Guest Post: Pandemic Ethics-Earthquakes, Infections, and Consent

David Killoren
Dianoia Institute of Philosophy
Australian Catholic University, Melbourne

People often seem to be stubbornly resistant to change. Consider humanity’s collective failure to respond adequately to the climate emergency. Consider the lifelong smoker who won’t quit even after an emphysema diagnosis. Consider the meat-eater who watches Dominion, resolves to go vegan, and then falls off the wagon the next day. Even when we feel that we have excellent reasons to change our lives, we often drag our feet.

Yet when the coronavirus appeared in late 2019, our antipathy to change suddenly seemed to evaporate. Medical experts and politicians called for sweeping changes and huge numbers of people simply heeded the call. To be sure, there are dissenters. America’s deeply strange president is among them. But the degree of compliance with new restrictions and requirements that we’ve seen in recent weeks is extraordinary. Work, education, dating, dining, art, sport, even casual conversations with strangers—all of these facets of life have been dramatically altered, canceled, or paused for an indefinite period that may last two years or more, and there’s been little complaining from the people. If nothing else, the coronavirus crisis demonstrates this: When conditions are ripe, we are willing to upend our lives.

I’m not here to criticize or to defend the way we’re responding to the virus. But I want to raise some questions that I think aren’t receiving due attention.

Living with earthquake risk

Seismologists give a 65% probability of a massive earthquake in the Turkish city of Istanbul before 2030 and are almost certain that it will happen before 2100. The precise magnitude and location of earthquakes cannot be known in advance, so there is a lot of uncertainty about the destruction that a massive earthquake will cause. Pessimistic scenarios involve deaths in the hundreds of thousands; optimistic scenarios involve far lower death counts.

Everyone in Istanbul knows all about this. The earthquake risk is very salient there in part because earthquakes occur often in Turkey. In 1999, more than 17,000 people were killed by an earthquake in Izmit (about an hour’s drive from Istanbul). The most recent deadly earthquake in Turkey was in January 2020 (31 died).

The city of Istanbul carries on and thrives despite the dark cloud of this risk. There is fear, but the fear doesn’t stop citizens from going on with their lives. When the earthquake happens someday, many people will die. Survivors will rebuild. Istanbul has existed (under various names) for more than two thousand years and has survived massive earthquakes before.

Why would one choose to live in a city where the risk of earthquake is so fearsome? Because it’s among the liveliest and most beautiful cities in the whole world. It’s the most prosperous city in Turkey. It’s twice the size of New York City. There are many opportunities in Istanbul that cannot be found elsewhere. It’s no mystery that people choose to live and work there.

Why does the government allow people to remain there if it is known that a massive earthquake is coming? Part of the explanation, surely, is that the government could not stop people from being there even if it wanted to. The Turkish people have taken a lot of abuse from governments in the hundred-or-so years that the modern Turkish state has existed, but 14 million people would not tolerate being made to leave their city, or so it seems reasonable to believe.

You might think that this situation is some kind of oddity unique to Turkey, but it’s really not. Seismologists give a 75% probability of a massive earthquake striking southern California before 2044. California is better prepared for earthquakes than Istanbul, but the death toll could nevertheless be large. And many other heavily populated areas all around the world are in places where massive earthquakes in the future are probable.

The people in countries threatened by earthquakes face a stark choice: they can radically upend their lives by relocating away from earthquake-prone areas—or they can continue life as they know it and allow that a great many of them will die tragic, preventable deaths. Collectively and individually, the people choose the latter option.

When the coronavirus appeared in late 2019, it presented people all around the world with a similar choice. We all had to quickly decide whether to radically upend our lives in order to try to prevent the virus from spreading—or to accept that a great many of us will die tragic, preventable deaths. Almost every country in the world has now chosen some variant of the life-upending, death-preventing option.

Broadly speaking, it seems to me that when we’re faced with these kinds of threats, we have two ways to respond: we can carry on, or we can flee. With regard to each threat of this nature, there’s lots of different ways to carry on and lots of different ways to flee, but the available responses usually seem to fall into one or the other of these intuitive categories.

Our response to the coronavirus has been to flee. Granted, we have not fled our cities (though in many places it sure looks like we have) but we have fled into the safety of our homes: we’re “sheltering in place.” This is no less true in places such as Istanbul and Los Angeles where people traditionally carry on in the face of earthquake threat. This is a human pattern, seemingly independent of location or culture: When we are threatened with earthquakes, we often carry on—but when threatened with this particular virus, SARS-Cov-2, we flee. Why?

