I HAVE been uneasy for several weeks now about the phrase “underlying conditions”, which is used to describe those who are most vulnerable to Covid-19. Physicians, politicians, and press also frequently use the term as a kind of caveat when reporting the death of someone from the virus. “Nineteen out of 20 of those who died had underlying conditions,” one reporter said the other day. The phrase often seems freighted with a secondary meaning; it seems to imply “So the rest of us don’t need to worry about that, then, do we?”
There was an academic on Radio 4’s Woman’s Hour the other day, Dr Jessica Taylor, who has just written a book, Why Women are Blamed for Everything. She asked why, despite all the research that has been done on sexual violence, many still hold the view that, if a young woman goes out in a short skirt and falls victim to rape, she was in some way “asking for it”. Dr Taylor, a lecturer in forensic and criminal psychology, explained the business of victim-blaming with reference to a cognitive theory, “belief in a just world”. It seems to me also to explain something about the cavalier use of the phrase “underlying conditions”.
“Belief in a just world” describes our psychological bias towards an unconscious assumption that, in the universe, noble actions will eventually be rewarded and evil actions punished. There is plenty of evidence, of course, to the contrary, and yet this bias is deep ingrained in some subterranean sense of cosmic justice. It goes beyond that, into the innate sense of optimism which most people have about outcomes. It explains why so many of us continue to ignore all the evidence about obesity or smoking.
This sense of “It won’t happen to me” is enhanced if we are able to assume that bad things happen only to those who are bad — or who have “underlying conditions”. In Camus’s novel The Plague, the death of the first victim is explained by his fellows by the fact that he played the trombone, and therefore had weakened his lungs.
Worse than that, the way in which the phrase is often used seems to me to suggest that, as a nation, we should not be too bothered about the untimely demise of those who have pre-existing health problems, even if they were managing them successfully, being useful members of society, and living happy and fulfilled lives. Their “underlying condition” was, none the less, somehow “asking for it”.
It is all part of the same utilitarian calculus as underlies the abuse of the notion of triage when particular patients are categorised as somehow less deserving. That is a moral judgement. But scarce health resources should, rather, be allocated on the basis of which patients are most likely to benefit from them. And that is a medical judgement.
Human value is not a measure of health, age, our mental or physical abilities, or the part that we play in society. Christians express this insight by saying that we are all made in the image of God and are therefore equal in dignity or value. An “underlying condition”, sickness, or even dying does not diminish this — and we should take care to remind the rest of society of that.