Live Free and Kill Grandma?
The moral discovery of the “asymptomatic host”
The “new” New Hampshire License Plate?
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A guiding principle of a sort of libertarian ethic was imagined brilliantly by the jurist Oliver Wendell Holmes when he wrote: “The liberty to swing your fist ends where my nose begins.” This fist/nose image is a proud creed. “You are free to do what you want as long as it doesn’t harm anyone else!” It serves us well as a quick morality check on policies which threaten to breach our rightfully cherished sense of freedom. It is emblazoned on the license plates in New Hampshire in the snappy moto: “Live free or die”. Patrick Henry famously declared his devotion to it by shouting “Give me liberty or give me death!” at the Second Virginia Convention in 1775. It is even invoked as a way to distinguish moral positions from policy proposals. You may hear statements like, “Hey, I think gay marriage is wrong, but it doesn’t affect me and I think adults should be able to do whatever they want as long as they aren’t harming anyone else.” The fist/nose principle is as American as the stars and stripes. But this noble battle cry of self contained liberty is under strain with more regularity as our knowledge of communal dangers increases.
Much of the strain results from what evolution has equipped us humans to be responsive to. We react quite well to dangers that our sensory data delivers to our conscious experiences, especially to our visual and auditory fields. If we experience the image and sound of a roaring lion charging directly at us bearing its sharp teeth, evolution triggers an appropriate fear response and a message to our leg muscles to deploy the “run away as fast as you can” program.
Some dangers are real but invisible to our senses up to a certain point. In Don Hoffman’s bold hypothesis “The Case Against Reality” he uses the example of exposure to the sun. Evolution has rendered ultraviolet radiation invisible to all of our senses, until our skin is exposed to “too much” of the invisible stuff and we start to feel and see itchy painful red sunburn. This swiftly prompts action in the form of seeking shade or sunblock. But even this type of semi-invisible danger pales in comparison with what we now face. The failure or success of responding to the charging lion or the painful sunburn are dangers to our own selves. If we decide not to run away or move we’re the one who suffers the consequences.
A swinging fist and an innocent nose is a clear analogy of tangible physical entities with barriers that evolution has rendered in obvious visible ways. When the fist hits and the blood spurts, the line has been crossed and the principle violated. But when we attempt to apply the principle to challenges like the invisible-to-the-naked-eye culprit of virus transmission, suddenly the analogy begins to erode. When we add the significant complication of a networked world with near instant information sharing and rapid travel, the analogy loses even more potency. The fist/nose principle can be challenged in this statement:
“In an interconnected and interdependent world acquiring knowledge about abstract indirect shared risks, vulnerabilities, and dangers, my nose may be much closer to your fist than it appears.”
Social scientists and economists have known about this concept for a long time. We know the “visibility” of moral responsibility is even more powerful when we are reminded that it is visible to everyone else. We value our reputation and status in our tribe above nearly everything and we will do just about anything to protect it. Here’s a way to grasp the power of visible moral responsibility:
Imagine every human on Earth had evolved to have very good eyesight. We could actually see things as small as viruses and bacteria without technical aid. Pretend our eyesight was so good that we could even distinguish specific types of viruses from a distance. At this point, you likely don’t need me to remind you what the coronavirus looks like at great magnification. Now imagine that everyone on Earth was assigned a unique color which was branded onto viruses that passed through our bodies. Perhaps this color system would help officials and medical professionals track the specific order and method of spread of diseases in order to treat us more effectively. And remember that we could all see these color-coded viruses as easily as I can see, well, your swinging fist. You’d see your color- tagged-virus on the subway pole that you just grabbed after coughing into your hand, and everyone else would see it too. And when someone else picked up the virus from that pole, they would then also get your color. If they then pass it along to someone else their color appears just above yours and so on. The result would be that everyone carrying the infection would have a stack of colors in descending order of how they were acquired. Eventually you might see your color in a lead story photo of a dying grandmother choking for air while her family cries behind a pane of glass unable to comfort her in her last moments. And everyone else would see your color in the photo too. You might turn off your phone and lay low for a while.
In that world, people would be behaving very differently at the moment. Perhaps we would be strictly obeying social distancing and stay-at-home orders, fearful of one day having our color flash across the screen. We might not even need the suggestions in the first place.
My little daydream may sound outlandish but keep in mind that the only thing that I added to that world was some way to physically display a chain of responsibility with a fanciful color coding system. Viruses are not actually invisible if you have the right equipment situated between your evolved human eyes and the thing itself, and neither is ultraviolet radiation for that matter.
The early reporting on COVID-19 suggested that people with symptoms and those feeling ill should isolate themselves and the rest of us could go about our business. That situation would have been familiar. Our officemate Jim shows up at his desk with a sweaty fever and runny nose that we can all plainly see. He would be displaying his moral failing when several of his vulnerable office mates get sick a few days later. One of them might even die. Shame on you Jim. But as we all know by now, the current situation is far trickier and the data suggests that it is far more likely that most transmissions of the coronavirus pass through people who never display symptoms, in other words, their moral responsibility remains hidden from our evolved senses.