Well, different threats call for different responses. Maybe the virus is more fearsome than an earthquake. Or maybe fleeing indefinitely into our homes from the virus is less life-upending than fleeing from earthquake-prone areas. Maybe it’s that simple.

But I think there is something deeper going on, too. I think that a virus raises rather different ethical issues than an earthquake, and I think the ethical differences between these threats might explain some of the differences in our responses to them. My purpose in this essay is to wrestle with these ethical issues. But first, in order to make things vivid, I want you to consider a thought experiment.

What if we were to reopen Australia?

Here’s a hypothetical scenario. After some time in government-imposed lockdown, the people of Australia become restless and decide that enough is enough. Public pressure forces Australia’s politicians to announce an end to the current restrictions. Restaurants, cafes, bars, playgrounds, universities, office buildings, construction sites, churches, movie theaters—they all open back up. In this scenario, suppose, no one is legally required to go out into the world and expose themselves to the virus. Social isolation, self-quarantine, and staying home are still permitted and many people will still voluntarily restrict themselves in those ways. But such measures are no longer required and no longer encouraged by the government.

Predictably, infection rates, which had been falling, now begin to rise.

In the scenario I’m now asking you to imagine, we the Australian people choose to have the restrictions lifted even though we accept that this means that many citizens will be infected. Most will survive the illness, and some will never even feel sick—but many thousands, especially many of our older citizens and others who are especially vulnerable, will die horrible deaths. This isn’t the flu. We know that. In terms of the scale of the tragedy, this virus is much more like an earthquake than a flu outbreak. It poses a deadly threat to all of us, even to powerful people. We’re not in denial about what we are unleashing upon ourselves. But as a society, we decide that tragic, preventable deaths are a fair price for getting our way of life back.

The foregoing is a thought experiment, not reality. We aren’t making that choice and we seem unlikely to make it in the future. But what if we did? If we were to make such a choice together, as a society, would we be wrong to do so?

There’s a difference between the coronavirus and an earthquake

Of course, there are many differences between the coronavirus and an earthquake. But at least one of those differences might be especially important from a moral point of view.

An earthquake is inflicted on us by an external force: mindless shifting of tectonic plates seems to be the sole culprit. By contrast, we inflict a virus on one another. Each of us is a potential vector, a vehicle of transmission. This difference might matter.

Once the number of infections passes a certain threshold, the medical system will be overwhelmed, forcing a shortage of medical resources, leading to heartrending rationing dilemmas and to a higher death rate among those in need of hospitalization. Observing this, Stephanie Collins claims that going about your business (rather than staying home) is relevantly similar to joining in with a crowd of people to push a boulder off a cliff, causing some number of people at the bottom of the cliff to die.

Collins’s analogy might shed some light on the moral situation regarding coronavirus. And note that such an analogy doesn’t seem to apply in the case of an earthquake. An earthquake will simply occur or not, independently of what any of us do. An earthquake is a boulder rolling toward all of us, not a boulder that we roll at each other. This reinforces the thought that the morality of accepting coronavirus risk as a society might differ from the morality of accepting earthquake risk as a society.

Along roughly these same lines, Michael Huemer points out that “[a]ny individual who is at risk of carrying a communicable disease, such as Covid-19, is posing a risk of physical harm to others when he interacts with them,” and this, Huemer maintains, can justify the state in imposing coercive restrictions on citizens during a pandemic.

In view of these points, one might argue: It would be wrong for Australia to lift the recent restrictions in order to try to restore normal life, because it is wrong for anyone to go out into public spaces knowing that they might thereby infect others. A society needs to stop its people from wrongfully doing this kind of harm to one another, and that’s why the restrictions must be imposed.

Perhaps this argument seems compelling. But there are some complications here.

The moral power of consent

First, even if it is wrong to go about one’s business with the knowledge that one might infect others, it does not follow from this that it is wrong for the state to allow people to go about their business with the knowledge that they might be infecting others. Indeed, in many cases, it is wrong for the state to prevent people from acting wrongly. Consider a well-worn example: Cheating on one’s spouse is wrong—but it is equally wrong for the state to patrol cheaters. The government should not be in the business of enforcing marital fidelity.

