The Questionable Consolations of Philosophy

The Questionable Consolations of Philosophy Alan Ryan (bio) as i write, the united kingdom is four weeks into its lockdown. Bars, restaurants, and the majority of stores other than food shops and pharmacies are shut, and most of their workers have been laid off. The death toll from the novel coronavirus is, viewed against first expectations, not astonishingly high; in another, more alarming light, it has just about doubled the mortality rate for the time of year. Because the virus is a lot more lethal for the elderly and for those with underlying conditions, a couple of million of us are under virtual house arrest. I am one of them. We are urged, or ordered, to remain indoors for twelve weeks, and not to leave home for any reason whatsoever, relying on neighbors, good Samaritan groups, or family members to fetch provisions or medications. Some widely predicted consequences of lockdown are already visible: cases of domestic abuse—including murder—have just about doubled compared with their pre-lockdown levels, and the mental health of the vulnerable is under threat. Nobody knows what the long-term impact of the whole three months of quasi house arrest will be. The point of shutting away the most vulnerable is not entirely, indeed not mostly, for their own good. The British National Health Service (NHS) is very efficient in the sense of running with very little spare capacity. Compared with many European countries, there are usually few unused intensive care beds, for instance. If the vulnerable catch coronavirus, they are likely to need hospitalization, and if [End Page 289] a great many did so, the NHS would be overwhelmed. The slogan the UK government is unwilling to use would be "stay at home; the life you save is someone else's." Given the time to brood on the human condition, I have been curious about whether the effect of being in the category of the elderly vulnerable would be to make me change my views on mortality on the one hand and the proper allocation of medical resources on the other. Montaigne famously observed that "to philosophize is to learn how to die," so I have been curious to see whether he was right. By and large, he was. Indeed, I stick to Lucretius. Being dead is not a bad thing, because it is not a state of affairs within one's life and therefore not a misfortune for the dead person. Once dead, one is past all that. Of course, dying slowly and painfully is a very bad thing and to be avoided if at all possible. I have finally got round to signing a "do not resuscitate" form. As to the thought that in the allocation of scarce medical resources, I should gracefully give way to a young person who has many years of life ahead of her, I am mildly conflicted. In the abstract, it seems right; the point of medical treatment is to do good to the patient, and the more good the better. For questions like this, crude utilitarianism is as good an intellectual framework as there is. In the abstract, I have no objection to drawing the short straw here. But the preferred measure in medical ethics is "quality adjusted life years" or QUALYS. Every nasty ethical issue then revolves around our conception of quality. Five minutes' thought reveals a few of them. Do we really want to work less hard to save the disabled on the grounds that, by some measures, their lives are of lower quality than the lives of the able-bodied? Is the life of the cheerfully antisocial young man who is unwell through his own carelessness nonetheless rich in "quality," or do we want to demur? On the other hand, do we want a morality committee attached to intensive care units, deciding who gets to live and thus who gets to die? There's much to be said in favor of running an inefficient health care system so that questions of rationing care don't occur at this level. [End Page 290] If the consolations of philosophy fail, house arrest in Oxford offers scope for the consolations of history. The college that I

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