By Franklin G. Miller.
The Covid-19 pandemic poses policy challenges that may call for controversial measures. Savulescu and Cameron have recently argued in favor of “lockdown “of 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 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’t make it a sound policy. Their argument is deficient both conceptually and normatively.
The authors do not define who would be included in the group of the elderly subject to this coercive policy: “We will not attempt to identify an appropriate cut-off to identify ‘the elderly’ here.” But this is a significant omission. 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. More significantly, they do not attempt to explicate what precisely is meant by “lockdown”—that is, they don’t specify how extensive the restriction on the freedom of the elderly would be under this policy. Literally, “lockdown” signifies restriction on all activity outside the home or place of residence. Would the locked down elderly be prohibited from shopping at groceries or pharmacies? If so, provisions would need to be made for others to supply necessary food and medication, which is not mentioned in the article. Would the elderly be prohibited from taking a walk outside? That would be detrimental to their physical and mental wellbeing and poses no, or negligible, infection risk to them or to others. Failure to clarify what the “lockdown” would entail is a serious flaw.
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. The former concern is contingent on the supply of hospital beds and ventilators being outstripped by the demand for these scarce resources. If such a contingency materializes, then rationing of these resources in accordance with age (and other relevant) criteria might become reasonable, as I have argued elsewhere. While the authors mention this possibility, they surprisingly shift ground from a normative argument to invoking the law: “Using age as a determinant of access to resources may be unlawful discrimination.” However, they sidestep the relevance of this objection to their own policy proposal: “The legality of such a measure is not resolved in this article.”
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—indeed, a form of what is known as “hard paternalism.” Hard paternalism is not necessarily unjustifiable, as in the case of laws that require drivers to wear seatbelts and motorcyclists to wear helmets. But these (largely) paternalistic measures involve minimal restriction on liberty—very different from the drastic restriction of liberty entailed by lockdown.
Nor is it clear that a coercive policy of lockdown of the elderly is needed to protect them. The elderly can be strongly encouraged to minimize their exposure to infection—a form of behavior that they are already highly disposed to follow. 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. 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.
Author: Franklin G. Miller
Affiliations: Professor of Medical Ethics in Medicine, Weill Cornell Medical College, New York, NY.
Competing interests: None