Second, it’s not immediately obvious that it would be wrong to go about one’s business in the alternate-universe Australia described above. In such a scenario, it would be widely understood that interacting with others comes with an appreciable risk of being infected. Each citizen would need to weigh that risk against the benefits of interacting with others. By interacting with others, you would be tacitly consenting to the associated risks—much as in getting into the passenger seat of your friend’s car, you tacitly consent to the risk of a car accident. And this tacit consent could be presumed to be well-informed in a world where details about the virus were widely publicized. Yes, you would be risking infecting others if you were to go out and about—but you would be doing so in a context where others had willingly accepted that risk in order to go out and about themselves.

The situation is perhaps comparable to an issue in sexual ethics. Suppose you and a partner both want to have consensual unprotected sex. It is true that in such a case, you each risk transmitting an infection to the other. Any resulting infection is a result of choices that have been made—it’s not something that simply happens, like an earthquake. Despite this, it’s quite unclear that either party is acting immorally, because (ex hypothesi) both parties have consented to the activity and to the associated risks. In the alternate-universe Australia described above, going to a crowded bar might be similar to having unprotected sex: decidedly imprudent but not obviously immoral.

But there are further complications.

We shouldn’t abandon our most vulnerable citizens to the virus

Many of the people who would be infected were restrictions lifted would not be capable of consenting to the associated risks. If the virus begins to spread widely in Australia as it is doing elsewhere, it will infect many people with cognitive disabilities, such as dementia, that make true consent impossible. Such people deserve to be protected.

Also, there are limits to the moral power of consent. Consider the gruesome case of Armin Meiwes, who killed and ate a man with that man’s consent. The fact that Meiwes’s victim consented doesn’t seem to make Meiwes’s action morally acceptable. Meiwes has been convicted of murder and this seems like the right judgment. This case shows that a consensual interaction can be wrong if it’s harmful enough. Another example: charging $1M for a glass of water when someone is dying of thirst. Such cases of exploitation show that a consensual interaction can be wrong if it occurs in a case where the consenter has no minimally acceptable options.

These complications combine. In the coronavirus case, many of those who are incapable of true consent also happen to be among those most vulnerable to serious harm. That’s because older people tend to suffer more when they are infected with this virus and older people are also more likely to have the kinds of cognitive disabilities that undermine the capacity for consent. And many of those same people would have no good options were coronavirus to become widespread in Australia. Australia should not allow people to have to choose whether to stay home and go hungry or go to the supermarket and be exposed to a virus that is extremely dangerous for them.

One can imagine various possible solutions to these problems. Suppose Australia were to combine a policy of opening up and getting back to life for the majority of people, with a system of providing ample support for those who are most vulnerable to the virus. Such support could take many forms. Perhaps there would be a social agency tasked with helping to isolate and assist people who are most vulnerable. Generous stipends and services for such people could be provided. Prisons could be restructured with federal assistance, or prisoners could simply be freed on parole, to ensure that they are not forced to submit to being infected. One could even imagine a network of virus-free enclaves where people who are especially vulnerable to illness from the virus could live until the present crisis has ended. The costs of such support might be high, but those costs might nevertheless be lower than the social and economic costs of the lockdowns currently in place.

It seems to me that in order to even begin to make a persuasive moral case for the reopening of Australia, Australia would need to be able and willing to protect those who are highly vulnerable—a group that may include everyone over the age of 60 and everyone with a list of comorbidities—from being exposed to the virus. If there is no feasible way for this to be done, then it would at least be difficult to persuasively defend any robust reopening until a vaccine is developed.

Could we justifiably reopen our society if we could provide strong social support for the most vulnerable?

Imagine the following plan. (1) Divide people into two groups: Group A, containing people who are at lower risk for serious illness from the virus, and Group B, containing people who are at higher risk. (2) Introduce strong measures to protect individuals in Group B from being infected and to provide those individuals with the means to live well during this time. (3) Allow people in Group A to go about their lives. Call this the Protect the Vulnerable and Carry On Plan—the PVCO Plan.

A principled and defensible way of sorting people into Group A and Group B would have to be devised. And the measures put in place to protect individuals in Group B would need to be effective and known to be effective in advance.

Further, it’s evident that Group A (the low risk group) will contain a number of people who are incapable of true consent. For example, Group A will contain children, because it’s turned out that children are at low risk of being seriously harmed by the virus. If we were to adopt the PVCO Plan, we would in so doing expose those people to risk of infection without true consent. The PVCO Plan therefore requires the assumption that we can justifiably expose people to risk of infection without their consent as long as their risk of being seriously harmed by infection is low. This assumption seems to be widely accepted already (Australia is currently making little effort to protect children from being infected with the virus) but that doesn’t mean it is correct.

