Covid-19 and the ethics of risk

How can we fairly distribute risks across individuals and groups within societies? Jonathan Wolff, Sridhar Venkatapuram, and Nicole Hassoun consider

Life is full of risks, some welcomed, some distinctly unwelcome. The pandemic has increased risks for everyone, raising vital questions about their fair distribution. Aside from managing personal and family risks, we are also forced to consider the circumstances under which society can legitimately expect some people to take risks they might not understand or would prefer to avoid. Most prominent among these are threats to the physical health of certain groups of people, such as health workers, delivery drivers, teachers, and shop workers, although the mental health and economic wellbeing of many others are also at risk.

Several general frameworks for thinking about the fair distribution of risk have been proposed. The first is the most obvious. No one should have to experience a risk of harm unless they consent. This is the rights against risk theory. But it has at least three problems. First, we can’t always get enough people to consent to accept a risk (for example, no one works in grocery stores during lockdowns even if wages are increased). Second, offering already vulnerable people money to take exceptional risks can be exploitative. Third, and most critically, it’s an impossible theory to follow. Driving a car exposes countless people to risk. But it’s not possible to get the consent of them all. Indeed, all actions carry some risk of harm to others. 

The second theory, compensation after harm, suggests we can expose each other to risk, but must compensate anyone who thereby suffers harm. There is something liberating here, but the theory is deeply flawed. Most obviously, you cannot truly compensate someone, or even their family and friends, for their death and, arguably, even for grave injury. Second, if we know we are subject to harm at any time by others we might live our lives in fear. And if no adverse event happens, who will compensate us for our fear? So a more precautionary attitude is needed.

A third approach applies social cost benefit analysis to risk. Only allow the risk of harm to others if the expected benefits outweigh the costs. This is not a trivial condition. Reckless risk taking, where the probable costs greatly outweigh the probable benefits, is all too common. However, the converse—always allow a risk if the expected benefits outweigh the risks—is highly problematic. It could lead to a situation in which all the benefits go to one already privileged group, and all the costs go to the under-privileged. For example, the tradeoff of the economy versus health is more accurately some people’s economic wellbeing versus the health of others. Indeed, this was the situation in lockdown, with low paid workers facing higher risks while serving those fortunate enough to work from home.

Finally, a fourth theory appeals to a hypothetical social contract. Employing John Rawls’ theory of justice, it asks you to imagine the risk related principles you would agree to if you didn’t know how you would be personally affected. It could be you running the risk, or others taking it on your behalf. What would you agree to? Our proposal, building beyond the other theories, is this: 

Don’t impose the risk unless the benefits outweigh the cost (irrespective of who gets either). 

Try to find qualified volunteers or people who will accept extra pay to run the risk but not on exploitative terms.

If the adverse event happens, compensate insofar as possible. 

Take special care to minimise the risks in question.

Applying these principles to covid-19, frontline workers should receive extra pay, and get high priority if they fall ill. They should also be provided with high quality personal protective equipment, and should be in the first groups for vaccination. We need people to take risks on our behalf, but it’s a grave injustice if we take their service for granted without special protection, pay, and compensation. Similar concern may require priority for other groups too—for example, older people who have contributed a great deal to society already and are at very high risk due to the illness, or people who are poor or oppressed, and so forth.

Special concern is also justified by the fact that many people in these vulnerable groups face more risks of harm throughout their lives and, indeed, suffer more harms such as diseases and injuries. These risks include health risks, but also risks to their ability to provide for their families or to stay in their homes.

Most people probably consider the pandemic a natural disaster. It is anything but. Collectively, we have failed to address the threat of pandemics and the problems that vulnerable people face, which are long standing, predictable, and extraordinary. While many governments have been grappling with national security risks, including biological threats, we have been very slow to think about the fairness of how we collectively create and distribute risks across individuals and groups within societies. 

Jonathan Wolff is the Alfred Landecker professor of values and public policy at the Blavatnik School of Government, University of Oxford, and governing body fellow, Wolfson College, Oxford. Twitter @jowolffbsg

Sridhar Venkatapuram is an associate professor of global health & philosophy at King’s College London. He is also acting deputy director of King’s Global Health Institute and director of King’s Global Health Education & Training. Twitter @sridhartweet

Nicole Hassoun is a professor of philosophy at Binghamton University. Twitter @kikseven2

Competing interests: none declared.