policy or set of policies. Even if we compare ourselves to other countries, we can never be sure that our situation in Ireland is exactly comparable in all variables.
Furthermore, if we could somehow work out the consequences of a lock down strategy, we still would not be able to rationally weigh them up. The goods and bads in choices are irreducibly diverse. That’s why we have to make a choice. If one is going to weigh things, one needs a standard of measurement. What standard of measurement is to be used in weighing up the diverse goods and bads in coping with the Covid19 crisis? If we use several diverse standards of measurement, we face the problem of how to weigh up the different standards against each other.
We can try to simplify matters. We could focus on numbers of lives saved versus number of lives lost in each option. Hard to predict, but at least it looks like we are weighing up similar goods and bads using a transparent and rational standard of measurement. However, although lives saved or lost are important, no doubt, they are not the only things that matter. And we will cause harms if we cut down direct risks to life so much that we prevent people from living, from socialising, from working, from creating wealth, and so forth.
Perhaps all we can do is ‘do our best’ to make an informed guess about the goods and bads, about consequences. But even if we do that, we need to be guided by moral standards that cannot be reduced to (supposedl) scientific calculations. One such standard is the Golden Rule: treat others in the way that you’d like to be treated (if the positions were reversed). Only if this ethical standard of judgment is followed, honestly and consistently, can we be sure that the choices we make, and the structures we create, are not based on merely apparent ‘rational’ weighings of consequences, but on really fair and just choices to respect each and every person’s dignity. Judgments of proportionality that are shaped by the Golden Rule are able to avoid selfishness, moral blindness, prejudice and selfish partiality. We must love our neighbours as we love ourselves.
Dr John Murray is a lecturer in theology at Dublin City University.
Proporionality and Pandemics – A Difficult Assessment
By David Mullins
In the current health crisis, many goods have to be balanced. The big question is whether the good done by the lockdown is proportionate to the harm caused by it. So far, a big majority of people think that it is.
The principle of proportionality is used within Catholic Just War theory, for example. We do not go to war to resolve minor diplomatic incidents.
If we did, then the chosen means of resolution would be grossly disproportionate to any good that might be achieved and would therefore contradict the principle of proportionality.
Can we apply the same thinking to the ‘war on Covid-19’?
At the time of writing the European Centre for Disease Control estimate that 2.35 million cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 164,656 deaths.
However, the public health response to combatting Covid-19 has included measures that will ensure more than 117 million children [1] are now at risk of missing out on measles vaccines. This is according to the United Nations International Children’s Emergency Fund (UNICEF).
In 2018 [2], measles infected an estimated 10 million people and killed 140,000.
According to the World Health Organisation the measles virus, which is highly contagious, has a mortality rate of 3% to 6% with malnourished children especially at risk.
The Covid-19 mortality rate is difficult to be precise about but during a March 3rd media briefing, WHO Director-General Dr Tedros Adhanom Ghebreyesus stated [3]: “Globally, about 3.4% of reported COVID-19 cases have died.” It is likely to be much lower than this, however.
The public health response to Covid-19 has also brought about the suspension by the Global Polio Eradication Initiative (GPEI) of all activities that cannot adhere to guidance on physical distancing, such as house-to-house or other immunization activities using oral or injectable vaccines.
Augustin Augier, executive director of the Alliance for International Medical Action was reported on April 9th as saying that programs with the capacity to train about 500,000 African mothers to diagnose acute, potentially fatal malnutrition in their children have also been suspended.
Closer to home all cancer screening programmes related to routine cervical cancer screening, routine breast cancer screening, bowel cancer screening, abdominal aortic aneurysm (AAA) screening and surveillance monitoring, and routine diabetic eye screening and surveillance monitoring, have all been suspended in Northern Ireland [4].
Here in the Republic all test appointments and invitations to screening for cervical cancer are cancelled.
If we take proportionality to mean that our actions must not bring about a worse state of affairs than if we had done nothing-then I am not sure the test has been met. Our actions to combat one disease are allowing a whole host of others to flourish and usually among the poorer populations of the world.
You might argue that the methods employed are about gaining time for a vaccine to be developed and about ensuring that one infectious disease is not brought into environments where others already thrive.
The problem is that we have no way of knowing if this approach will ultimately prove correct. This is a difficulty we should not shy away from.
For now, all we have, is at best, a kind of speculative ethical proportionality.
Let us remember that there is still no vaccination against Middle East respiratory syndrome, which is now known to be caused by another form of the coronavirus [5] and which was first reported on September 2012 in Saudi Arabia.
So, what looks proportional now in terms of our response, may soon degrade into brutality if the same approach is still being persisted within 8 years’ time.
David Mullins is a bioethics commentator. He holds a Masters Degree in Bioethics, with a dissertation on “Ethical Alternatives to Embryonic Stem Cell Research”.