Risk, Part 1: Trade-Offs and Value Judgements

This is part 1 of a 2-part sequence on different aspects of how American society deals with risk.  It is related — but only tangentially so — to a post from a year ago regarding why America’s traditional attitude toward risk might be different than the attitudes of other cultures.

Part 2 (Fear and Control) — not yet finished when this was originally posted — is here.  Part 2 was started first but this one was both completed first and particularly germane to events then current in the news, so I posted it at that time rather than waiting for the set to be complete.

 

27 May 2020

Each year, nearly 40,000 people in the United States die in car accidents.

That number is prone to statistical variation, so it fluctuates somewhat randomly up and down by a few hundreds from year to year.  And the baseline that anchors such variation is influenced by factors like the total number of miles driven (and, indirectly through that, by the price of gasoline and the fuel efficiency of cars), the state of repair of the road network, socially- and legally-influenced personal choices like whether or not to wear seat-belts and how fast to drive, and by the various safety features built into automobiles either voluntarily or by government decree.  Hence, the numbers have trended upward and downward by larger amounts in slow cycles over time.

But, during my lifetime (which I find now, to my astonishment, spans a more than half the era of the automobile), that number has never been below 32,000 per year – somewhat more than 2.5 million cumulatively[1].  And we can predict, with near certainty, that the years to come – excepting, perhaps, this year of pandemic and social lockdown – will not break that pattern to any significant extent; that something in the neighborhood of another 30 to 40 thousand people will continue to die in that way each year, year after year, as time rolls by.

Moreover, although it is difficult to find any precise statistics on it, we know from casual observation of news reports that some significant fraction of those car accident victims are victims, indeed: free of any responsibility, fault, or blame beyond simply being in the wrong place at the wrong time when someone else’s attention wandered or someone else’s judgement lapsed.

That is, by any measure, a tragedy.

And, yet, it is a tragedy we bear, if not with indifference or forbearance then, at the least, with resilience.  We know we will, as a society, pay that cost every year.  Yet, as individuals, we choose to drive our cars; yet, as a society, we choose not to constrain – and even actively encourage – that individual choice.

Certainly, we have made reasonable strides toward reducing the annual death toll through regulatory mechanisms: we have mandated that manufacturers install and that drivers use seat-belts; we have required extra-strong bumpers and reinforced roofs and reinforced doors and crumple zones and airbags and always-on headlights and other safety features in cars; we have designed new roadways to incorporate banked curves and unimpeded sightlines and guardrails and impact barriers and Botts’ dots and rumble strips and other safety technologies; we have imposed speed limits and added features like speed-bumps; we have become much less tolerant, in recent years, than we historically have been of drunk driving.

Yet, we could, with sufficient fortitude and an altruistic dedication to sacrifice, do much more.  We know that the likelihood of accidental death in an automobile rises as its speed increases.  We could eliminate nearly all of those deaths by legislating and strictly enforcing a national maximum speed limit of 25 MPH upon everyone, everywhere.  We know that the likelihood of accidental death in an automobile rises with the number of miles driven and with the density of traffic on the roads.  We could eliminate nearly all those deaths by prohibiting the private use of cars, leaving the roads solely to the use of professional drivers who deliver us essential goods and provide us with essential services.

Yes, either of those would require a profound and disruptive transformation in both our culture and our economy.  But neither is impossible – their effects were, in fact, the norm of human experience little more than a century ago.  And they would save many lives.

In a similar vein, there are other things we could do to reduce the unintended human toll of accident and disease.  Something like 41 people die every year in skiing accidents[2]; other sports that involve moderately high speeds and/or heights and/or the potential for unintended collisions take similar tolls; and something like 1 in 40,000 to 80,000 amateur athletes die every year 80,000 die every year more generally from sports-induced cardiac arrest[3].  We could eliminate most of those deaths by outlawing participation in amateur sports.  About 3500 people die every year by drowning[4].  We could eliminate those deaths by making the use of swimming pools and beaches and boats and bathtubs illegal.  Nearly ²/₃ of a million deaths every year in the U.S. are attributed to heart disease[5], the vast majority of which are almost certainly associated with poor personal eating and exercise habits.  We could eliminate a large fraction of those deaths by mandating and enforcing a national heart-healthy diet and exercise program.  Roughly 5000 people die each year in workplace accidents[6].  We could eliminate the bulk of those deaths by shutting down large sections of the economy and forcing people to shelter in place instead of going to work.

