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Let's Talk About Eugenics
Mar. 22nd, 2020 09:17 pmThe prospect of rationing care has come up for discussion on Disability Twitter, and I really feel like this is something that merits a longer conversation than one can have in a tweetstorm (quite aside from the fact that discussing potentially contentious topics on Twitter is a good way to end up with the internet trying to *eat* you), so here we are.
In the abstract, rationing care to those who are less likely to survive so that people who are more likely to survive can get the chance to be more likely to survive seems like it *should* make sense. It assumes you're following utilitarianism strictly, but nothing on the surface sounds objectionable there.
Surfaces are, of course, deceiving.
Because you know who falls pretty heavily into the category of people who are less likely to survive if they get coronavirus? *Disabled* people. Which means that following that strict utilitarianism also means you're going to systematically choose to let disabled people go without medical care in order to save the lives of abled people. Given the existing ableism of society and the way people are already batting around "oh, but it only kills people with preexisting conditions", that is *not* a neutrally valenced choice.
Especially given that it seems to be a short jump from that to advocating actively *killing* people: I've seen a number of people make the also-seemingly-logical follow-on of "if we're going to ration the medical care, should we also offer medical assistance in dying to the people who we decide we're not giving medical care to." Normally, in normal conditions, I'm actually a proponent of allowing for that-- it's your life and you should be able to end it if you choose. But in a pandemic situation where things get wild really fast? There was already a case in Hurricane Katrina where a doctor-- Anna Pou-- flat-out murdered a whole bunch of patients under the cover of medical assistance in dying and a grand jury refused to indict her for it. In a disaster setting, there isn't time for the kind of care you need to take with that to make sure nobody's being coerced, and I don't think you can responsibly offer it.
It also seems to be a short jump from that to straight-up eugenics: "Should we, in cases of rationing, save people who are more valuable to society over people who are less valuable to society?" which I have issues with even when it's being presented in philosophy classes (like, the *entire structure* of things like the trolley problem is something I take issue with), but if you're asking that question seriously in a context where it might actually be implemented, which I have seen at least some people doing, this is how you eventually find your way back around to "we should kill all the undesirables"-- and sterilizing the undesirables was medical precedent a distressingly short time ago.
Of course, this also assumes both perfect information and that you're ignoring the existing biases in society. If you think the utilitarian model is going to be applied on strictly utilitarian grounds when crisis is flying and medical staff are running on instinct and snap judgements, well, I have a lovely bridge to sell you. Medical personnel aren't necessarily going to know the full medical history of their patients-- especially if they're incentivizing not mentioning preexisting conditions by saying those might get you pulled off a ventilator later-- and they're not going to have time to carefully consider all the variables about who's more likely to survive. Unconscious bias is *going* to rule the day if you start saying it's okay to pull people off ventilators to save people more likely to survive. Maybe sometimes even some conscious bias.
So what's the answer? I don't have one. These sorts of discussions are long and hard and I can't wrap it up for you in a nice summation of "so here's what we should do". This is why you're supposed to have procedures for this *before* the crisis hits and emotions are flying every which way and no one has time to look carefully to make good decisions. I just want to make sure people are aware that the moral exigencies of battlefield medicine operate differently on an actual battlefield, where most of the participants have the baseline levels of health involved in being a soldier (the modern wars involving a lot of civilians as collateral damage are another moral discussion entirely), and making those choices in a pandemic where it's tantamount to saying "we're okay with letting large numbers of this marginalized group die in order to save large numbers of this not-marginalized group."
In the abstract, rationing care to those who are less likely to survive so that people who are more likely to survive can get the chance to be more likely to survive seems like it *should* make sense. It assumes you're following utilitarianism strictly, but nothing on the surface sounds objectionable there.
Surfaces are, of course, deceiving.
Because you know who falls pretty heavily into the category of people who are less likely to survive if they get coronavirus? *Disabled* people. Which means that following that strict utilitarianism also means you're going to systematically choose to let disabled people go without medical care in order to save the lives of abled people. Given the existing ableism of society and the way people are already batting around "oh, but it only kills people with preexisting conditions", that is *not* a neutrally valenced choice.
Especially given that it seems to be a short jump from that to advocating actively *killing* people: I've seen a number of people make the also-seemingly-logical follow-on of "if we're going to ration the medical care, should we also offer medical assistance in dying to the people who we decide we're not giving medical care to." Normally, in normal conditions, I'm actually a proponent of allowing for that-- it's your life and you should be able to end it if you choose. But in a pandemic situation where things get wild really fast? There was already a case in Hurricane Katrina where a doctor-- Anna Pou-- flat-out murdered a whole bunch of patients under the cover of medical assistance in dying and a grand jury refused to indict her for it. In a disaster setting, there isn't time for the kind of care you need to take with that to make sure nobody's being coerced, and I don't think you can responsibly offer it.
It also seems to be a short jump from that to straight-up eugenics: "Should we, in cases of rationing, save people who are more valuable to society over people who are less valuable to society?" which I have issues with even when it's being presented in philosophy classes (like, the *entire structure* of things like the trolley problem is something I take issue with), but if you're asking that question seriously in a context where it might actually be implemented, which I have seen at least some people doing, this is how you eventually find your way back around to "we should kill all the undesirables"-- and sterilizing the undesirables was medical precedent a distressingly short time ago.
Of course, this also assumes both perfect information and that you're ignoring the existing biases in society. If you think the utilitarian model is going to be applied on strictly utilitarian grounds when crisis is flying and medical staff are running on instinct and snap judgements, well, I have a lovely bridge to sell you. Medical personnel aren't necessarily going to know the full medical history of their patients-- especially if they're incentivizing not mentioning preexisting conditions by saying those might get you pulled off a ventilator later-- and they're not going to have time to carefully consider all the variables about who's more likely to survive. Unconscious bias is *going* to rule the day if you start saying it's okay to pull people off ventilators to save people more likely to survive. Maybe sometimes even some conscious bias.
So what's the answer? I don't have one. These sorts of discussions are long and hard and I can't wrap it up for you in a nice summation of "so here's what we should do". This is why you're supposed to have procedures for this *before* the crisis hits and emotions are flying every which way and no one has time to look carefully to make good decisions. I just want to make sure people are aware that the moral exigencies of battlefield medicine operate differently on an actual battlefield, where most of the participants have the baseline levels of health involved in being a soldier (the modern wars involving a lot of civilians as collateral damage are another moral discussion entirely), and making those choices in a pandemic where it's tantamount to saying "we're okay with letting large numbers of this marginalized group die in order to save large numbers of this not-marginalized group."
