Cross Post: Selective lockdowns can be ethically justifiable – here’s why

Written by: Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu

 

Spitzi-Foto/Shutterstock

COVID is surging in some European countries. In response, Austria and Russia are planning to reimpose lockdowns, but only for the unvaccinated. Is this ethical?

Some countries already have vaccine passport schemes to travel or enter certain public spaces. The passports treat those who have had vaccines – or have evidence of recent infection – differently from those who have not had a vaccine. But the proposed selective lockdowns would radically increase the scope of restrictions for the unvaccinated.

Lockdowns can be ethically justified where they are necessary and proportionate to achieve an important public health benefit, even though they restrict individual freedoms. Whether selective lockdowns are justified, though, depends on what they are intended to achieve.

One benefit of a lockdown is that it can prevent a country’s healthcare system – especially hospitals – from becoming overwhelmed. If that is the aim, though, there is little need to lock down people at low risk of being hospitalised, such as those who have received a COVID vaccine. But we might also exclude from lockdown young people (even if unvaccinated) who are at low risk of severe COVID (a recent Moscow lockdown took this approach). So this aim would only support a selective lockdown targeted at the unvaccinated elderly or the medically vulnerable, or both.

Alternatively, the primary aim of a lockdown may be to stop the virus from spreading. Since the young and old pose similar risks of onward transmission, this would not support an age-selective lockdown. Yet a lockdown justified on this basis perhaps also should not distinguish between vaccinated and unvaccinated people. That is because vaccines reduce but do not eliminate transmission. The aim of reducing transmission might only support a lockdown of the entire population. And it is not clear that the benefit would be proportionate to the cost of such a lockdown.

Graph showing COVID cases rising rapidly in Austria and the Netherlands
Daily new COVID cases per million of population.
Our World In Data, CC BY

A quite different justification for both vaccine passports and selective lockdowns for the unvaccinated is that they might encourage people to have the vaccine. Indeed, John Swinney, deputy first minister of Scotland, claimed that the goal of the Scottish vaccine passport schemes was to increase vaccine uptake.

Clearly, if the goal of new lockdown restrictions is to get people to have the vaccine, it should only apply to those who have not yet been vaccinated.
However, this is ethically dubious. Restricting individual liberty just to make someone act in a particular way often amounts to coercion.

When the stakes are high, it may sometimes be justifiable to impose some degree of coercive pressure to achieve public health goals, for example, to prevent harm to others. But the costs to individual autonomy are considerable, so coercive pressure can only be justified if it is necessary to achieve very valuable goals.

Other methods of increasing vaccine uptake without encroaching on individual liberty, such as education campaigns and the use of incentives, would be ethically preferable.

Inequality

A common objection to vaccine passport schemes, which may also apply to selective lockdowns, is that they treat people unequally. For that reason, some people might be happy with locking down the whole population, but not a particular group – such as the unvaccinated or the unvaccinated elderly.

However, unequal treatment isn’t always unjustified. Even if selective lockdowns treat people differently, this is not necessarily discrimination.. We have previously suggested that in responding to this pandemic, we face a trilemma between liberty, equality and COVID deaths. Selective lockdowns are an illustration of this kind of choice. There are unavoidable ethical trade-offs in our response to a resurgence of the pandemic – we need to decide which ethical values we will prioritise, and which we compromise.

In areas where the virus is spiking, we can reduce COVID deaths and treat people equally by imposing a general lockdown, but that would involve a substantial cost to liberty. One that Austrian chancellor Alexander Schallenberg isn’t willing to take. Defending his country’s selective lockdown, he said: “I don’t see why two-thirds should lose their freedom because one-third is dithering.”

Alternatively, we could treat people equally and not restrict anyone’s liberty. That might put healthcare systems at risk and lead to more deaths.

So selective lockdowns could be justified to prevent a health system from being overwhelmed. They may be unequal, but the alternatives are also unpalatable.

