The Week: Mean Conservatives Want the Elderly to Die

From The Week:

There’s a strain of argument being voiced in certain quarters — most famously from Rick Santelli, who has since apologized for suggesting we infect everybody and get it over with — that the whole world’s approach to the virus is misguided. Rather than limit the virus’s spread, we should effectively encourage it — at least among the young and healthy — and focus on isolating the most vulnerable. Once the disease has spread very widely, “herd immunity” will inhibit transmission and prevent future outbreaks. Meanwhile, we shouldn’t shut down our economies, but focus on keeping them up and running as fully as possible. Some people may die, but lots of people die from car accidents, and we don’t shut the roads — and lots of people will die from the costs of an economic contraction as well.

This is the philosophy that underpins the U.K.’s initial response to the crisis, and for which it has come in for an avalanche of criticism. The reason is that the risks of failure are enormous, a fact that the government is belatedly acknowledging. It is far from easy to comprehensively isolate the most vulnerable populations — which include everyone over 70 at a minimum — for the length of time it would take for the disease to pass through 60-70 percent of the population, at which point herd immunity would kick in. And if isolation fails, then the death rate could spike massively. Meanwhile, it’s not even possible to identify perfectly who the most vulnerable are. In France, it was reported Saturday, 50 percent of the cases in ICUs were under 60 years old. Even if the prospects of recovery are much better for that group than for older patients, that prospect dims considerably if the medical system is overwhelmed and can no longer provide adequate respiratory care. And that is certain to happen if the virus is allowed to spread uncontrolled through the population.

On a coldly economic level, though, one might still ask: so what? Let’s take the U.K. as an example, since they are the most prominent proponents of the “herd immunity” strategy. Say that nothing is done to halt the spread and attempts to isolate vulnerable populations like the elderly fail. The over-70 crowd is literally decimated by the virus: One in ten of the infected die. Say that for adults under 70, by contrast, the death rate is half a percent. By the time 60 percent of the population is infected, that would mean approximately 600,000 deaths across the U.K. That sounds awful — but given the concentration of casualties among the elderly, the excess death rate would surely be lower, as over 450,000 Britons over the age of 70 already die annually, and those most-likely to be felled by the virus are also those most likely to die of other causes. And these are hardly the economy’s most productive citizens; the economic impact of them dying earlier might even be positive. Moreover, if the elderly were simply denied medical intervention for any reason and limited to the simplest forms of palliative care during the duration of the crisis, we could probably keep the medical system from being overwhelmed and provide adequate care for those capable of returning to productive work.

I hope nobody would be comfortable making an argument like that explicitly. But it lurks in the background of the all-purpose dismissiveness voiced by the likes of Rush Limbaugh and Sean Hannity about the seriousness of the virus (who are following the President’s lead in doing so), or in pieces like this one by Heather Macdonald at the conservative cultural journal The New Criterion. It is implicit more generally in any purely economic read on the crisis. The fact is that only a portion of modern health care is aimed at enhancing productivity; much of it aims at improving and lengthening the lives of those whose most productive years are largely behind them. If you don’t have any non-economic reason for valuing those lives — like the value of their presence in the world to children, grandchildren, neighbors, and friends, or simply the inherent dignity of being human — then it is hard to argue for spending scarce resources on them in normal times, much less in times of crisis.

Of course, there is a point where lifeboat ethics come into play. Where resources are acutely scarce, triage becomes necessary. You treat those who are in acute need and with good prospects for recovery first; those with less acute need have to wait, and those with poorer prospects likely die. That’s the position that Italy’s doctors are in right now.

But a big part of what makes us civilized is that we seek not to live that way. We don’t want doctors to have to decide minute to minute who is worth saving based on their potential value, and we don’t want to tell our parents and grandparents that their potential value is too low for them to be worth saving.

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