TROLLEY PROBLEM

Coronavirus is not a science problem, it is a moral dilemma

You drown not by falling into a river, but by remaining submerged in it

In Summary

• Seeing as science is not producing the required answers in flattening the curve, the government is faced with a moral dilemma of either flipping the switch killing one and saving five, or inaction even where it is within their power to act.

•  They have opted for the optimism bias, which is the tendency to greatly underestimate the undesirable outcomes of destroying millions of livelihoods and months of education, while overestimating favourable outcomes such as reducing the number of people who get infected with the virus.

Police in California Estate on Thursday, a day after the government ordered cessation of movement in and out of Eastleigh, Nairobi, due to high Covid-19 cases
Police in California Estate on Thursday, a day after the government ordered cessation of movement in and out of Eastleigh, Nairobi, due to high Covid-19 cases
Image: FREDRICK OMONDI

Imagine you are standing beside some railway tracks. A few meters away, are five workers working on the tracks.

In the opposite direction, you spot a runaway train carriage hurtling fast down the tracks. You shout to warn the workers, but they can neither hear you nor the hurtling train because they are wearing ear mufflers as part of their protective gear.

As the disaster looms, you notice a lever connected to the tracks. You realise that if you pull the lever, the runaway train carriage will be diverted down the second set of railway tracks. However, on this alternate track, is one other employee also working on the railway tracks. He, too, cannot hear your warning shouts, nor the oncoming train.

 

What would you do? Would it be morally permissible for you to pull the lever to save the lives of the five employees but kill the one?

Or imagine you are a renowned surgeon who has one of the best success rates in transplanting organs. At the moment, you have five patients who need different organs to survive. Two need one lung each, two need a kidney each, and the fifth needs a heart. If they do not get their organ transplants by the end of the day, they will all die. On the same day, a man walks in for his routine annual medical checkup. He is in excellent health and happens to be a perfect match to all the other five patients.

As the surgeon, would it be morally permissible for you to kill the one healthy man and harvest his organs to save the lives of the five that need the organ transplants?

In philosophy-speak, this moral paradox is called the trolley problem. It attempts to render into visceral example the thorny question of utilitarianism versus consequentialism moral theory. Utilitarianism is making the decision that has the greatest good for the most number of people. Consequentialism is the consequences of an action or inaction. But exactly which consequences are permissible? Is it moral to make the intentional decision to kill some in order to save many more, or let events unfold without intervention? No matter your choice, it always ends in tears.

The coronavirus pandemic has refused to go away, and there are schools of thought that are convinced that this is not a passing cloud. They have said we should prepare to live with it forever. The government, through the National Emergency Response Committee headed by Health CS Mutahi Kagwe has rolled out variations of mitigation measures, including social distancing, dusk-to-dawn curfew, the closing of some business enterprises, quarantining, cessation of movement and more recently, the lockdown of Eastleigh estate in Nairobi, and Old Town in Mombasa.

But it appears that no matter what mitigation measures they implement, the positive cases keep rising daily. It is highly likely that the increase in numbers can be attributed to an increase in testing. However, this ought to be interpreted cautiously because correlation does not always imply causation. This is because the Ministry of Health reported that 71 per cent of those infected were asymptomatic. So the increase in the number of positive cases could also be attributed to infections by asymptomatic infected persons.

These mitigation measures have resulted in the loss of many people’s livelihoods, while still others have been separated from family through the cessation of movement and lockdown interventions. It has been reported that more than 130,000 have lost their jobs in the formal sector. I hazard a guess that this is a conservative estimate.

 

What is more terrifying is that many more Kenyans are just one degree of separation from being rendered jobless. These include 300,000 in the tourism sector, 50,000 in the horticultural sector, and another 58 per cent in the informal sector whose livelihoods rely on imports from China, according to a report tabled in Parliament by the Ministry of Labor and Social Protection. If you cannot feed or shelter your family, then on the balance of probabilities, your outcomes are not significantly different from exposure to the virus.

A study published in the Social Science and Medicine Journal and led by Prof Karina Davidson from Columbia University found that the risk of death for unemployed persons was 63 per cent times higher than the risk of employed persons and unemployed men were 37 per cent more likely to die than unemployed women. The risk was higher for those in their early and middle careers.

Begs the question, have these mitigation measures, justified as they are, caused more harm than they have mitigated? Are they driven by the moral calculus of utilitarianism or consequentialism? In its response, is the government content to risk huge damage to the physical and mental health of many people to save others?

I submit that the government is faced with the trolley problem. What they are grappling with is no longer the science of how to flatten the curve. And it is instructive to note that flattening the curve does not equate to reducing the infections. It simply means maintaining the same level of infections over a longer period of time in a bid not to overrun our health system capacities. The ideal science should provide answers on to ensure a downward sloping curve, which means a decrease in the infections.

Seeing as science is not currently producing the required answers towards the downward sloping curve, the government is, therefore faced with a moral dilemma of either flipping the switch killing one and saving five, or inaction even where it is within their power to act. And they have decided to pull the lever. They have opted for the optimism bias, which is the tendency to greatly underestimate the undesirable outcomes of destroying millions of livelihoods and months of education, while overestimating favourable outcomes such as reducing the number of people who get infected with the virus.

As you ponder whether it is fair to question the government’s decision to pull the lever, consider that the same government would not forcibly remove one kidney from a healthy person to save another’s life, even when doing so will likely have no effect on the compelled donor. So why is it okay to forcibly remove a livelihood from one person in order to save the life of another unknown person?

My second submission is that seeing as this pandemic has now mutated from a science into a moral dilemma, the government should now consider the doctrine of double effect. This doctrine states that if genuinely doing something morally good has a morally bad side effect, then it is ethically okay to do it providing that the side effect wasn’t intended. An example is when saving the life of a pregnant mother causes the death of her unborn child.

Finally, my unsolicited advice is to the credentialed class of NERC experts. You drown not by falling into a river, but by remaining submerged in it. Likewise, in the absence of a cure or vaccine, you can either allow Kenyans to swim their way out of this raging river that will undoubtedly sweep some of them away, or submerge them indefinitely through curfews, movement cessations and lockdowns until they drown.

Will your moral calculus be utilitarianism or consequentialism? Either way, it will end in tears.

Those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety – Benjamin Franklin