1. bookVolume 12 (2022): Issue 1-2 (June 2022)
Journal Details
License
Format
Journal
eISSN
2453-7829
First Published
16 Apr 2016
Publication timeframe
2 times per year
Languages
English
Open Access

Utilitarianism on the front lines: COVID-19, public ethics, and the “hidden assumption” problem

Published Online: 18 Jun 2022
Volume & Issue: Volume 12 (2022) - Issue 1-2 (June 2022)
Page range: 60 - 78
Journal Details
License
Format
Journal
eISSN
2453-7829
First Published
16 Apr 2016
Publication timeframe
2 times per year
Languages
English
Abstract

How should we think of the preferences of citizens? Whereas self-optimal policy is relatively straightforward to produce, socially optimal policy often requires a more detailed examination. In this paper, we identify an issue that has received far too little attention in welfarist modelling of public policy, which we name the “hidden assumptions” problem. Hidden assumptions can be deceptive because they are not expressed explicitly and the social planner (e.g. a policy maker, a regulator, a legislator) may not give them the critical attention they need. We argue that ethical expertise has a direct role to play in public discourse because it is hard to adopt a position on major issues like public health policy or healthcare prioritisation without making contentious assumptions about population ethics. We then postulate that ethicists are best situated to critically evaluate these hidden assumptions, and can therefore play a vital role in public policy debates.

Keywords

ALVAREZ, F., ARGENTE, D. & LIPPI, F. (2021): A simple planning problem for COVID-19 lock-down, testing, and tracing. In: American Economic Review: Insights, 3(3), pp. 367–382. Search in Google Scholar

ANDERSON, R. M. (1991): Discussion: the Kermack-McKendrick pandemic threshold theorem. In: Bulletin of mathematical biology, 53(1), pp. 1–32. Search in Google Scholar

ASHEIM, G. B. & ZUBER, S. (2014): Escaping the repugnant conclusion: Rank‐discounted utilitarianism with variable population. In: Theoretical Economics, 9(3), pp. 629–650.10.3982/TE1338 Search in Google Scholar

ATKESON, A. (2020): What will be the economic impact of COVID-19 in the US? Rough estimates of disease scenarios (No. w26867). National Bureau of Economic Research. [online] [Retrieved March 18, 2021]. Available at: http://www.nber.org/papers/w2686710.3386/w26867 Search in Google Scholar

BLACKORBY, C., BOSSERT, W., DONALDSON, D. (1998): Uncertainty and critical-level population principles. In: Journal of Population Economics, 11(1), pp. 1–20.10.1007/s001480050055 Search in Google Scholar

BLACKORBY, C., BOSSERT, W. & DONALDSON, D. J. (2005): Population issues in social choice theory, welfare economics, and ethics. Cambridge: Cambridge University Press.10.1017/CCOL0521825512 Search in Google Scholar

BOSA, I., CASTELLI, A., CASTELLI M., CIANI, O., COMPAGNI, A., GAROFANO, M., GIANNONI, M., MARINI, G. & VAINIERI, M. (2020): Cambridge Core Blog. [online] [Retrieved December 14, 2021] Available at: https://www.cambridge.org/core/blog/2020/04/16/italys-response-to-the-coronavirus-pandemic/ Search in Google Scholar

BRITISH MEDICAL ASSOCIATION (2020): Covid-19 ethical issues: a guidance note. [online] [Retrieved January 20, 2022] Available at: https://www.bma.org.uk/media/2226/bma-covid-19-ethics-guidance.pdf Search in Google Scholar

CHEN, F. H. & TOXVAERD, F. (2014): The economics of vaccination. In: Journal of theoretical biology, 363, pp. 105–117.10.1016/j.jtbi.2014.08.003 Search in Google Scholar

CILLO, U., BURRA, P., MAZZAFERRO, V., BELLI, L., PINNA, A. D., SPADA, M., NANNI COSTA, A. & TONIUTTO, P. on behalf of I-BELT (Italian Board of Experts in the Field of Liver Transplantation) (2015): A multistep, consensusbased approach to organ allocation in liver transplantation: Toward a “blended principle model”. In: American Journal of Transplantation, 15(10), pp. 2552–2561.10.1111/ajt.13408 Search in Google Scholar

