An Actual Trolley Problem

I’ve always seen a certain style of thought experiment in analytic philosophy and psychology as having limited value–say for example the famous “trolley problem” that asks participants to make an ethical choice about whose life to save in a situation where an observer can make a single intervention in an ongoing event that directs inevitable harm in one of two directions.

The problem with thought experiments (and associated attempts to make them into actual psychological experiments) is that to some extent all they do is clarify what our post-facto ethical narrative will be about an action that was not genuinely controlled by that ethical reasoning. Life almost never presents us these kinds of simultaneous, near-equal choices, and we almost never have the opportunity to reason clearly in advance of a decision about such choices. Drama and fiction as well as philosophy sometimes hope to stage or present us these scenarios either to help us understand something we did (or was done to us) in the confusion of events, or perhaps to re-engineer our intuitions for the next time. What this sometimes leads to is a post-facto phony ideological grandiloquence about decisions that were never considered in their actual practice and conception as difficult, competing ethical problems. Arthur Harris wasn’t weighing difficult principles about just war and civilian deaths in firebombing Dresden, he was wreaking vengeance plain and simple. Neoliberal institutions today frequently act as if they’re trying to balance competing ethical imperatives in purely performative way en route to decisions that they were always going to make, that were always going to deliver predictable harms to pre-ordained targets.

But at this moment in late March 2020, humanity and its various leaders and institutions are in fact looking at an honest-to-god trolley problem, and it is crucial that we have a global and democratic discussion about how to resolve it. This is too important to leave to the meritocratic leaders of civil institutions and businesses, too important to be left to the various elected officials and authoritarian bureaucracies, too important to be deferred to just one kind of expertise.

The terms of the problem are as follows:

Strong national quarantines, lockdowns, and closure of nonessential businesses and potential gathering places in order to inhibit the rapid spread of the novel coronavirus COVID-19 will save lives in all countries, whether they have poorly developed health infrastructures, a hodgepodge of privately-insured health networks of varying quality and coherence or high-quality national health systems. These measures will save lives not by containing the coronavirus entirely but simply by slowing the rapidity of its spread and distributing its impact on health care systems which would be overloaded even if they had large amounts of surplus capacity. The overloading of health care facilities is deadly not just to people with severe symptomatic coronavirus infections but to many others who require urgent intensive care: at this same moment, there are still people having heart attacks, life-threatening accidental injuries, poisonings, overdoses, burns from fires, flare-ups of serious chronic conditions, and so on. There are still patients with new diagnoses of cancer or undergoing therapy for cancer. There are still people with non-COVID-19 pneumonias and influenza, still people with malaria and yellow fever and a host of other dangerous illnesses. When a sudden new pandemic overwhelms the global medical infrastructure, some of the people who die or are badly disabled who could have been saved are not people with the new disease. Make no mistake: by the time this is all said and done, perhaps seventy percent of the present population of the planet or more will likely have been exposed to and been carriers of the virus, and it’s clear that some percentage of that number will die regardless of whether there was advanced technology and expertise available to care for them. Let’s say it’s two percent if we can space out the rate of infection: that is still a lot of people. But let’s say it’s eight percent, including non-COVID 19 people who were denied access to medical intervention, if we don’t have strong enforced quarantines at least through the first three months where the rate of infection in any given locale starts to rise rapidly. That’s a lot more people. Let’s say that a relatively short period of quarantine at that level–three months–followed by moderate social distancing–splits the difference. A lot of people, but fewer than in a totally laissez-faire approach.

Against that, there is this: in the present global economy, with all its manifest injustices and contradictions, the longer the period of strongly enforced quarantine, the more that another catastrophe will intensify that will destroy and deform even more lives. There are jobs that must continue to be done through any quarantine. Police, fire and emergency medical technicians must work. Most medical personnel in emergency care or hospitals must work. Critical infrastructure maintenance, all the way down to individual homes and dwellings, still has to be done–you can’t leave a leaking pipe in the basement alone for four months. Banks must still dispense money to account holders, collect interest on loans, and so on. And, as we’re all discovering, there are jobs which can be done remotely in a way that was impossible in 1965 or 1985. Not optimally from anyone’s perspective, but a good deal of work can go on in that way for some months. But there are many jobs which require physical presence and yet are not regarded as essential and quarantine proof. No one is getting routine tooth cleaning. The barber shops are closed. Restaurants and bars are closed. Ordinary retail is closed. Amusement parks and concert halls are closed. All the people whose lives depend on those businesses will have no money coming in the door. Three months of that might be barely survivable. Ten months of that are not. Countries with strong social-democratic safety nets have some insulation against the damage that this sudden enforced unemployment of a quarter to a half of the population. Countries like the United States with almost no safety nets are especially exposed to that damage. But the world can’t go on that way for the full length of time it might take to save the most lives from the coronavirus pandemic. And make no mistake, this will cost lives as well. Quite literally from suicide, from sudden loss of access to shelter and health care, from sudden inability to afford the basic necessities of everyday life. But also from the loss of any future: the spiralling catastrophe of an economic downturn as grave as the Great Depression will deform and destroy a great deal, and throw the world into terrifying new disequilibrium.

It cannot be that saving the most lives imaginable from the impact of the pandemic is of such ethical importance that the destructiveness of the sudden collapse of the world economy is unimportant. It cannot be that business as usual–already deformed by inequality and injustice–must march forward over the deaths caused by the unconstrained, unmanaged spread of COVID-19. Like many people, this problem is not at all abstract for me. I’m 55, I have high blood pressure, I have a history of asthma, I’m severely overweight and when I contract the disease, I may well die. I have a mother that I love who is almost 80, aunts and uncles whom I love who are vulnerable, I have valued colleagues and friends who are vulnerable, and of course some who may die in this have no pre-existing vulnerabilities but just draw a bad card for whatever reason. But there has to be a point where protecting us to the maximum degree possible does more harm to others in a longer-lasting and more devastating way.

And this trolley problem cannot be left to the civic institutions and businesses that in the US were the first to act forcefully in the face of an ineffective and diffident national leadership. Because they will decide it on the wrong basis and they will decide it in a way that leaves all of us out of the decision. They will decide it with lawyers in closed rooms, with liability and insurance as their first concerns. They will decide it following neoliberal principles that let them use the decision as a pretext to accomplish other long-standing objectives–streamlining workforces, establishing efficiencies, strengthening centralized control.

It cannot be left to political authorities alone. Even in the best-case scenario, they will decide it in closed rooms, following the technocratic advice of experts who will themselves stick to their specialized epistemic networks in offering counsel: the epidemiologists will see an epidemic to be managed, the economists will see a depression to be prevented. In the worst-case scenario, as in the United States, corrupt leaders will favor their self-interest, and likely split differences not out of some transparent democratic reasoning but as a way to avoid responsibility.

This has to be something that people decide, and that people are part of deciding. For myself, I think that we will have to put a limit on lockdowns and quarantines and that limit is likely to be something like June or July in many parts of the United States and Europe. We can’t do this through December, and that is not about any personal frustration with having to stay at home for that length of time. It’s about the consequences that duration will wreak on the entirety of our social and economic systems. But it is not anything that any one of us can decide for ourselves as a matter of personal conscience. We the people have to decide this now, clearly, and not leave it to CEOs and administrators and epidemiologists and Congressional representatives and well-meaning governors and untrustworthy Presidents. This needs not to be a stampede led by risk-averse technocrats and managers towards the path of least resistance, because there’s a cliff at the end of all such paths. This is, for once, an actual trolley problem: no matter what we do, some people are going to die as a result of what we decided.