Essay: The Ethics of Young Before Old: Italy’s Ventilator Allocation during COVID-19

As I am writing this it feels as though a lifetime has passed since early March, a mere 2 months ago. This was a time when new coronavirus cases per day in the UK were in the double digits and things were largely business as usual, with the rising death tolls in neighbouring European countries omens of what was to come. Amongst this chaos came the news, unparalleled in recent memory, that Italy had begun to prioritise the young over the old in ventilator allocation. Despite this, however shocking this news was, it was not as surprising to me as the complete lack of controversy surrounding the decision. You’d expect such a drastic decision to cause some kind of divide, some kind of tension at least. The long subscribed to approach of ‘first come, first served’ had crumbled and left in its wake a new standard of medical ethics, a standard that seems to have been accepted as inevitable considering the circumstances. How is it that such a provocative idea actually isn’t controversial at all? Furthermore, is this an indication that any opposing ethical belief is doomed in any future scenario as dire as this? This is a world alien to most people reading this article. Suddenly the ethical thought experiments and dilemmas which we once casually discussed in Divinity lessons have become reality, a situation which is truly testing what we really value.
So, what happens when more people require potentially life-saving treatment than is available? The solution was for Italy is that those with a higher chance of survival should be given treatment over those with a lower chance of survival. Often with such a dilemma one can count on there being differing approaches from teleologists, those that believe ends can justify means, and deontologists, those that believe that the goodness of an action lies only in the action itself, regardless of consequence. However, it seems those that follow these two usually divergent paths agree with Italy’s course of action. This conclusion is expected of any teleological approach as schools of thought such as Bentham’s utilitarianism tend not to look at problems with much emphasis on the human experience, instead taking a more calculated, pragmatic approach. As far as utilitarianism is concerned, the best case scenario for the pandemic would be the one which causes the least number deaths overall, and this is the unashamedly teleological approach that the worlds’ governments have taken. However, the number of deaths may not be the only factor for a teleologist, but the value of life of those that die as well. There’s a reason why if one is asked which is more tragic, the death of a child or the death of an 85-year-old, the overwhelming majority of people will choose the death of a child. This is largely due to the amount of life lived, however from a purely analytic point of view, it also has to do with how much the person in question can give back to society. Thus, the value of life of a child is greater than that of the 85-year-old as the 85-year-old has given all he has to give. Therefore, if one is to look purely at the consequences of the action, we not only want to protect lives but protect younger lives, a maxim that has clearly been taken on board by the Italian government.
It is almost a constant that deontological approaches to morality oppose the views upheld by utilitarianism, hence why the circumstances in which we find ourselves are so strange. As Anders Sandberg, a philosopher at the Future of Humanity Institute at the Oxford University, said to news website Quartz, “The deontologist might well start with a justice argument: each person is individually valuable and should have an equal chance of health care”, however, we are currently in a situation where this is simply not possible as there is not a sufficient amount of available healthcare to give people this ideal ‘equal chance’. So, what happens next? Is this where deontological ethics fails? Possible approaches to treat everyone with a fair chance may be a lottery system for who gets a ventilator (a quite frankly dystopian concept), or a utilisation of John Rawls’ ‘Difference Principle’ which dictates that in any scenario of inequality, we must organise our system to result in “the greatest benefit of the least advantaged”. However, a key problem with both of these approaches is that ultimately, they don’t save lives as effectively as teleological approaches. In this coronavirus outbreak, the death toll is so high that the only truly reasonable priority that a hospital or government can put into practice is one that prioritises saving lives. These theories may solve some problems in theory but what happens when a lottery system chooses to save the life of a terminally ill 90-year-old over that of an 18-year-old? John Rawls’ ideas may seem just in tackling systemic inequality, but how is it possible for a doctor in charge of prioritising ventilators to calculate the hundreds of factors involved in the definition of ‘advantaged’ when each passing second reduces the probability of survival? In times such as these, the rules put into place must be hard and fast because the time taken in analysis costs lives.
So, what does this mean for deontological ethics as a whole? For me, it has become more clear than ever that the context of a situation is vital to choosing the correct course of action. It is in rare, once in a lifetime events such as this, that the true idealism and shortcomings seen in Kant and other deontological thinkers are brought to light. When there are no right options, one must rely on analysis based on the situation to choose the best of a bad bunch. We will never be able to completely do away with deontological ethics, especially is smaller scale dilemmas where it can undoubtedly seem far more appropriate in choosing the morally correct option rather than merely the most practical, more cynical one arguably put forward by teleological ethics. However, it seems in times like these, a little bit of cynicism is required.