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Press: A grim moral dilemma: deaths now, or later?

09 April 2020

PA

An image of the Queen and quotes from her broadcast to the nation on Sunday evening are displayed in Piccadilly Circus, London

An image of the Queen and quotes from her broadcast to the nation on Sunday evening are displayed in Piccadilly Circus, London

THREE weeks into the crisis, there is a serious moral argument developing in the rich countries affected by the pandemic. The question at issue is how to weigh deaths now, from the coronavirus, against deaths in the future from the effects of poverty and economic contraction.

The clearest two statements for accepting more deaths now came from the former Supreme Court Justice Lord Sumption, and from Dr Johan Carlson, the Swedish epidemiologist in charge of the Public Health Agency there.

Dr Carlson said explicitly that the measure of success for him was not the number of deaths in this outbreak. In an interview with Dagens Nyheter, he said: “Our metric is not the number of deaths from the coronavirus. The outcome that matters is what we’ll see in four or five years. 850,000 people are taken into hospital every year and we have to take care of all the other diseases, too. What else will the virus displace?”

Lord Sumption, writing in The Sunday Times, made a similar argument, with sharper edges: “We take security for granted. We do not tolerate avoidable tragedies. Fear stops us thinking about the more remote costs of the measures necessary to avoid them, measures that may pitch us into even greater misfortunes of a different kind.

“We are already pushing a fifth of small businesses into bankruptcy, many of which will have taken a lifetime of honest toil to build. The proportion is forecast to rise to a third after three months of lockdown.

“Generations to come are being saddled with high levels of public and private debt. These things kill, too. If all this is the price of saving human life, we have to ask whether it is worth paying.

“The truth is that in public policy there are no absolute values, not even the preservation of life. There are only pros and cons.”

Dr Carlson’s argument is purely consequentialist. Lord Sumption blends that kind of reasoning with appeals to more abstract principles: “We have set about abolishing human sociability in ways that lead to unimaginable distress. We have given the police powers that, even if they respect the limits, will create an authoritarian pattern of life utterly inconsistent with our traditions. We have resorted to law, which requires exact definition, and banished common sense, which requires judgment.”

There will be more of this kind of reasoning, as the economic costs, and even the inconveniences of life under lockdown, mount up. And what strikes me about this is how very little reference is made to religious beliefs in these arguments about the worth and purpose of life. Perhaps this is unrealistic of me. It would certainly be astonishing if any Swede in public life made reference to Christianity as a ground on which to reason.

 

BUT the Churches’ responses have been entirely concerned with those who must suffer the consequences of decisions made by others, and not with those who make them. This is not just a mater of large questions of public policy. Throughout the NHS, as the pandemic reaches its peak, doctors, and also nurses, are going to have to make decisions about who lives and who dies.

The Economist covered this aspect best: “In Italy there are reports of doctors weeping in hospital hallways because of the choices they have to make. In America and Europe many doctors are faced with terrible decisions about how to allocate scarce resources such as beds, intensive care, and ventilators.

“The decision over whether or not to ventilate then becomes a decision between life or death. If a young patient arrives needing a ventilator, and none are available, there is a chance that one will be removed from someone else who is identified as being less likely to survive. In extreme situations, it may even be taken from someone who might survive but who is expected to live for a shorter length of time.

“On April 1st the British Medical Association, the doctors’ trade union, stepped into the breach, making clear the trade-offs: ‘there is no ethically significant difference between decisions to withhold life-sustaining treatment or to withdraw it, other clinically relevant factors being equal.’”

Perhaps there is nothing specifically Christian to say about these choices, or at least nothing that may be said in public — I don’t doubt the importance of consolation and the assurance of forgiveness for those who must make those choices. The NHS guidelines, produced by NICE (National Institute for Health and Care Excellence), for who should be saved and who left, or helped, to die are freely available on the web. They rely on an internationally recognised measure (the Clinical Frailty Scale) of weakness, dementia, and helplessness. It’s difficult to know what else could be done, but this is clearly going to have the effect of eliminating the frail or demented elderly.

So, here we sit in Holy Week 2020, and realise that the rulers of this world must still decide when and how it is expedient for one man to die for the good of the people. Seldom has the otherworldliness of Christianity seemed more obvious or more necessary.

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