Could the PVCO Plan be justifiable? In my view, the answer to that question depends largely on a straight-up cost-benefit analysis.

Social and economic life weighed against tragic, preventable deaths

An obvious benefit of the PVCO plan is that it would allow social life in Australia to return to something like what it was before all of this began. People in all layers of society would benefit from this but it would be more beneficial for some groups than others. I suspect the social disruption caused by our present course disproportionately harms some of the worst-off members of our society. As one small illustration of this point, consider that Alcoholics Anonymous meetings are no longer being held in person. All of us, but especially our society’s most fragile members, depend heavily on being able to freely interact with other people.

In an influential defense of a human right against social deprivation, Kymberlee Brownlee focuses on quarantine as a main example of a form of treatment that can be rights-violating, saying that “an appreciation of the intrinsic value of social interaction should lead us to take a critical attitude toward medical quarantine.” Government-imposed lockdowns and self-quarantine mandates in Australia afford more freedom to interact with others than the sorts of quarantine that Brownlee has in mind, but it’s nevertheless reasonable to worry about the possibility that many people are experiencing overwhelming levels of social deprivation as a result of current policies.

Another major benefit of the PVCO Plan is that it might allow Australia’s economy to recover. Some expect Australia’s unemployment rate to rise to 20%. We might avoid this if we were to reopen workplaces sooner rather than later. The benefits of avoiding economic calamity would be felt not only within Australia but in many other parts of the world because many countries depend on participation in Australian markets. We are on course for a global Great Depression that will result in increasing poverty, desperation, political instability, and even starvation and death in countries that are less wealthy and less free than Australia. Reopening our economy stands a chance of preventing some of that damage. This strikes me as a particularly powerful consideration in favor of reopening.

However, inviting renewed spread of the virus would come with its own economic problems. Ezra Klein argues persuasively (in the American context) that containing the virus is necessary for economic renewal. In light of this, it’s quite uncertain how much economic ground could be regained by reopening the economy. This is a complex matter.

A principal downside of the PVCO Plan is that it would lead to a lot of tragic, preventable deaths. Those deaths have to be weighed against the benefits of reopening.

The number of deaths depends on (i) the percentage of the Australian population who would fall into Group B (the high risk group) and Group A (the low risk group), (ii) how effectively we could protect Group B from exposure to the virus, (iii) the percentage of Group A who would be infected, and (iv) the death rate among infected members of Group A. (Some evidence bearing on (iv) is contained in a recent analysis published in The Lancet which contains estimates of infection fatality ratios in mainland China; but the lethality of the virus varies.) To keep the death rate as low as possible, the controlled transmission idea described by James Trauer, Ben J Marais, and Emma McBryde, or the similar-in-principle controlled infection scheme proposed by Robin Hanson and defended by Richard Chappell, might be tried. We can’t know in advance how many people would die—just as the people of Istanbul and southern California can’t know in advance how many people will die as a result of their decision to inhabit earthquake-prone areas.

Whatever we do in the future, we should stay the course for now

New infections are currently decreasing at a steady pace in Australia. It is currently reasonable to hope (though not to expect) that the virus might be eradicated throughout the continent. If that happens, and if we are able to prevent the virus from being reintroduced in Australia, then we might be able to revitalize and restore our economy and our social life without having to accept mass sickness and death.

But suppose the virus isn’t eradicated. Suppose that, despite all of our efforts, it continues to spread at a low but significant rate for weeks and months to come. Suppose further that it eventually becomes clear that development of a vaccine is not months but years away—or worse, that development of a vaccine turns out to be technically impossible. Then we’ll have to decide whether to continue restricting ourselves indefinitely—or to lift the restrictions and accept a significantly higher risk of severe illness and death for all Australians. We will need to find a way forward that respects both the value of our social and economic freedoms and the value of our health.

During this time I keep thinking of Saint Francis’s legendary embrace of the leper. It turns out that leprosy is not extremely contagious, but (in the version of the story that I was told as a child) Francis didn’t know that. In embracing the leper, Francis risked not only his own health; he also risked passing leprosy on to third parties. Today, our society faces a conflict between the value of health and the value of human connection, and Francis represents one way of responding to that conflict. It’s not obvious to me that Francis’s way is wrong but it’s not obvious to me that it’s right, either.