CRAXÌ, L., VERGANO, M., SAVULESCU, J. & WILKINSON, D. (2020): Rationing in a pandemic: Lessons from Italy. In: Asian Bioethics Review, 12(3), pp. 325–330.10.1007/s41649-020-00127-1 Search in Google Scholar

EMANUEL, E. J., PERSAD, G. & UPSHUR, R. (2020): Fair allocation of scarce medical resources in the time of Covid-19. In: The New England Journal of Medicine, 382(21), pp. 2049–2055.10.1056/NEJMsb2005114 Search in Google Scholar

FINE, P. E. M. & CLARKSON, J. A. (1986): Individual versus public priorities in the determination of optimal vaccination policies. In: American journal of epidemiology, 124(6), pp. 1012–1020.10.1093/oxfordjournals.aje.a114471 Search in Google Scholar

FINK, S. (2020): U.S. Civil Rights Office rejects rationing medical care based on disability, age. In: The New York Times. [online] [Retrieved December 20, 2021] Available at: https://www.nytimes.com/2020/03/28/us/coronavirus-disabilities-rationing-ventilators-triage.html Search in Google Scholar

GEOFFARD, P. Y. & PHILIPSON, T. (1996): Rational epidemics and their public control. In: International Economic Review, 37(3), pp. 603–624.10.2307/2527443 Search in Google Scholar

GEOFFARD, P. Y. & PHILIPSON, T. (1997): Disease eradication: Private versus public vaccination. In: American Economic Review, 87(1), pp. 222–230. Search in Google Scholar

GERSOVITZ, M. (2003): 25 births, recoveries, vaccinations, and externalities. In: R. J. Arnott, B. Greenwald, R. Kanbur, & B. Nalebuff (eds.): Economics for an imperfect world: Essays in honor of Joseph E. Stiglitz. Cambridge, MA: MIT Press, pp. 469–483. Search in Google Scholar

GERSOVITZ, M. (2011): The economics of infection control. In: Annual Review of Resource Economics, 3(1), pp. 277–296.10.1146/annurev-resource-083110-120052 Search in Google Scholar

HALL, R. E., JONES, C. I. & KLENOW, P. J. (2020): Trading off consumption and COVID-19 deaths. In: Quarterly Review, 42(1), pp. 2–13.10.3386/w27340 Search in Google Scholar

HARSANYI, J. (1955): Cardinal welfare, individualistic ethics and interpersonal comparisons of utility. In: Journal of Political Economy, 63(4), pp. 309–321.10.1086/257678 Search in Google Scholar

HURKA, T. (2000): Comment on ‘Population principles with number-dependent crirical levels’, unpublished manuscript, Department of Philosophy, University of Calgary. Search in Google Scholar

KERMACK, W. O. & MCKENDRICK, A. G. (1927): A contribution to the mathematical theory of pandemics. In: Proceedings of the Royal Society A: Mathematical, Physical and Engeering Sciences, 115(772), pp. 700–721. Search in Google Scholar

KREMER, M. (1996): Integrating behavioral choice into epidemiological models of AIDS. In: Quarterly Journal of Economics, 111(2), pp. 549–573.10.2307/2946687 Search in Google Scholar

MCADAMS, D. (2020a): Economic epidemiology in the wake of Covid-19. In: Covid Economics, 48, pp. 1–45. Search in Google Scholar

MCADAMS, D. (2020b.): Economic epidemiology in the wake of COVID-19. In: Economics, Issue 82120, pp. 1–40. Search in Google Scholar

NEW YORK STATE DEPARTMENT OF HEALTH (2015): VENTILATOR ALLOCATION GUIDELINES. [online] [Retrieved February 10, 2022] Available at: https://www.health.ny.gov/regulations/task_force/reports_publications/docs/ventilator_guidelines.pdf Search in Google Scholar

PANOVSKA GRIFFITHS, J., KERR, C. C., WAITES, W. & STUART, R. M. (2021): Mathematical modeling as a tool for policy decision making: Applications to the COVID-19 pandemic. In: Handbook of Statistics, 44, pp. 291–326.10.1016/bs.host.2020.12.001 Search in Google Scholar

