One of the few things that are currently giving people hope is the fact that within a year, we got a couple of working vaccines for Covid and the distribution is now rolling out. Being smart we also know that this a) is doing shit right now, b) will take time, c) is fraught with ethical dilemmas.
With only few doses available right now, societies struggle with the question of whom to vaccinate first, and it’s not an easy one. Because no matter how you decide, there will always be people in the group you vaccinate first who would have recovered with little problem, and there will always people in the group you vaccinate later who will die, and since we cannot reliable predict who is who on an individual level, we can only do so on group membership.
And yes, many of us will wish for a place further up in the queue. I was devastated when I heard that in Germany teachers were pushed back to the end of the line, while also being expected to continue full in person teaching (we’re currently back to homeschooling, let’s see for how long), usually with some bullshit arguments about children losing out. More on that later. As this discussion continues, the NYT Magazine published a debate on “Whom to Save First”. Absolute trigger warning for absolute ableism and casual racism for that article. And if you are on blood pressure medication, make sure you only read it after you’ve taken yours because it made me really angry and took me like three turns to read to the end.
The people in the discussion are:
- Ngozi Ezike, an internist and pediatrician
- Gregg Gonsalves , a professor of epidemiology at the Yale School of Public Health and an AIDS and global health activist.
- Juliette Kayyem is a professor at the Harvard Kennedy School, where she is the faculty chairwoman of the Security and Global Health program
- Siddhartha Mukherjee is a professor of medicine at Columbia University and a cancer physician and researcher.
- Peter Singer is a bioethics professor at Princeton
- Emily Bazelon, a staff writer for The New York Times Magazine, who moderated the discussion
Tell me if you spot the problem right away. Our line up includes 4 doctors and researchers, which is a good idea when talking about the data, the predictions about the effects, questions about logistics, etc. These are also the parts of the discussion that I found more interesting, and while they also raised good ethical points (like what about the prison population, who are basically sitting ducks for the virus), they also only represent one group involved in that discussion and affected by the decisions. As always, science and logic can give us data and predictions, it cannot tell us what is right and what is wrong.
That leaves us with exactly one ethicist, and I’m going to use that term lightly here, which is Peter Singer. In case you haven’t heard of him before, I’m sorry to have done that to you now, but here’s a good overview on why many people, especially in the disabled community absolutely abhor Singer. Questions around ableism and eugenics have been at the forefront of the discussions about Covid since the start, as it is a disease that kills predominantly elderly people or people with chronic conditions, with lots of people claiming that we shouldn’t all have to drastically change our lives just because of those people. So why, on a discussion on a subject that predominantly affects old and disabled people would you only invite an ethicist who doesn’t think they’re worth saving anyway and no disabled person to advocate for the rights and lives of disabled people? (Hint: it’s because of ableism).
So let’s get to the meat of the matter. About all countries seem to have decided on two groups to vaccinate first: The very old and infirm, especially in nursing homes and hospitals, and health care workers and all those involved in the care of the first group. Most people would agree with that order: protect those most likely to die and with a high risk of catching it, and protect those with a high risk of infection <i>and</i> a high risk of transmitting the disease to very vulnerable people*. Now, normally you’d have to search the Republican party or whatever is your local equivalent to find somebody who’d begrudge granny her vaccine, but if you are nominally a leftist and still hate old and disabled people, here’s Peter Singer for you:
The objective that we should aim for is to reduce years of life lost. I know a lot of people are talking just about saving lives. But I do think that it’s different whether somebody dies at 90 or 50 or a younger age still. So, in my view, that’s what we should be looking at.
Yes, you read that correctly: A human life is not a human life. A human life is valued according to the numbers of years that person still has to live happily (From Singer’s other writing you will know that he thinks he knows when a life is worth living, so the years to live of a disabled person count automatically less than the years to live of an able bodied person). So preventing death in one 50 yo should probably count as much (or even more, since many of those years will be “happy”) as preventing death in 7 octogenarians. You think I’m cynical and dishonest in making up calculations where human lives are reduced to mere numbers, strawmanning poor Singer? Look at what he says when another participant gently pushes back:
The basis for the British government’s plan is, of course, to treat those who are at the highest risk of dying and thus to minimize the number of deaths. But it is also important to consider what your life would be like if you don’t die.