Jonathan Pugh, Research Fellow in Applied Moral Philosophy, University of Oxford; Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of Oxford, and Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children’s Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.
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8 Responses to Cross Post: Selective lockdowns can be ethically justifiable – here’s why

  • Alberto Giubilini says:

    One interesting question for me is why focused-protection strategies (say, lockdowns only for vulnerable groups, as per Great Barrington Declaration model) were never considered before we had the vaccines because they were considered unethical, but they now are implemented on the basis of vaccination status.
    If the aim is to prevent transmission, then, as you say, lockdown should apply to everyone, regardless of vaccination status, since these vaccines do not really prevent transmission.
    If the aim is to encourage vaccine uptake, then the measures are a form coercive vaccination policy. Which might or might not be justified, but Governments need to be explicit that lockdown in this case is a punitive measure.
    If the aim is simply to prevent COVID patients overwhelming the health care system, as the Austrian chancellor’s statement seems to suggest, then the measure should only apply to old unvaccinated people, since the young are unlikely to require hospital care even if they are unvaccinated. But if that is the aim, then focused protection strategies as per Great Barrington Declaration model should have been introduced early on in the pandemic, instead of population-wide lockdowns.
    Whatever the explanation for the Austrian policy,

    • Alberto Giubilini says:

      (posted earlier by mistake). whatever the explanation for the Austrian policy, it seems there is either a lack of transparency about the intended aims or an inconsistency in the application of some ethical principle

    • dionissis mitropoulos says:

      Hello Prof Giubilini. I am not a philosopher but i want to address a point you made. You said:

      “If the aim is simply to prevent COVID patients overwhelming the health care system, as the Austrian chancellor’s statement seems to suggest, then the measure should only apply to old unvaccinated people, since the young are unlikely to require hospital care even if they are unvaccinated.”

      What is your response to the thesis that, in the scenario you mention, even old (70 years old and above?) unvaccinated people should have the option to escape the age-focused lockdown by signing a paper to the effect that in case a hospital bed they occupy as a result of their not having been vaccinated for Covid is needed for another patient, then the doctors have the right to take the bed from them and give it to the new patient if need there be? I think that i was the first to have thought about this autonomy-respecting solution but had not stated it publicly before others did; the public statements i have seen to that effect are two and they were both of the variety “all those of you who oppose total lockdowns go forfeit your right to a hospital bed if you insist, i bet you are not ready to do it”. Dr Nassim Taleb had a tweet to that effect. It was my own position too, except in my case i do not mean the putative choice by a hypothetical old person to be a reckless choice, as Dr Taleb would have it, but as a potentially very reasonable alternative for certain old people who 1) are determined to never get vaccinated and 2) are very healthy or who, even if truly vulnerable, value life in different ways than those who endorse lockdowning themselves. I would definitely take this option, if offered to me when I am old.

      • Alberto Giubilini says:

        Thanks Dionissis. I do think people’s freedoms should be respected as much as possible, i.e. to the extent that respecting them does not significantly harm others (including significantly limiting others’ freedoms). This means taking value pluralism seriously and respecting the free choices of those that hold the kinds of values you mention. It is reasonable for some people to value their freedom and their social life more than the safety (or, sometimes, false sense of safety) that lockdowns and other restrictions give. In the present context that might create significant harm to others and contribute to undermining a valuable public good (health care systems). Thus, if the person is prepared to take on him/herself the risks and costs of their choice without imposing it on others , taking freedom seriously means that they should allow to do what you suggest. So I think I would agree with you on the second point: vulnerable people should be free to refuse lockdown if they are prepared to take on themselves that kind of risk/cost, rather than imposing it on others. But this should only apply in situations of real emergency and as a factor to consider in triage situations, that need to include other factors (age, chances of survival, expected QALYs saved, and possibly others). These are very complex and often tragic decisions that cannot be based on a single factor.
        I am instead not sure about vaccination, because in that case vaccine refusal does come with an increased risk for others that the person cannot really prevent or internalize, namely the increased risk of passing the virus on to others. It is true that current vaccines are not too effective at preventing infection and contagion, but to the extent they do at least something (however small the effect is) in that direction, that counts as a reason for getting the vaccine. I think there are other reasons for excluding certain groups from vaccine requirements (uncertain risk/benefit profile for young people), but I am not sure the one you mention applies here. Of course, if vaccines’ effectiveness at stopping virus transmission is very small, then this point does not apply and I would agree with you also with regard to your first point.

      • dionissis mitropoulos says:

        Hello again Prof Giubilini and thank you very much for your very philosophically informative response.