PARFIT, D. (2000): Equality or Priority? In: M. Clayton & A. Williams (eds.): The ideal of equality. Houndmills: Palgrave, pp. 81–125. Search in Google Scholar

PESTIEAU, P. & PONTHIÈRE, G. (2022): Optimal lockdown and social welfare. In: Journal of Population Economics, 35(1), pp. 241–268.10.1007/s00148-021-00867-w Search in Google Scholar

PETERSON, A., LARGENT, E. A. & KARLAWISH, J. (2020): Ethics of reallocating ventilators in the covid-19 pandemic. In: BMJ, 369, p. m1828. Search in Google Scholar

PHILIPSON, T. J. & POSNER, R. A. (1993): Private choices and public health: The AIDS pandemic in an Economic Perspective. Cambridge, MA: Harvard University Press. Search in Google Scholar

RICCIONI, L., BERTOLINI, G., GIANNINI, A., VERGANO, M., GRISTINA, G., LIVIGNI, S., MISTRALETTI, G. & PETRINI, F. (2020): Raccomandazioni di etica clinica per l’ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessita e risorse [Clinical ethics recommendations for admission to intensive treatments and their suspension, in exceptional conditions of imbalance between needs and resources]. In: Recenti Progressi in Medicina, 111(4), p. 207–211. Search in Google Scholar

ROYAL COLLEGE OF PHYSICIANS (2020): Ethical dimensions of COVID-19 for frontline staff. [online] [Retrieved March 10, 2022] Available at: rcplondon.ac.uk/file/20551/download Search in Google Scholar

SEN, A. (1987): The Standard of Living. Cambridge: Cambridge University Press. Search in Google Scholar

SHAW, D., HARVEY, D. & GARDINER, D. (2020): Don’t let the ethics of despair infect the intensive care unit. In: Journal of Medical Ethics Blog. [online] [Retrieved February 10, 2022]. Available at: https://blogs.bmj.com/medical-ethics/2020/03/26/dont-let-the-ethics-of-despair-infect-the-intensive-care-unit/. Search in Google Scholar

SPEARS, D. & STEFÁNSSON, H. O. (2021): Additively-separable and rank-discounted variable-population social welfare functions: A characterization. In: Economics Letters, 203, p. 109870.10.1016/j.econlet.2021.109870 Search in Google Scholar

SPEARS, D. & ZUBER, S (2021): Foundations of utilitarianism under risk and variable population. In: IZA Discussion Paper, No. 14515. [online] [Retrieved February 10, 2022]. Available at SSRN: https://ssrn.com/abstract=3879363 or http://dx.doi.org/10.2139/ssrn.387936310.2139/ssrn.3879363 Search in Google Scholar

THOMSON, W. & LENSBERG, T. (2006): Axiomatic theory of bargaining with a variable number of agents. Cambridge: Cambridge University Press. Search in Google Scholar

TOXVAERD, F. & ROWTHORN, R. (2020): On the management of population immunity. Cambridge: University of Cambridge. Search in Google Scholar

VERGANO, M., BERTOLINI, G., GIANNINI, A., GRISTINA, G. R., LIVIGNI, S., MISTRALETTI, G., RICCIONI, L. & PETRINI, F. (2020a): SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances. In: Minerva Anestesiologica, 86(5), pp. 469–472.10.23736/S0375-9393.20.14619-4 Search in Google Scholar

VERGANO, M., BERTOLINI, G., GIANNINI, A., GRISTINA, G. R., LIVIGNI, S., MISTRALETTI, G., RICCIONI, L. & PETRINI, F. (2020b): Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: The Italian perspective during the COVID-19 pandemic. In: Critical Care, 24(165), pp. 1–3.10.1186/s13054-020-02891-w Search in Google Scholar

WANG, H., WANG, Z., DONG, Y., CHANG, R., XU, C., YU, X., ZHANG, S., TSAMLAG, L., SHANG, M., HUANG, J. & WANG, Y. (2020): Phase-adjusted estimation of the number of coronavirus disease 2019 cases in Wuhan, China. In: Cell discovery, 6(1), pp. 1–8.10.1038/s41421-020-0148-0 Search in Google Scholar

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