This is part of my series on How To Be A Good Person.
I live in Utah, where like many states, hospitals are running out of ICU beds. This shortage prompted someone to ask:
Once ICUs are full, should hospitals use criteria like adherence to social distancing and mask mandates to determine who gets the next ICU bed?
Doctors and nurses have no business making moral judgments about people. In their eyes, we should all just be humans and equally deserve medical care.
Now, before you object, ask yourself:
- Who do you trust to judge your personal worthiness?
Exhausted doctors? Overworked nurses? Faceless bureaucrats?
- Under what conditions should they deny you an ICU bed?
- Should they trawl through your social media, browser history, credit card statements, and call history? Should they demand character references?
Or do we protect your privacy and let them decide with insufficient data?
- How do you appeal their decision when you’re incredibly ill and barely conscious?
- What will you do when you’re denied a bed because your bribe was too small?
Next, let’s walk through a couple of specific objections.
But Stewie, why should we reward people who are careless and obstinate?
When I watch a heist movie, I’m omniscient. I know who robbed the bank and how they did it. I know who’s good, who’s bad, and who deserves to be punished. Likewise, in thought experiments, we can make blanket statements like, “Bob was careless and obstinate.” Everything is clean and tidy.
But real life is not a movie or a thought experiment. It’s messy, and no ICU doctor has enough information to accurately judge who was reckless and who was conscientious.
I mean, even murderers get a trial, complete with witnesses, evidence, defense attorneys, and a jury of 12 people. Why do we go to much trouble? Because no one is omniscient, so knowing whether someone committed a crime is really, really hard. And knowing which people are bad, in sum, (and therefore less deserving) is even harder.
Character judgments are the domain of judges and juries. Not doctors.
But Stewie, there’s a shortage of ICU beds. How will doctors decide who gets one?
Doctors are in a terrible position of deciding who lives and who dies.
Now, there are many criteria that they could use. For example, doctors could favor folks who look like them (e.g., racism), abide by laws (e.g., mask mandates), or offer the biggest bribes. They could use a first-come-first-serve approach, have a lottery, or consider morbidity risk.
Personally, I like the principles of “First, do no harm” and “save as many people as you can.” These treat people equally and limit abuse.
Movies and TV shows have given us a false sense of omniscience, where we know who’s good and who’s bad. But real life is not like that.
So I get really uncomfortable when people suggest a simple heuristic to deem others as less worthy of medical care. No person has enough information to make such pronouncements. No one can be trusted with such power. And history is littered with examples of people abusing this sort of power for personal gain.
Put another way, do you want physicians invading your privacy and judging you as less deserving of life-saving care?