        I certainly acknowledge the risk that unvaccinated people (i. e. people like me, I am a conscientious objector, not just towards vaccines, but towards almost all medical interventions via medicines that have been tested on animals, and I have other conscientious objections too, and additional non-conscientious reasons) are posing to third parties, namely the risk of transmitting the virus. In my previous comment I was only trying to make the point that the hypothetical old person, on the assumption that she is determined to not get vaccinated, she may be practically rational under certain circumstances if she chooses to risk losing the right to a hospital bed, given her other values and given her initial determination to not get vaccinated. I was not addressing the practical rationality of the initial decision to not get vaccinated, and certainly not the morality of the decision: from the very first days of Covid I was willing to offer to my fellow citizens the protection that the State is (de dicto) aiming at offering them, namely to make my self immune so as to contribute to slowing of the spread and protect the Health Care system, but, given my conscientious objection to getting vaccinated, I was willing to get deliberately infected in an “institutionalized” way (for example, instead of an appointment for a covid vaccine at the hospital I could keep company to a Covid patient for a while, aiming at catching the virus in the process), not only because this would afford me the best medical advice as to how to go about it (for how long should I stay next the Cocid-sick old lady at the hospital?) but mainly because this would annul the social stigma that characterizes *all* people who do not wish to get vaccinated – the labels “antivaxxer” and “denier” being the cognitive triggers of connotations about our characters so deleterious that I think amount to a violation of a human right when uttered by officials or powerful institutions. Surely, if the State would allow me to get immunity in my preferred way and put its stamp on this procedure this would protect *me*, and people like me, from the social stigma of being thought of as a free-rider, or as a “denier”, or as someone with a generalized lack of concern for the health of his fellow citizens, or as a dupe of conspiracy theorists, or as epistemically totally irresponsible, and all other connotations that the decision not to get vaccinated triggers in the heads of my fellow citizens, given the current public discourse. Not to mention that I would be allowed to exercise my social-life’s options (as things stand, I will never be able to attend an analytic philosophy gathering for the public, much as I am willing to be immunized by infection and hence be a non-threat towards society). Which brings me to a few more questions I would like to pose to you; what follows is a gesture towards morally relevant policy considerations that my philosophically-untrained-but-slightly-philosophically-informed brain has come up with, in the hope of eliciting a response from you that can guide the thinking of people like me:

        Given the fact that I am very healthy, and given the fact that my risk of dying from Covid on the assumption that I get infected is negligibly small in my value-informed risk-preferences book (1 in 14,000, https://qcovid.org/ ), isn’t it inconsistent on the part of the State to stop me and people like me from seeking the deliberate infection that we have informedly decided upon? Heathy people (i.e. people with zero comorbidities) below 70 years old who also have normal weight face a very low personal risk if infected (the flu IFR is 1 in 1,000, any pathogen’s risk around there I decree to be low risk for me). Now, on the assumption that these people are conscientious objectors to vaccines like me, we are going to be posing a constant threat to others if we stay uninfected because, ex hypothesi, we will never get the vaccine – I am talking about the subclass of the unvaccinated that are truly determined, like I am, to never get vaccinated. Isn’t the State morally required, if it is indeed aiming at protecting the unvaccinated and the immunocompromised, as it says, to allow us to get what we explicitly seek? (lots of unvaccinated people in Greece exchange phone numbers promising to infect each other in order to acquire or renew the Green Pass). It is true that the State, in principle, would have preferred to avoid any deaths it deems reckless (such as the deaths that would result from the decisions of some of the people in my subclass of the unvaccinated to get deliberately infected under a hypothetical regime of institutionalized infection) but, as the experts have recognized, sooner or later we will anyway get infected in an unplanned way (given our non-negotiable decision to never get vaccinated). So why isn’t the State willing to “frontload” our infections in a planned and institutionalized way, infections which are bound to happen anyway? The State’s refraining from institutionalizing these voluntary infections is increasing the risk for the other subclass of the unvaccinated (i.e. not my subclass which consists of conscientious objectors) that comprises the people who are considering taking the Covid vaccine if they get persuaded that it is safe, but who are taking their time to make sure the vaccine is indeed safe. I cannot pin down the structure of the argument that I would have liked to be able to make drawing from concepts in the literature of self defense, but here are my first steps:

