Newington high street in Edinburgh and I’m shopping for ground coffee. I have in mind a particular bag of coffee that’s a favourite. One of the two little supermarkets has this coffee for half price. I know that I want to buy some, the coffee is identical in every way, and it’s no more trouble to me to walk to one shop as opposed to the other. I buy it from the cheaper shop. Everyone would do the same.
One time in ten years on this high street, and hopefully never, a car will drive towards Edinburgh city centre and the car ahead of it will brake suddenly. The driver will have to swerve (imagine he has to swerve) and to the left is one pedestrian while to the right are two. The driver can see them all, they are all equally helpless and they would all die instantly. It is a terrible choice. In that last moment, the driver swerves into one person instead of two. Everyone would do the same.
“We have to swerve left or right. Would you like us to swerve left and kill two people or swerve right and kill one person?”
“We have committed a billion pounds to healthcare in an attempt to save lives. Would you like us to spend this billion on covid-19 and save 100,000 lives or on cancer and save 200,000 lives?”
Of course the question as it is framed in the public perception is, instead, “Would you like us to spend a sum of money to save lives lost to covid-19?”, to which people’s answer without further context is likely to be yes.
How do we get from one question to the other? How do we draw out the context? How do we encourage a utilitarian approach to morality and collective decision making, in order to increase lives saved?
In other words, what are the factors that distract us from a clear choice?
Let’s look at the differences in turn. Firstly we look at spending our energy on a pandemic as an optional excursion in our lives, in our nations’ histories, where really we will be taking a path whichever it is. That is to say that there is no default; certainly not the default that we dedicate resources to a new illness as a matter of course. We choose to spend money and therefore that money is not available for other uses. Assuming a need for a choice avoids inertia in decision-making and forces thought about each option.
We would estimate the cost of treating a pandemic and then offer the same amount of money to the alternative healthcare attempt.
Secondly we are bound as humans to place a premium on problems that we can see. Seeing a problem could mean saving a person in trouble in front of us. It could also mean treating a problem that is novel and in the news as opposed to one that is ongoing and less newsworthy. Pandemics are given names and they unfold in real time. To remove this factor of visibility we could mention the other illness, whether one illness repeatedly or a range of them in turn, in the same sentences that we use to mention the pandemic.
Just because a pandemic is costing lives does not mean that our limited healthcare spending will save most lives by treating the pandemic. We might save more lives by spending on another illness.
A third factor is time. Humans discount the future; we regard £100 in a month’s time as worth less than £100 today, perhaps £95 or some other amount less than £100. If we are told that in a month’s time 100 people will die, we don’t feel that it is as important as 100 people today. Cancer deaths will increase in five year’s time if we reduce screenings today because healthcare is directed towards pandemic concerns, but we don’t know exactly how many more will die from cancer. Something might come up. For a fair comparison we could talk about the total of covid-19 deaths in 5 years’ time versus extra cancer deaths in 5 years’ time.
The special factor in a pandemic is people’s individual assessment of their own mortal risk. Are people afraid? This is a factor outwith our model of a crashing car choosing left or right. We therefore add the consideration that steering right, while killing only one person as opposed to two, increases our personal fear of death. Perhaps that person is standing beside a cliff and the car would crash over it.
How do we remove this particularly personal fourth factor from our decisions? We could talk about the risk of dying from cancer and the possible manner of a cancer death, as we talk about these for the pandemic. An element of the fear of the pandemic is of catching it today and thus dying within a month, which is a different fear from the longer-term fear of an ongoing cancer story with its potential ups and downs. We could talk about the risk of dying from the pandemic this month as opposed to dying from cancer this month, with the month’s figures brought forward. If 10,000 people die from cancer in a typical month then we can compare this with pandemic deaths in a month.
The missing link here is the ability to affect our risk; we feel that many illnesses hit us at random and that we have little or no control over whether we get them, whereas we are apt to think that a coronavirus can be avoided. We turn back to the risk of death overall, from particular causes. Individuals are part of society and are subject to the same risks as everyone else.
Our finished sentence is then, having neutralised our four factors above, “We have committed a billion pounds to healthcare in an attempt to save lives. Would you like us to spend this billion on covid-19 and within 5 years have saved 100,000 lives or on cancer and within 5 years have saved 200,000 lives and also making it less likely that you will die?”
We say, “and also making it less likely that you will die” because we treat the individual as part of society and thus equally likely to benefit from those 200,000 lives saved from cancer.
Now considering utilitarian approaches to morality in general, how do we regard the human instinct to try to save a person who is dying in front of us? Should we override this instinct to save more than one person elsewhere?
Why do humans have this essential human behaviour, of trying to save someone in front of us and of not placing as much importance on distant or future suffering? One advantage of it is that is prevents us from reasoning our way to answers that could be cruel. We jump on every illness that we see, even if it means more illnesses popping up elsewhere, like an old fashioned button radio.
In effect we encourage a competition for visibility of illnesses in question, so that they can be subdued in their turn. We create a battle for attention instead of a battle for reasoning, debate, priorities and calculation.
If we don’t follow utilitarianism in a pandemic, it could be because we don’t follow it at any time.
We maintain and polish our human instinct that life is valuable by valuing lives that we see around us; we fear that if we sacrifice any life that it is in our power to save, by being nearby, then we will lose sight of the value of life everywhere.
Perhaps the way around this is to increase the visibility of life everywhere – every illness, every place, and every future time – and to increase our sense of being able to affect it.