I want to underscore this point. This is a big deal and it presents a relatively new philosophical challenge for our species. We now have the knowledge to confirm who is carrying lethal stowaway viruses while appearing completely fine. That is something that would astonish and confound humans in eras only a few hundred years ago. Through technological advancement, we have transcended the evolved invisibility of an asymptomatic host and concurrently exposed the moral responsibility which accompanies it. Not just shame on Jim and his sneezing. But shame on the laughing group of friends enjoying a sunny day in the park who all appear healthy? Yikes.
We often think of people who are “too focused” on the economic fallout at the moment to be cold, uncaring. and callous. I’d like to defend their concerns.
In the classic Trolley Problem hypothetical, which has become a gem of moral philosophy conversations, we are asked to decide if we should pull a lever which diverts a runaway trolley barreling down a track with five people in its path onto a new track where only one person is in the way. As regrettable as this sadistic situation is, most people agree that choosing the track with only one person is the “preferable” choice. Certainly, if I had set it up that pulling the lever diverted the path from the one to the five, we’d be horrified by someone pulling it. This seems to provide the definitive answer, as long as the six lives in question are interchangeable anonymous humans of precisely the same age and not for instance, your child on the track.
Thinking in these crude mathematical terms is outside of what is called The Overton Window or The Window of Discourse, a concept which describes the range of policies and conversations acceptable to the mainstream population. Some people recoil at this kind of mathematical moral reasoning. It just feels kind of icky. But the Trolley Problem “works” on some level because the value of the items on the tracks has been reduced to a fungible asset, in this case what an economist would call “life-years”. In the end the problem reduces to math and five minus one equals four. Even if this abstract answer is morally “right”, we should not forget the tragedy. That the one on the track was still a death. Still someone’s son or daughter, still someone’s father or mother, still someone’s lover, still… someone. But so were are the other five.
This current global moment feels a lot like this problem. The binary tracks in the analogy would go like this. Pull the lever towards Track 1: Respond by doing very little to change our behavior, inevitably overwhelm the healthcare system, kill plenty of grandmothers, and keep the economy somewhat afloat. Pull the lever towards Track 2: Respond with authoritarian lockdowns, crash the economy, and prevent a lot of would-be grandma deaths.
The Track 1 business-as-usual path comes with some pretty ugly numbers and millions of deaths. We can calculate those with some fairly reliable accuracy given the data we have from other parts of the world. The Track 2 authoritarian lockdown path is much harder to calculate. Poverty kills. Depressions and recessions kill. But how much? An overwhelmed healthcare system doesn’t just kill COVID-19 patients but increases the fatality rate for things like strokes and heart attacks when there aren’t enough resources to care for them. But how much? These calculations are daunting but not impossible. There are economists armed with powerful computers who are quite good at that kind of thing. The economist Robin Hanson has been trying to do exactly this.
Of course both of these tracks are caricatures of extreme responses. There are proposals (cut checks to everyone and subsidize harmed businesses for lockdown path , movement restrictions only for the elderly and immune vulnerable for Track 1) . But even if we could calculate both tracks with great accuracy and reduce the equation to “life-years” would it even help us? Let’s say we ran the numbers and it turned out that we actually would be saving more life-years by taking the business-as-usual Track 1 path. This reflects what the great philosopher Donald J. Trump just tweeted in all caps “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”
There is a variation of the Trolley Problem called “The Bridge Problem” where you are standing on a bridge overlooking a single train track with an out-of-control trolley heading for five people. Next to you on the bridge is a person who you could push onto the tracks below in such a way that he would jam the gears and bring the trolley to a stop. This would kill him but spare the five lives. Of course, the math is the same as the classic Trolley Problem but it suddenly feels very different. You are going to have to touch this guy. You are going to see his horrified face and hear his loud protests to your plan. You are going to listen to him yell as he falls to his ugly death. Some people just can’t do it.
I think we’re in the bridge problem here. Of course, we don’t know the life-years or misery calculations of a severe prolonged economic global downturn. Below us is a very foggy scene on the tracks, but we can be sure it is a significant number. But next to us is the person we must sacrifice. And that person is very real and has a name. She might look like this. Are you going to be the one to push her?
In philosopher Lisa Tessman’s fantastic book, “When Doing the Right Thing is Impossible”, she argues that there are genuine philosophical moral dilemmas where every choice is “unacceptable” even if one choice results in fewer “unacceptable” things happening than the other. She rejects the philosophical soundness of reducing two different lives to a fungible asset like life-years. My years of life left will never be comparable to yours no matter how hard we try. I find this argument psychologically useful.
Tessman writes at length about the nightmare situation in New Orleans’s Memorial Hospital after Hurricane Katrina when doctors had to prioritize who lived and died in a hospital with dwindling supplies, power, and evacuation time. This situation is sadly repeating itself in Italy as I write these words. The doctors who face these decisions are in true moral dilemmas and no matter what they choose to do, they will be “wrong”. We ought to have sympathy for all decision makers at this moment. They can only lose a little less, never win. And no matter what choice is made, there will be regret and sadness associated with it.