        All of us (unvaccinated) are ( I am granting for the sake of argument) culpable threats towards third parties – the official State position sounds like grounding this culpability in inadequate concern for our fellow citizens evinced in our refusal to get vaccinated. But leaving aside this putative culpability towards third parties, we the whole class of the unvaccinated are also seen by the State as culpable threats towards ourselves and towards each other. But, surely, in the State’s eyes, we the conscientious objectors must be more culpable for the threat we pose to the other subclass of the unvaccinated than *they* are for the threat they pose to us. Why? Because, I tentatively argue, the initial State assumption is that culpability emanates from the attitude of refusing the vaccine. But then, a lesser degree of attitudinal recalcitrance towards this or all vaccines should be resulting in less culpability, according to the officialdom’s ethos – recently, Prof Yanis Varoufakis https://www.youtube.com/watch?v=Xp1rj7QMGXQ min 33:50 up to min 36:00 spoke with a gentle tone of this subclass of the hesitant unvaccinated, characterizing them “good-will persons” (καλοπροαίρετοι), in apparent contradistinction to the rest of the unvaccinated, the “ideologically unvaccinated”, some of who hold the “far-rightwing” view that “no one will violate our bodies with substances, especially the State”. (Well, pardon my ill will, I belong to the other group of the unvaccinated). If culpability, or degree of culpability, is to play a role in the allocation of risks (I am totally unaware of the literature in self defense) it seems to be the case that the State is obligated to protect the class of the hesitant unvaccinated from us by allowing us, the more culpable party, to be deliberately infected (because both hesitants and determined ones are going to be meeting each other in the supermarket, and our lack of immunity will be endangering the hesitants). And on a different accounting, If the State protects *me*, namely the determined to never get vaccinated, from getting deliberately infected (and my risk of death is very low), then the State endangers another unvaccinated person who is waiting to take a vaccine when she becomes persuaded that it is safe. This person could have much higher risk of dying from Covid than me, but even if our risks are comparable, the State ignores that the other person may sometime be persuaded to get vaccinated and avoid being endangered that much, whereas in my case it is certain that I will be infected, if not now then sometime in the future. The State, by its lights, in effect sacrifices people from the hesitant unvaccinated class for the sake of deferring a bit later the exposure to risk of those who are in the other class, the class of the determined unvaccinated. Isn’t this inconsistent with the State’s desiderata to protect the (more) innocent and to maximize the number of lives saved? To sum up, I see a utilitarian argument for allowing voluntary deliberate infections because they will save lives (the lives of those vulnerable who wouldn’t have died by being infected from us, if we had been allowed to get our inevitable infections sooner rather than later). I also see the quasi-deontological argument from lesser culpability that I gestured at. I also see a deontological argument based on the principle of secondary permissibility that i read about at Public Ethics:

        https://www.publicethics.org/post/secondary-permissibility-and-enabling-harm-a-case-of-covid-19

        It seems to me to be coming down to the fact that we the determined unvaccinated have (ex hypothesi) the exposure-to-the-virus coming anyway, and therefore, according to the principle (or a variation of the principle?), the deontologist State is allowed to enable our voluntary exposure for the sake of preventing the death of others, even though this may be counting as the State’s using us as a means to saving the others. I cannot understand the deontological mechanics here but it seems to me the permission is uncontroversial intuitively. Somehow it seems relevant to me that it was the State that initially prevented us from entering the hospital when we were heading there to get our deliberate infection for the sake of the hesitant unvaccinated. Maybe the State was culpable in the first place to stop us from entering the hospital? After all, to use a variation of the example of the Public Ethics article, the 5 turned the trolley on themselves in order to save the 10 unvaccinated hesitant, and the State intervened to save us and redivert the trolley towards the 10. Aren’t the 10 wronged by the State? And isn’t the State now obligated to undo the wrong by rediverting the trolley towards the 5 who are still asking the State for it? Apologies for the total lack of analytic clarity, I am utterly ignorant of Deontological Ethics.

