This blog-post is not a theoretical thinking exercise. It is an acceptance of the fact that, at the time of
writing, a 30-miles-radius-circle around my wife and I includes the current epicenter and 30% of the COVID-19 cases in the US (about 36,000 of 122,000).
What triggered this writing is a timely article in today's New York Times, Who Should Be Saved First? Experts Offer Ethical Guidance. I found the article very comprehensive, and profuse with other reputable references for the points of view presented. While most points of view presented are utilitarian, the utilitarianism was about the affected person's prospects for the longest remaining life. Making this split-second-actionable may favor the young against the old; those with good physique against those without; and other subjective biases of the decision-maker.
In principle, I like the utilitarian approach - but differ in the myopic application of that metric to the life prospects of the individual. I'd like to extend the concept of utilitarianism to the society-at-large, as in "how much does society stand to benefit from the saving of the life of person A vs person B?" This makes the water murkier in the estimation of societal benefit. What is so easy to estimate for the value of corporations - its stock value as a single number that captures the entire future prospects of the firm - is immensely complex for human life.
How does the value of a member of society change with time (age) and any events along the way? What is it at birth? How much do education, training, skills increase it? How much do health mishaps decrease it? How can societal utilitarianism be prevented from being used to discriminate by race or other differences? Or, is it discriminatory by design, and hence unfit for use in contemporary societies? Do its risks far outweigh the benefits? I ask these questions fully recognizing that I may not be up on the totem pole by any of these metrics; nevertheless, this may provide closure to the near ones of any of us, should the "ventilator dilemma" doesn't get resolved in our favor, when push comes to shove.
I also polled some friends for their points of view. They felt comfortable and safe sharing their views knowing that they may be diametrically opposite my views. One friend suggested economic marginal contribution potential. Another suggested age (i.e., favor the young vs the old) - this is also discussed as a first approximation of the utilitarian approach, but can result in discrepancies as in: would you favor a young criminal on death row vs an older person contributing member of society. Others suggested "first come first served" or lottery - these are definitely not controversial, and used in the present day in the absence of other metrics. Some friends find the "capitalistic" approach inhumane, and that an individual may deserve to be favored for her/his past contributions. Another (male) friend suggested favoring females, but did not provide a reason. And then, there were opinions about favoring a particular religion/ political affiliation.
There was also a school of thought that economic losses are recoverable, while human life is not - so, the dilemma should not exist at all - and there were suggestions of contraptions that could allow multiple patients be treated by a single ventilator (though ICU beds, and sparse staff would not be able to be thus shared). Health care professionals were also suggested as a favored class, and this fits within the societal utilitarian construct.
As a supply chain professional, I recognize that stock-outs are inevitable in probabilistic demand situations - we don't face them much in the health care system in the US, because these systems are sized for high demands. But, the current demand is extreme and unprecedented. Stockouts in the health-care system are now inevitable, much that they are inevitable for toilet paper, eggs, milk and bread in grocery stores.
The personalization and rationalization is to deal with: "we as individuals becoming the unsatisfied demand in the stock-out." That is when it really hits home!
All said and done, a health care professional may exercise a difficult decision, we may not like the decision or its outcome - and we ought not to put additional burden on the already stressed health care system to explain and justify. "Just because" - as teenagers have taught me - would be a perfectly acceptable justification.
What triggered this writing is a timely article in today's New York Times, Who Should Be Saved First? Experts Offer Ethical Guidance. I found the article very comprehensive, and profuse with other reputable references for the points of view presented. While most points of view presented are utilitarian, the utilitarianism was about the affected person's prospects for the longest remaining life. Making this split-second-actionable may favor the young against the old; those with good physique against those without; and other subjective biases of the decision-maker.
In principle, I like the utilitarian approach - but differ in the myopic application of that metric to the life prospects of the individual. I'd like to extend the concept of utilitarianism to the society-at-large, as in "how much does society stand to benefit from the saving of the life of person A vs person B?" This makes the water murkier in the estimation of societal benefit. What is so easy to estimate for the value of corporations - its stock value as a single number that captures the entire future prospects of the firm - is immensely complex for human life.
How does the value of a member of society change with time (age) and any events along the way? What is it at birth? How much do education, training, skills increase it? How much do health mishaps decrease it? How can societal utilitarianism be prevented from being used to discriminate by race or other differences? Or, is it discriminatory by design, and hence unfit for use in contemporary societies? Do its risks far outweigh the benefits? I ask these questions fully recognizing that I may not be up on the totem pole by any of these metrics; nevertheless, this may provide closure to the near ones of any of us, should the "ventilator dilemma" doesn't get resolved in our favor, when push comes to shove.
I also polled some friends for their points of view. They felt comfortable and safe sharing their views knowing that they may be diametrically opposite my views. One friend suggested economic marginal contribution potential. Another suggested age (i.e., favor the young vs the old) - this is also discussed as a first approximation of the utilitarian approach, but can result in discrepancies as in: would you favor a young criminal on death row vs an older person contributing member of society. Others suggested "first come first served" or lottery - these are definitely not controversial, and used in the present day in the absence of other metrics. Some friends find the "capitalistic" approach inhumane, and that an individual may deserve to be favored for her/his past contributions. Another (male) friend suggested favoring females, but did not provide a reason. And then, there were opinions about favoring a particular religion/ political affiliation.
There was also a school of thought that economic losses are recoverable, while human life is not - so, the dilemma should not exist at all - and there were suggestions of contraptions that could allow multiple patients be treated by a single ventilator (though ICU beds, and sparse staff would not be able to be thus shared). Health care professionals were also suggested as a favored class, and this fits within the societal utilitarian construct.
As a supply chain professional, I recognize that stock-outs are inevitable in probabilistic demand situations - we don't face them much in the health care system in the US, because these systems are sized for high demands. But, the current demand is extreme and unprecedented. Stockouts in the health-care system are now inevitable, much that they are inevitable for toilet paper, eggs, milk and bread in grocery stores.
The personalization and rationalization is to deal with: "we as individuals becoming the unsatisfied demand in the stock-out." That is when it really hits home!
All said and done, a health care professional may exercise a difficult decision, we may not like the decision or its outcome - and we ought not to put additional burden on the already stressed health care system to explain and justify. "Just because" - as teenagers have taught me - would be a perfectly acceptable justification.
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