It’s the Trolley Problem, Stupid! (guest post by Raj Thamotheram and Ben Hammersley)



Spoiler Alert: it’s not really about facts.

This blog follows Ben Hammersley’s recent participation in Preventable Surprises and Ethical Systems’ Breaking the Fever online conversation series. One silver lining in this crisis is both the possibility and need to form novel collaborations and alliances.

We are experiencing a real-life version of the famous “Trolley Problem”. This is a well-known ethics thought-experiment. Imagine a runaway trolley-car or tram on rails. Its brakes have failed and it’s hurtling towards a group of six people who are about to be crushed. You are standing next to a lever: if you pull it, will divert the trolley-car down another track. On that track, though, stands another man, who won’t be able to get out of the way. Do you pull the lever?

The aim is to highlight questions about the morality of action versus inaction and the difference between utilitarianism and deontological ethics. If you do nothing, the six people die. But they were going to die anyway. If you act, although you have saved six lives, you’ve actively chosen to kill one person – someone who wouldn’t have died otherwise. That makes you responsible for his death in a way that you (arguably) wouldn’t have been if you’d done nothing and let the six die. So what do you do?

With the current pandemic, the lives vs. economy question is similar, but deeper, because it forces us to stare into the sun a bit: how do we compare the value of, say, The Economy against People At Higher Risk. At first glance, this devolves very quickly into “Evil Capitalist Wants My Granny To Die So He Can Keep Making Money”. #NotDying4WallStreet is a popular meme right now. But as a form of public debate it’s very polarising and therefore ineffective. More substantively, recessions and even more so depressions also kill a lot of people – directly and indirectly, immediately and over the longer term. So might it actually mean that, overall, it is better for grannies to be allowed to die for the economic well-being of the country? Those who are exposed to the stock market would, indeed, have strong reasons for supporting this option but beyond this, might overall life expectancy drop by (say) 5-10 years, and suicide rates and physical abuse at home increase by (say) 50%? If we could see it dispassionately and entirely numerically, it should be possible to come to a rational view of all the trade-offs (e.g. increased suicides vs decreased mass killings).

Complicating matters is that *perhaps* there is – in practice – no trade off: large numbers of deaths could also tank the economy because of the loss of confidence of consumers. Also the trolley problem metaphor isn’t really accurate – many (probably most) of the elderly, the diabetic, the obese, the immune-compromised and all the other high risk people who will die because of a herd immunity strategy wouldn’t have died *this year*. Their lives are being prematurely – in some case, very prematurely – put at risk. And there’s the small problem that no one knows if herd immunity is actually possible for this virus without a vaccine – the current evidence suggests it probably isn’t.

The bigger problem is that we can’t reach that decision through rational debate, because it involves people being transparent about what they really hold most important, but it’s probably unrealistic to expect a honest conversation at a time of crisis. It also it calls into question tax-rates, government borrowing, who pays for healthcare and so on. These are all subjects which are closely related to partisan views so this also hinders genuine dialogue and creative thought. This is especially true in the US, but increasingly so in the UK. Who wants to take a bet that both current governments will try to restart their economies with a tax cut? Yes, it would be insane but…

So the likely scenario – especially in the UK – is that that the decision is made to unlock once there is enough irritation with the restrictions. Polling is happening daily. Of course, this will be done in a culturally acceptable manner so that most people don’t have to think about it too deeply. The testing and contact tracing will be “managed” (as it has been from the start) so that there isn’t really reliable data as to how many people died for the cause. High risk people will be told to self-isolate for longer and if they get sick, whose fault is that? The elderly with symptoms may be discouraged, as appears to be happening in Sweden, from going to hospital and data about ICU survival rates will be employed to justify “dying with dignity at home”. And the government will channel any anger or mourning into a ritual or a monument or a major solemn event that lets the public grieve. Today’s “Clapping for the NHS” could be done on a much grander scale and the way Princess Diana’s funeral was orchestrated to channel public anger is a good case study in how high profile deaths could be used. That opposition parties felt compelled to stop criticising Boris Johnson and the government when he was in ICU (for precautionary reasons) is noteworthy. A new Carolingian Age, alongside Brexit, and we all “forget” what happened. Nationwide “willful blindness”!

It’s *extremely* hard to persuade the people who most support “herd immunity” (or whatever euphemism they prefer) because it’s part and parcel of their world view – see here for a preliminary analysis of the overlap between the pro Brexit and the Herd Immunity camps. It’s also one where the conditions for alternative strategies eg “Test, Trace & Isolate” (eg universal basic income to address the precarious situation of self-employed and gig workers, debt jubilees and so on) seem utterly impossible given the governments of the day. And it’s also a world view where taking the hard but necessary decision is what “Heroic Leaders” do – this is, arguably, Prime Minister Johnson’s best chance to be Churchillian.

To have any chance of success, engagement with herd immunity advocates has to look towards the story they have in their heads about this and reframe that narrative. Facts and logical arguments should work better with those who are undecided. What does this mean in practice? Those who are high risk need to talk to their contacts about what they feel about herd immunity both in public – perhaps #BorisDontAbandonMe / #DonaldDontAbandomMe – but as important, in one to ones with their nearest and dearest.

This personal communication, done skillfully, might cause these herd immunity advocates to consider different options. Much like the climate change debate, the most important thing advocates of #TestTraceIsolate can do is *talk* with their closest contacts. Your life may, literally, depend on it!

Ben Hammersley is a futurist. Raj Thamotheram is founder and now a Senior Adviser with Preventable Surprises.

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