        A final point I would like to make, which seems to have been totally ignored in the public discussion: the unvaccinated have been systematically demonized as the source of variants, based on the true consideration that unplanned infections that drag on for long time give time to the virus to “try” new mutation tricks. I will post a link from ex Yale Prof Dr David Katz, a healthy nutrition and Preventive Medicine expert, the article is from January 2021, I quote Dr Katz’s then assessment of how we could have avoided the generation of variants before there were any vaccines, and I am doing so because I think that there is an analogue here now, applicable to the total population of the unvaccinated:

        https://www.linkedin.com/pulse/dramademiology-covid-pandemic-manifesto-here-now-david/?trk=read_related_article-card_title

        “Here we are, now- contending with a proliferation of mutant viral strains. This was inevitable the moment our management of the pandemic required this many months. Pathogens and our immune system are opposing sides in an arms race; random mutation deals arms to both, but vastly faster to the virus. The more viral generations, the more hosts populated, the greater the chances of advantageous mutation. Those come to prevail, because that’s the nature of the advantage.The only practical way to constrain the impact of mutation with an airborne pathogen that can take refuge in animal reservoirs…is risk-stratified exposure”.

        “But intentionally high, early exposure among those reliably at the lowest risk of adverse outcomes, followed by those at next lowest risk, and so on…was a way to let the original viral strain produce widespread immunity with minimal harm.”

        Well, in the same vein, voluntary planned exposure now of those determined-to-never-be-vaccinated, no matter their risk, will lower the potential for generation of new variants (which is a benefit for the whole global population), protecting in the process the lives of the rest of the unvaccinated, and of the immunocompromised in the whole population (through the reduction in risk of us infecting them). But even if the State has some excuse for not letting some of the determined unvaccinated be deliberately exposed on the grounds that they are vulnerable, what can the State’s objection possibly be if it stops low risk people like me from being deliberately infected? This is like the epitome of inconsistency, the State complaining for the generation of variants, pinning the variants (semi-veridically) on the unvaccinated, while behaving in ways that prevent a subclass of the unvaccinated from contributing to stopping the possible production of those variants the State is accusing the unvaccinated of culpably generating, and with no excuse for the State that it is trying to prevent harm to us, given our very low risk of being harmed.

        Thank you Prof Giubilini, I think we need more such public discussions about the vaccine mandates and the lockdowns. You analytic philosophers are in a position to help us, the public, focus our attention on moral issues that are in our heads but are still inarticulate. If we add to this the conceptual clarity that analytic philosophy thrives on, it is a no brainer that analytic philosophers should be engaging the public more on these vaccine and lockdown issues. Not as moral connoisseurs (for they are not more moral than the public, at least not qua analytic philosophers), but as experts capable of helping us the public have far more constructive, focused, and conceptually clearer discussions.

  • Pavel Novak says:

    I think Covid is rather story about our society and our political approach. Why?

    The first interesting point is how rapidly we have adopted the Covid newspeak. According to Orwell the goal of the newspeak is to hide the real meaning of the words in order to manipulate people and make them believe that the political power acts are published in favour of people or in favour of the good. The word „lockdown“ so far completely unknown (despite there were a lot of infectious diseases) is the precise case. Lockdown means the ban/prohibiton, preventing people to go out. But it is just not popular to use such awfull words.

    The second point is the international unity. Actually this is the dominant factor that entitles the governments to proceed all these Covid measures. It is hard to imagine that the „lockdown“ would be imposed in just one country. On the other way round the countries that did not imposed „hard“ lockdowns (e. g. Sweden) were condemned…. If national health care ministers want to defend lockdown or the other Covid measures they usually do not talk about the reasons on which they are neccessary or how they help us to cope with pandemic. They rather say „Look… Overthere they also introduce lockdowns and face masks. Therefore we must use them too“.

    The third point is the „risk society“ according to Ulrich Beck. The technological progress creates the risks on which the society must react, in lot of cases just reflexively. If I am frightened of virus I reflexively put the mask on my face. The internet is just another example. Due to its existence around the world we all read the same news furthermore spreading very rapidly (via above the international unity). Try imagine the world without world wide web. In which way we imposed „home office“, on line communication with our colleagues and on line lecturing at schools? How we organized testing or vaccinating?

    The fourth point is the mentality. From the 19th century there are democratic waves (S. P. Huntington‘s term). The last democracy wave according to Huntington was from 1975 to 1989. At that times people believed to liberty and cooperation. During the ninetees, in the era in which the Eastern Europe countries left the communism we could hardly imagine that any politician decided about lockdown and order people to stay at their houses. The another impact of internet is the increase of hatred. That is why nowadays we again believe to safety not to liberty. From this point of view the Covid measures are just the reflection of this antiliberal mentality. The Covid medical characteristics are not the case.
    Finally the last point is the most frightening and dangerous. The holly and boastful believe that man is strong enough to change the nature, to make the world better, to turn the history. Just this believe in the past led to the immense tragedies, millions of deaths. „Just give me ten years and you will not recognise our country“ said Hitler to Germans at the beginning of his rule. He was right ….

