{"id":314,"date":"2020-06-24T08:22:14","date_gmt":"2020-06-24T08:22:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/covid-19\/?p=314"},"modified":"2020-06-24T08:22:14","modified_gmt":"2020-06-24T08:22:14","slug":"lockdown-of-the-elderly-is-misguided-policy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/covid-19\/2020\/06\/24\/lockdown-of-the-elderly-is-misguided-policy\/","title":{"rendered":"Lockdown of the elderly is misguided policy"},"content":{"rendered":"<p>By Franklin G. Miller.<\/p>\n<p>The Covid-19 pandemic poses policy challenges that may call for controversial measures.\u00a0 Savulescu and Cameron have <a href=\"https:\/\/jme.bmj.com\/content\/early\/2020\/06\/18\/medethics-2020-106336\">recently argued in favor of \u201clockdown \u201cof the elderly as a reasonable alternative to the population-wide lockdowns<\/a> that have been implemented during the pandemic in various jurisdictions around the world. They claim correctly that such a policy would not necessarily be unjust age discrimination, since the elderly are known to be more vulnerable to becoming severely ill from Covid-19; however, that doesn\u2019t make it a sound policy.\u00a0 Their argument is deficient both conceptually and normatively.<\/p>\n<p>The authors do not define who would be included in the group of the elderly subject to this coercive policy:\u00a0 \u201cWe will not attempt to identify an appropriate cut-off to identify \u2018the elderly\u2019 here.\u201d\u00a0 But this is a significant omission.\u00a0 If their policy proposal is meant to include all those who are 65 years of age or older, it would coercively restrict the liberty of many more people than if it included only those aged 75 or 80 and older.\u00a0 More significantly, they do not attempt to explicate what precisely is meant by \u201clockdown\u201d\u2014that is, they don\u2019t specify how extensive the restriction on the freedom of the elderly would be under this policy.\u00a0 Literally, \u201clockdown\u201d signifies restriction on all activity outside the home or place of residence.\u00a0 Would the locked down elderly be prohibited from shopping at groceries or pharmacies?\u00a0 If so, provisions would need to be made for others to supply necessary food and medication, which is not mentioned in the article. \u00a0Would the elderly be prohibited from taking a walk outside?\u00a0 That would be detrimental to their physical and mental wellbeing and poses no, or negligible, infection risk to them or to others.\u00a0 Failure to clarify what the \u201clockdown\u201d would entail is a serious flaw.<\/p>\n<p>Savulescu and Cameron attempt to justify this proposed lockdown policy with respect to reducing the burden on health care resources and the benefit to the elderly.\u00a0 The former concern is contingent on the supply of hospital beds and ventilators being outstripped by the demand for these scarce resources.\u00a0 If such a contingency materializes, then rationing of these resources in accordance with age (and other relevant) criteria might become reasonable, <a href=\"https:\/\/www.thehastingscenter.org\/why-i-support-age-related-rationing-of-ventilators-for-covid-19-patients\/\">as I have argued elsewhere<\/a>.\u00a0 While the authors mention this possibility, they surprisingly shift ground from a normative argument to invoking the law: \u201cUsing age as a determinant of access to resources may be unlawful discrimination.\u201d\u00a0 However, they sidestep the relevance of this objection to their own policy proposal: \u201cThe legality of such a measure is not resolved in this article.\u201d<\/p>\n<p>In supporting lockdown of the elderly on the ground that it will be beneficial to them, the authors do not consider the objection that this would be paternalistic\u2014indeed, a form of what is known as \u201chard paternalism.\u201d\u00a0 Hard paternalism is not necessarily unjustifiable, as in the case of laws that require drivers to wear seatbelts and motorcyclists to wear helmets.\u00a0 But these (largely) paternalistic measures involve minimal restriction on liberty\u2014very different from the drastic restriction of liberty entailed by lockdown.<\/p>\n<p>Nor is it clear that a coercive policy of lockdown of the elderly is needed to protect them.\u00a0 The elderly can be strongly encouraged to minimize their exposure to infection\u2014a form of behavior that they are already highly disposed to follow.\u00a0 A standard principle of public health ethics is to implement the least restrictive policy that constrains the freedom of individuals in the aim of protecting the population from disease and harm.\u00a0 Encouraging safe practices by the elderly, along with measures to test for infection, trace contacts, and appropriately isolate those who are infected or exposed to those known to be infected, would obviate any need for a coercive lockdown of the elderly.<\/p>\n<p><strong>Author<\/strong>: Franklin G. Miller<\/p>\n<p><strong>Affiliations:<\/strong> Professor of Medical Ethics in Medicine, Weill Cornell Medical College, New York, NY.<\/p>\n<p><strong>Competing interests:<\/strong> None<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Franklin G. Miller. The Covid-19 pandemic poses policy challenges that may call for controversial measures.\u00a0 Savulescu and Cameron have recently argued in favor of \u201clockdown \u201cof the elderly as a reasonable alternative to the population-wide lockdowns that have been implemented during the pandemic in various jurisdictions around the world. They claim correctly that such [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/covid-19\/2020\/06\/24\/lockdown-of-the-elderly-is-misguided-policy\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":383,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[96,95],"tags":[],"class_list":["post-314","post","type-post","status-publish","format-standard","hentry","category-journal-of-medical-ethics","category-pandemic"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lockdown of the elderly is misguided policy - Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/06\/23\/lockdown-of-the-elderly-is-misguided-policy\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Lockdown of the elderly is misguided policy - Coronavirus (COVID-19) Blog Posts Collection - BMJ Journals\" \/>\n<meta property=\"og:description\" content=\"By Franklin G. Miller. The Covid-19 pandemic poses policy challenges that may call for controversial measures.\u00a0 Savulescu and Cameron have recently argued in favor of \u201clockdown \u201cof the elderly as a reasonable alternative to the population-wide lockdowns that have been implemented during the pandemic in various jurisdictions around the world. 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