It might still be that we should protect 90-year-olds first, based on data suggesting that 90-plus are at eight times the risk of dying from the virus as people around 70, whereas their life-expectancy difference is roughly something like four and a half years as against 15 years for 70-year-olds. If that’s correct, then the higher risk to the 90-year-olds outweighs the difference in life expectancy.
No, we shouldn’t vaccinate granny first because she’s at high risk of horribly suffocating while totally at the mercy of her caregivers, we should vaccinate her because there’s some bullshit calculation about life expectancy. Singer does not place any value on the individual life, their individual suffering, it’s just a question of “years saved”, though he also has quite some opinions on the worth of any year of life lived according to some “objective” white dude metrics:
But even there I would make some exceptions. I don’t know whether the public-health systems are going to be able to do this or whether the political leaders are able to accept it, but if we are talking about everybody in an elderly-care home getting vaccinated, I think we should ask questions about the quality of their lives.
Now, end of life discussions, questions about assisted suicide are difficult, fraught with emotions, and anybody who ever had a loved one slowly wither away and basically die over a prolonged period of time knows that those are not easy questions, that you will deal with complicated emotions and that yes, indeed, you may see death as a mercy in the end. What treatment to give to a person who cannot make the decision themself and which to withhold is difficult and heartbreaking, which is why everybody should discuss those matters beforehand and have them written down. But Singer doesn’t want to explore those moral questions, as they are questions that relate to bodily autonomy and individual freedom. He wants to seem all Vulcan and just place some objective value on people’s lives and then calculate their worth.
Ironically, he goes then on and argues that if we cannot ask people directly, it would be immoral to just vaccinate them because they cannot consent:
If a patient is not capable of expressing a view on whether or not to receive treatment — and that includes vaccination — families should be consulted, and they should make the call. We shouldn’t just go through nursing homes and automatically vaccinate those who are not capable of giving consent.
What is it now, Peter? Do we suddenly have to ask difficult questions about consent? And if so, why the hell do you assume that those people would consent to ending their lives in a most horrible manner? Because all I know so far about ICU Covid treatment is that once you’re at that point, everything is horrible and has been for a while. Suffocating is generally considered a very cruel death,a s your whole body is still fighting. I can imagine what Singer’s “solution” would be, and no, thank you, I think that one Hadamar is enough.
Now that Singer has established that we really shouldn’t vaccinate all those old and disabled people, the discussion moves to who we should vaccinate and why. Spoilers: It’s not because people who are getting sick from Covid are suffering and still possibly dying and having long term effects. No, for Singer it’s all about how you getting Covid is going to inconvenience others:
Setting priorities in this phase should depend on the impact on essential services. For services in which workers are mostly young, and even if they get the virus they’re not likely to have severe symptoms, and they will not be absent from work or will be absent only briefly, then maybe you don’t have to vaccinate them first. But if we have essential services that are really being set back by the fact that people are getting the virus — for example, if we’re at risk of not having enough truck drivers to deliver the vaccine — that would be a reason to give these workers high priority.
He completely dismisses the massive suffering caused by Covid, the long term risks, and of course the impact on families and communities. If they’re young, just let them get sick (for example retail workers), because they will only miss a few days of work. Because the most important thing in your life is going to work. Bazelon argues along the same line:
That makes me think of teachers. The service of in-person schools has been cut off in parts of the country for 10 months now. This has come at a huge cost to kids, in terms of learning loss and social and emotional development. Some vulnerable kids aren’t in school at all. Children generally have borne a greater share of the burden of the virus than we often talk about.
Teachers are not valued as people. Our health and wellbeing is completely unimportant. What matters is that we go to school and work, in a good attempt of appealing “won’t somebody think of the children???”. Yes, I do think of the children. That’s my fucking job. But children are also wonderful argument killers. Once you invoked children, your opponent can only lose, because we all know that children (at least the able bodied) are the ultimate cause worthy of protection (unless you should feed them). the same people who generally won’t give a fuck about public education, the state of schools and the welfare of vulnerable kids have suddenly discovered them as a group to advocate for, and whose needs magically align with their own ideas.
Kayyem agrees, saying the quiet part loud:
Education is critical infrastructure. We didn’t designate it as such, as we did with electricity and water or the food-supply chain. But it turns out that a society cannot move, literally cannot flow, if parents are at home because of kids. The economic impact has been huge. And on the other side of this pandemic, the long-term impact for kids who were already behind is disastrous.