  • dionissis mitropoulos says:

    PART 1

    Hello again Prof Giubilini and thank you very much for your very philosophically informative response.

    I certainly acknowledge the risk that unvaccinated people (i. e. people like me, I am a conscientious objector, not just towards vaccines, but towards almost all medical interventions via medicines that have been tested on animals, and I have other conscientious objections too, and additional non-conscientious reasons) are posing to third parties, namely the risk of transmitting the virus. In my previous comment I was only trying to make the point that the hypothetical old person, on the assumption that she is determined to not get vaccinated, she may be practically rational under certain circumstances if she chooses to risk losing the right to a hospital bed, given her other values and given her initial determination to not get vaccinated. I was not addressing the practical rationality of the initial decision to not get vaccinated, and certainly not the morality of the decision: from the very first days of Covid I was willing to offer to my fellow citizens the protection that the State is (de dicto) aiming at offering them, namely to make my self immune so as to contribute to slowing of the spread and protect the Health Care system, but, given my conscientious objection to getting vaccinated, I was willing to get deliberately infected in an “institutionalized” way (for example, instead of an appointment for a covid vaccine at the hospital I could keep company to a Covid patient for a while, aiming at catching the virus in the process), not only because this would afford me the best medical advice as to how to go about it (for how long should I stay next the Cocid-sick old lady at the hospital?) but mainly because this would annul the social stigma that characterizes *all* people who do not wish to get vaccinated – the labels “antivaxxer” and “denier” being the cognitive triggers of connotations about our characters so deleterious that I think amount to a violation of a human right when uttered by officials or powerful institutions. Surely, if the State would allow me to get immunity in my preferred way and put its stamp on this procedure this would protect *me*, and people like me, from the social stigma of being thought of as a free-rider, or as a “denier”, or as someone with a generalized lack of concern for the health of his fellow citizens, or as a dupe of conspiracy theorists, or as epistemically totally irresponsible, and all other connotations that the decision not to get vaccinated triggers in the heads of my fellow citizens, given the current public discourse. Not to mention that I would be allowed to exercise my social-life’s options (as things stand, I will never be able to attend an analytic philosophy gathering for the public, much as I am willing to be immunized by infection and hence be a non-threat towards society). Which brings me to a few more questions I would like to pose to you; what follows is a gesture towards morally relevant policy considerations that my philosophically-untrained-but-slightly-philosophically-informed brain has come up with, in the hope of eliciting a response from you that can guide the thinking of people like me:

    Given the fact that I am very healthy, and given the fact that my risk of dying from Covid on the assumption that I get infected is negligibly small in my value-informed risk-preferences book (1 in 14,000, https://qcovid.org/ ), isn’t it inconsistent on the part of the State to stop me and people like me from seeking the deliberate infection that we have informedly decided upon? Heathy people (i.e. people with zero comorbidities) below 70 years old who also have normal weight face a very low personal risk if infected (the flu IFR is 1 in 1,000, any pathogen’s risk around there I decree to be low risk for me). Now, on the assumption that these people are conscientious objectors to vaccines like me, we are going to be posing a constant threat to others if we stay uninfected because, ex hypothesi, we will never get the vaccine – I am talking about the subclass of the unvaccinated that are truly determined, like I am, to never get vaccinated. Isn’t the State morally required, if it is indeed aiming at protecting the unvaccinated and the immunocompromised, as it says, to allow us to get what we explicitly seek? (lots of unvaccinated people in Greece exchange phone numbers promising to infect each other in order to acquire or renew the Green Pass). It is true that the State, in principle, would have preferred to avoid any deaths it deems reckless (such as the deaths that would result from the decisions of some of the people in my subclass of the unvaccinated to get deliberately infected under a hypothetical regime of institutionalized infection) but, as the experts have recognized, sooner or later we will anyway get infected in an unplanned way (given our non-negotiable decision to never get vaccinated). So why isn’t the State willing to “frontload” our infections in a planned and institutionalized way, infections which are bound to happen anyway? The State’s refraining from institutionalizing these voluntary infections is increasing the risk for the other subclass of the unvaccinated (i.e. not my subclass which consists of conscientious objectors) that comprises the people who are considering taking the Covid vaccine if they get persuaded that it is safe, but who are taking their time to make sure the vaccine is indeed safe. I cannot pin down the structure of the argument that I would have liked to be able to make drawing from concepts in the literature of self defense, but here are my first steps:

    All of us (unvaccinated) are ( I am granting for the sake of argument) culpable threats towards third parties – the official State position sounds like grounding this culpability in inadequate concern for our fellow citizens evinced in our refusal to get vaccinated. But leaving aside this putative culpability towards third parties, we the whole class of the unvaccinated are also seen by the State as culpable threats towards ourselves and towards each other. But, surely, in the State’s eyes, we the conscientious objectors must be more culpable for the threat we pose to the other subclass of the unvaccinated than *they* are for the threat they pose to us. Why? Because, I tentatively argue, the initial State assumption is that culpability emanates from the attitude of refusing the vaccine. But then, a lesser degree of attitudinal recalcitrance towards this or all vaccines should be resulting in less culpability, according to the officialdom’s ethos – recently, Prof Yanis Varoufakis https://www.youtube.com/watch?v=Xp1rj7QMGXQ min 33:50 up to min 36:00 spoke with a gentle tone of this subclass of the hesitant unvaccinated, characterizing them “good-will persons” (καλοπροαίρετοι), in apparent contradistinction to the rest of the unvaccinated, the “ideologically unvaccinated”, some of who hold the “far-rightwing” view that “no one will violate our bodies with substances, especially the State”. (Well, pardon my ill will, I belong to the other group of the unvaccinated). If culpability, or degree of culpability, is to play a role in the allocation of risks (I am totally unaware of the literature in self defense) it seems to be the case that the State is obligated to protect the class of the hesitant unvaccinated from us by allowing us, the more culpable party, to be deliberately infected (because both hesitants and determined ones are going to be meeting each other in the supermarket, and our lack of immunity will be endangering the hesitants). And on a different accounting, If the State protects *me*, namely the determined to never get vaccinated, from getting deliberately infected (and my risk of death is very low), then the State endangers another unvaccinated person who is waiting to take a vaccine when she becomes persuaded that it is safe. This person could have much higher risk of dying from Covid than me, but even if our risks are comparable, the State ignores that the other person may sometime be persuaded to get vaccinated and avoid being endangered that much, whereas in my case it is certain that I will be infected, if not now then sometime in the future. The State, by its lights, in effect sacrifices people from the hesitant unvaccinated class for the sake of deferring a bit later the exposure to risk of those who are in the other class, the class of the determined unvaccinated. Isn’t this inconsistent with the State’s desiderata to protect the (more) innocent and to maximize the number of lives saved? To sum up, I see a utilitarian argument for allowing voluntary deliberate infections because they will save lives (the lives of those vulnerable who wouldn’t have died by being infected from us, if we had been allowed to get our inevitable infections sooner rather than later). I also see the quasi-deontological argument from lesser culpability that I gestured at. I also see a deontological argument based on the principle of secondary permissibility that i read about at Public Ethics:

    https://www.publicethics.org/post/secondary-permissibility-and-enabling-harm-a-case-of-covid-19

    It seems to me to be coming down to the fact that we the determined unvaccinated have (ex hypothesi) the exposure-to-the-virus coming anyway, and therefore, according to the principle (or a variation of the principle?), the deontologist State is allowed to enable our voluntary exposure for the sake of preventing the death of others, even though this may be counting as the State’s using us as a means to saving the others. I cannot understand the deontological mechanics here but it seems to me the permission is uncontroversial intuitively. Somehow it seems relevant to me that it was the State that initially prevented us from entering the hospital when we were heading there to get our deliberate infection for the sake of the hesitant unvaccinated. Maybe the State was culpable in the first place to stop us from entering the hospital? After all, to use a variation of the example of the Public Ethics article, the 5 turned the trolley on themselves in order to save the 10 unvaccinated hesitant, and the State intervened to save us and redivert the trolley towards the 10. Aren’t the 10 wronged by the State? And isn’t the State now obligated to undo the wrong by rediverting the trolley towards the 5 who are still asking the State for it? Apologies for the total lack of analytic clarity, I am utterly ignorant of Deontological Ethics.

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