In recent editorials on Sky News and in News Corp newspapers, a new distinction entered Australia’s Covid-19 discourse: between dying “with” the virus and dying “from” the virus.
While relatively new in Australia, this talking point is months old. It first surfaced in the US, championed by a range of rightwing commentators. US virus researcher Anthony Fauci dismissed the suggestion the US death toll had been overstated in this way as a “conspiracy theory”.
On the level of principle, asking whether these people were already so unwell that they would have died anyway, whether or not they had Covid-19, is a reasonable consideration. Of course we should be precise and accurate in capturing the risk and harm of Covid-19. If someone is killed in a car accident, whether they had the virus or not is irrelevant. Their death shouldn’t be added to the Covid-19 deaths.
These kinds of deaths aren’t being counted in Australia. The Communicable Diseases Network Australia’s guidelines define a Covid-19 death as “a death in a probable or confirmed Covid-19 case, unless there is a clear alternative cause of death that cannot be related to Covid-19 (eg trauma). There should be no period of complete recovery from Covid-19 between illness and death”.
This is the sense in which a distinction between dying “with” and dying “from” Covid-19 is reasonable. It’s the way in which Victorian premier Daniel Andrews used it when discussing Australia’s youngest Covid-19 related death. He said: “We are talking about the youngest person that has died of this virus, or at least with this virus,” leaving open for the coroner the option of exploring other possible causes of death.
However, this isn’t the way that rightwing agitators want to use the distinction. They’re concerned with cases where a death can be related to Covid-19 but can’t solely be attributed to it because of other health factors in play. For them, the only way you can die from Covid-19 is if it’s the only thing that can plausibly be said to kill you.
This is an unusual claim. We don’t think that way about any other event. When we describe the deaths that emerged from the second world war, we include those who died from starvation who would have otherwise survived. When we measure alcohol related deaths, we include those who died from drink-driving. Similarly, we should consider that people whose existing conditions were exacerbated by Covid-19 to the point where they died, to have died from the virus.
And yet, despite the ease with which we can dismiss the argument, there’s something more revealing at play here. The grammatical distinction of dying with v dying from hides a much more serious distinction that informs what’s going on here. Namely, a distinction between deaths that matter and deaths that don’t.
In my view, the reason those who advocate in favour of the from/with distinction are doing so is because they want people to see that those who merely died of Covid-19 are irrelevant to any analysis of the costs and benefits of a lockdown. For them, if Covid-19 only killed you because you were already pretty unwell, then you were probably going to die soon anyway. Sad, yes. But not as sad as if someone “healthy” were to die.
Moving on from the from/with distinction, in May, UNSW economist Gigi Forster, one of the loudest opponents to coronavirus restrictions, argued that our weighing of lives lost to Covid-19 is misleading because it doesn’t account for age. Those who have died are “predominantly the lives of older people with a few years, not an entire life, left to live”.
It is correct that standard economic approaches would factor in age, as well as other factors such as disability and health conditions. They wouldn’t count lives, they would count “quality-adjusted life years”. From this health economics standpoint, once you’re of a certain age, or below a certain health threshold, your years of life simply matter less than those of healthier, younger people. According to this approach, while all lives are worth living, not all lives are equally worth saving.
However, the fact this is a well-established practice does not make it a good one. Like any algorithm, it carries the appearance of objectivity while being laden with subjective, biased and ideological claims.
Limiting our counting of Covid-19 mortalities to those who were previously in the peak of health is to court a widespread, deep and ruinous belief. Namely, that at some point on the spectrum of age and health, your status changes from “living” to “waiting to die”. And if you were already on the waitlist, is it so bad if you get there a bit faster?
This kind of thinking is cruelly unimaginative. It’s easy to assume – especially if you’re scoring a perfect 1.0 on the quality of life scale – that if someone is unable to enjoy all the things that give you a sense of vitality, then as alive as they might be, they’re not really living anymore.
The French philosopher Jean-Jacques Rousseau wrote that, “To live is not to breathe but to act. It is to make use of our organs, our senses, our faculties, of all the parts of ourselves which give us the sentiment of our existence. The man who has lived the most is not he who has counted the most years but he who has most felt life.”
It would be easy to take Rousseau to be glorifying youthful vitality and the robustness of life. However, that too would be unimaginative. Instead, we should read him as inviting us to think of a “full life” as one in which we acknowledge, appreciate and experience the full range of the human condition. Instead of using accounting techniques to explain what’s wrong with ageing and illness, we could use the lived experience of those who are ill and aged to learn what’s wrong with us.
Rousseau’s passage ends by saying, “men have been buried at one hundred who have died at their birth”. It’s worth considering what it would take to be considered dead in this way. I can’t speak for Rousseau, but I reckon one candidate is the person who is willing to understate the importance of someone else’s life as a way of protecting their own.
• Matt Beard is an Australian moral philosopher, fellow at the Ethics Centre and a regular writer on philosophy and ethics
Source: The Guardian