If the preservation of human life is the be-all and end-all of private action and public policy, indisputably worth any cost in both economy and liberty, then we would do all those things and we would do them without argument or regret.  Nonetheless, in fact, we do none of them.  We have no plans to do any of them.  And there is no hint of any popular movement agitating for us to consider changing our minds in that regard.

Which suggests that we all intuitively understand, even if we can neither articulate nor rationalize the precise placement of the implied ethical boundaries – or are loath to admit to them – that the trade-offs in risky human activity between the potential for loss of human life and the potential for benefit, economic or otherwise, are not as stark and as obvious as the simple and common mantra –that saving human life is always worth any cost – implies.

 

To be blunt: there is, indeed, some upper bound on how much cost, either in economic benefit or in liberty, represents a fair trade for a statistical human life.  And we all personally adjudge where that bound lies, implicitly if not explicitly, many times per day, every day, as a matter of routine.  We all take risks and impose risks on others because we think we will reap some economic or physical or emotional or social or moral or spiritual reward from doing so.  We leave the relative safety of our beds to roam through a world filled with environmental poisons and pathogens; and we introduce, in turn, our own personal pathogens into that world every time we breathe, and some additional environmental poisons into that world as we move through our environment and mold it to our needs.  We consume resources others might have used and, thereby, deny them that use.  As a result of that consumption, we generate noxious waste, both biological and industrial.  We both tame fire and play with it and, upon occasion, it burns beyond our control.  We walk boldly down the streets and, despite the traffic, walk boldly across them, endangering both ourselves and the drivers that we force to avoid us as they pass.  We ride bicycles.  We drive cars.  We get on busses and trains and airplanes.  We go to work.  We go to the store or to the movies or to a restaurant or to the park.  We climb stairs and trees and mountains.  We stroll through forests and fields and deserts.  We dive in the depths of the sea or swim and surf and sail across its surface.  We jog and go to the gym; or we remain sedentary and invite obesity.  We play games and sports.  We lie in the sun and walk in the rain.  We indulge in social interactions, even intimate and antagonistic ones.  We bear children.  We eat food that is bad for us, and more than is good for us.  We drink alcohol.  We take drugs.

And we honor others’ freedom to do the same.

We do all that despite the fact that we can predict, with utter certainty, that our activities will result in some large number of people losing their health and their lives to accident or disease.  We don’t know precisely how many; and we don’t know which specific people they will be.  That is why we consider those losses ‘statistical’, rather than definite – not because there is any realistic possibility that none of them will happen, and not because they don’t represent real and tangible harm, but because the link between cause and effect is subtle and oblique and subject to random chance – because there is a considerable and unresolvable uncertainty about precisely how large those losses will be, about how they will end up being distributed among us, and about how much any individual action might affect them for better or for worse.

We go about our lives and people die.  We know people will die.  But that doesn’t mean we have killed them.  The ugly truth is, the world is a dangerous place and we, all of us, play the odds, with our own lives to some large degree and with the lives of others to a lesser one.  There is a legitimate, important, and ongoing debate that we may and should have over where, on the continuum of behavior, the margin lies between prudent risk-taking and reckless disregard.  But we must acknowledge that there is a continuum, not a simple border: not all risks are reckless ones and there are costs sufficiently dire, and benefits sufficiently valuable, that they may justify the risk of precipitating some amount of generalized and arbitrarily-distributed human suffering in order to forestall or foster them.

 

That sweeping elocution on the nature of risk applies generally, to every personal choice and to every government policy, from our daily commutes to the way we respond to climate change.  But I wrote it within the specific context of the current Covid-19 epidemic.  And, in that context, it would be natural to suppose it was intended as the logical preface to an accusation that the cautious approach America and much of the rest of the world have been taking to social distancing, including a partial economic lockdown, is neither justified nor reasonable. It might be natural to suppose that it suggests a rapid and indiscriminate overturning of those social distancing policies is warranted.