Actually it’s about parents being able to go to work and make money for people who are already rich. Yes, throw in some lines about kids who were already behind. Unless you can show me your work on how you fought for disadvantaged kids before Covid, I’m going to call it crocodile tears. While I absolutely do think, for absolutely selfish reasons, that teachers should be right behind very vulnerable people when it comes to the vaccine, I’m not going to claim that this is to mostly benefit disadvantaged kids. the best you can do for disadvantaged kids is to massively invest in child welfare and social services. I think we should get the vaccine because we are in a high risk environment and I don’t want to fucking die.
Here’s how I know that they don’t actually care about kids. Bazelon picks up Singer’s line about “years of life saved” and goes on about the long-term effect on children:
In thinking in terms of years of life saved, research suggests that children who fall behind because of elementary-school closures are likely to have shorter life expectancies, on average.
You know what, lady? You could fix that. And 8 years old who misses out on primary school does have a lot of time to catch up. You could support those kids, their schools, their families. Shorter life expectancies are not a natural force. They are something society can absolutely do something about, but that would require more than giving their underpaid, overworked teachers in crumbling buildings a Covid jab.
There’s some interesting talk about logistics etc. in the middle (and suddenly there’s other people doing the talking…) until we get to another big issue: the world-wide distribution of the vaccine: The affluent north is buying up all the available vaccine, while also blocking the global south from just replicating the vaccines by Moderna etc. There’s some casual racism about how we cannot trust the Indian and Chinese vaccines, but hey, there’s testing, and then the ethicist Singer drops the following:
According to 1DaySooner, which advocates for volunteers, nearly 40,000 are willing to take part. If you can give people a vaccine and then deliberately expose them to the virus, you get results much faster. And you can study the antibody responses and the immune responses, because you can house volunteers in a residential quarantine facility where they’d be available for that kind of testing. I recognize that they don’t have the representative demographics that you would want, but these trials do offer the possibility of getting much speedier results.
Yes, Peter, experimenting on humans is completely cool. “But they are volunteers”, they say, ignoring the fact that people are desperate. Here we have a world renowned ethicist claiming that infecting people with a potentially deadly disease is ok. Somehow all the doctors in that discussion just gloss over it? Did they not get it, or did they do the thing where you will bush over such things because how can you even start such a discussion? Singer goes on to abuse people with little voice for themselves in his arguments, repeating the idea that people should be able buy access to the vaccine if in return others could get some benefits:
Singer: The economist Richard Thaler wrote in The Times recently about letting celebrities and wealthy people jump the vaccination queue by bidding for spots at an auction. That would show they wanted to get the vaccine, which would help encourage other people to get immunized. And Thaler thought the money could go to people who are suffering because, for example, the virus cost them their jobs. My idea is that instead of dollars, people should bid on sending units of vaccine to the Global South.
Mukherjee: Peter, what if you could jump the queue, and get 10 doses of vaccine for your friends and family, if you contribute 5,000 or 10,000 or 500,000 doses for the Global South. Would you be open to such an option?
Singer: Yes, I would be, I think. Clearly, for a utilitarian like me, the benefits greatly outweigh the costs.
Let’s look at what is proposed here: Singer isn’t asked to forego his vaccine. He isn’t ask to decide whether his child or grandchild should get the vaccine or a woman in a sweatshop. No, the terrible moral dilemma is to get the vaccine for those he loves AND sending vaccine doses to the Global South as a good White Saviour. The cost in this scenario is entirely paid by other people, presumably those in assisted living facilities. That’s the best version of the trolley problem ever, isn’t it?
While others in the discussion ask for solutions that lead to more vaccines being produced, i.e. ignoring patents etc, Singer never ever touches the idea that we could just not do this based on profit. His idea isn’t about producing more doses so the whole planet can be vaccinated, but about keeping the vaccine a rare and highly profitable good that is then distributed more equally, with rich people getting a chance to feel good about it. this shows that Singer doesn’t even take his own philosophy seriously. If it ever were about the greatest amount of happiness, then he’d have to address wealth distribution, both within industrialised nations as well as in the world. But he doesn’t. In his philosophy, which claims to look at humanity more as a whole, he is still displaying a Libertarian individualism, and for all his pseudo Vulcan objectivity, it turns out that somehow he always comes out on top…
Now having written this and therefore read that article a couple of times, I’m cranky: So please, won’t somebody think of my children who now have a cranky mum and please never ever suggest I should listen to Singer on any subject ever again?
*We still don’t know if the vaccine will also stop you from transmitting Covid, but hopes are high.