I think we should be much kinder to people in these situations even if they choose something that we personally wouldn’t. If you push grandma onto the tracks, I might be a bit horrified, but I’ll understand and be there to comfort you when you are torn up about it. Hopefully, it wouldn’t be so “easy” for you.
Tessman does go on to assign an amount of blame onto the conditions which allowed a forecast-able impossible situation to materialize by pointing out the failures of the building management to address backup generators stationed below flood lines and likely racial and class biases in city planning policies which left the hospital underfunded and under resourced well before the hurricane hit. These kinds of conversations are important and relevant to how we might want to reorder our economic philosophy in order to be more resilient and protect the most vulnerable members in the future. But those kinds of conversations have to wait while the flood waters are rising or the virus is spreading.
So, here’s what I think. I don’t think we should push grandma onto the tracks, even if the fog clears on the tracks and the economic fallout is tremendously painful. At that moment while staring at the piles of bodies and pain inflicted by a depression, the solace of knowing that we “aren’t the kind of people who murdered grandma” won’t be much comfort. We will always feel like we made the “wrong” choice. According to Tessman, that feeling would be right.
But there would be a way to turn that regret into optimistic action. In my view, it is the role of philosophers, architects, and politicians to design a world which achieves progress and avoids as many impossible moral dilemmas as we can. We would be morally obliged to reassess the tracks. This surely won’t be our last dilemma and likely won’t be our last pandemic. One thing we can see easily from this is how the poor and economically vulnerable are often tied to the tracks first. Asking low wage service workers to be jobless without supplementing their losses is absurd. Or even worse asking them to work while sick threatens everyone. Have we acquired enough wealth to distribute it in such a way that shutting down the machine for a bit is less painful? Did we fail to put away enough for a rainy day? Perhaps.
Of course we could push grandma onto the tracks and go about our business (and yes, I do know that COVID-19 also is a real threat to younger folks). But there are risks there as well, it might not work. The economy still would suffer greatly with everyone getting sick. There are plenty of horrors beyond the obvious Johns Hopkins map we’ve all seen.
In the wake of that particular shame and regret we could turn towards the optimistic action of actually curing viruses better. The philosopher David Deutsch outlines a powerful definition of optimism: “all evil is caused by lack of knowledge.” As he explains, this is not even really a definition of optimism but an explanation for failure. It may sound trite but if we had the knowledge of how to cure this virus then all of the above dilemmas dissolve away and we never have to even consider bridge style murder.
It bears remembering that our particular knowledge of viruses has only been won fairly recently in human history. It wasn’t until the 1890’s that viruses were first observed (though something like them was theorized centuries earlier) and what is known as the “Germ Theory of Disease” fully booted its close-but-no-cigar predecessor, the Miasma Theory of Disease, which suggested that “bad air from rotting organic material” was the cause of disease spread. You can see how adopting the miasma theory could be mildly effective at avoiding disease and limiting spread and thus fool many scientific minds into thinking they had the true picture. Lingering around the bad air of rotting organics correlates with getting ill to a confusing degree and entrenched miasma theory in a way which stubbornly resisted eradication.
So, we’ve really only been at this virus thing with deeper knowledge for 130 years. That might also be a bit depressing if you were hoping for a swift and decisive cure to this and future pandemics. But the world is currently devoting an immense amount of creativity and talent to the problem, so you never know. We should celebrate that people are asking the question “When will we have a vaccine?” rather than “What really causes disease?” Though it’s clear that our knowledge is still inadequate. Just look around. The havoc that this tiny organism unleashed is monumental. The situation is untenable morally. And as Tessman argues, “impossible.”
By this point of the analysis the fist/nose image is nearly a farce. But in all of this we should not lose sight of that cherished sense of freedom. That too is in danger with both choices in the problem. Understanding how seemingly innocent actions like going to a concert while feeling perfectly healthy or adding carbon dioxide to the atmosphere while joyriding our new four-wheeler are actually very much like swinging fists hitting all kinds of noses, it’s easy to embrace more far left authoritarian answers and make swinging ones fist forbidden altogether. The danger of ceding liberty temporarily in favor of common safety is notoriously perilous. But there is no choice here. Liberty is going to be sacrificed either for grandma or grandson. We are just going to have to make sure we get it back. But there is a way to earn that.
We can’t unlearn the knowledge of the “asymptomatic host” as a moral truth. We’re going through some major pain as a result and there is no escape. But this is an opportunity for moral growth. Our only choice is to dedicate ourselves to go through less next time. A more resilient global economy and better biological knowledge of how to cure disease sound like clear marching orders for humanity. We can argue about exactly what that looks like once the flood waters subside and the virus is contained. but keep in mind After Hurricane Katrina New Orleans erected a $1.1 billion dollar hospital built to withstand debris flying at 200mph and operate for seven days without access to outside electricity, water, or other supplies. We’ll come out of this with some valuable lessons and a lot of work to do.
In the meantime, let’s give everyone a break. Be kind. Every answer is “wrong”.