Neither supposition is either accurate or true.  It is intended not as a critique of, or a support for, any particular policy but as a frame through which to view the process for determining policy.  It suggests not that one policy or the other is clearly superior or misguided, but that considering some degree of both – both of closing down and of opening up – is well within the bounds of sensible; and that we ought therefore, to be able to debate the merits and drawbacks of each without resort to vituperation and accusations of idiocy or of malice.

More importantly, we ought not be trying to shut that debate down before it starts by making grand proclamations that one policy or the other is mandated by a moral certainty and unassailable truth —  in particular, by the grand proclamation that avoiding even one extra death, from Covid or from some other cause, is by definition and inarguably worth “any cost” we may be asked to bear because “you can’t put a price on human life”, or because we should “care more about people than about money”, or because, as the headline on a recent Paul Krugman editorial in The New York Times suggested, no one should have to “…die for the Dow”[7].

The correctness of the general directive that we “listen to the science” is clear and unassailable, yet far too many people have been wielding that directive not as a plea for rationality but, rather, as just such a moral club: “The science says some people are likely to die if they interact with others.  Therefore, we must stop the world and get off: we must all isolate from each other in extremis.  Q.E.D.  Because… Science!”  As far as it goes, the assertion that we should “listen to the science” is, in fact, unassailable.  But science should be merely the start of the conversation, not its end.

Science can tell us what will happen if we undertake or don’t undertake certain policies; or, rather, it can tell us what might happen, within some large range of uncertainty and strictly within the bounds of its constrained area of expertise.  Epidemiological models for disease progression may give us more or less plausible estimates for how many people are likely to get sick and/or to die from Covid-19 within certain specified geographical areas and demographic profiles, and within some specified time interval, given that we do or do not “lock down” with a specified degree of rigor, and given that we can or cannot make effective use of testing and vaccination.  The same models may predict, under the same sets of assumptions and with the somewhat higher level of uncertainty always associated with predicting human behavior, how likely it is that we will or will not overload the capacity of our health-care delivery system as the result of a short-term surge in infection rate, and how many incremental deaths such an overload might generate.  Scientists can provide – based not on the scientific method, per se, but on the historical record of how similar research has progressed in the past and on the current, limited, understanding of the disease mechanisms – an estimate, though a much less reliable one, of when a vaccine might or might not become available for use.  And, in the event a vaccine is delayed indefinitely or, indeed, never does become available, the epidemiological models will almost certainly predict, to our dismay, that, beyond what is necessary to prevent an actual crisis in the delivery of care, further increments in the level of rigor with which we pursue social distancing will affect the timeline of the unfolding disaster much more than they will affect its ultimate scale.

But “science” – or, at least, the science of epidemiology, which is what people telling us to “listen to the science” seem primarily to have in mind – while clear on the potential benefits of the lockdowns it stipulates, is utterly silent on their costs: it has nothing to say about how much poverty or deprivation will result, or about what the adverse health effects of that incremental amount of poverty and associated shortages of basic goods might be; it has nothing to say about the emotional toll social isolation and idleness and confinement and destitution might take on people; it has nothing to say about how much more difficult and unlikely economic recovery becomes with each passing month of economic inactivity, or how much harm a failure to recover might cause; it has nothing to say about the effect that consuming our capital reserves in order to buffer the current economic blow will have on future economic productivity and well-being; it has nothing to say about what political and cultural and moral costs might accrue as the result of a quasi-permanent state of emergency and the acceptance of correspondingly quasi-permanent emergency powers in the hands of those who govern.

More importantly, science is, and must be, silent on how to assess the trade-offs between the direct costs it documents, the potential for lives lost immediately to the pandemic, and those indirect and secondary costs that will play out over time and are beyond its ken.  Assessing those trade-offs involves a value judgement, not a scientific one.  Values, both moral and practical, are beyond the reach of the scientific method.  Science can tell us what outcomes to expect and with what likelihoods if we choose various options.  It cannot tell us the moral and practical significance of those outcomes and cannot, therefore, tell us which options we ought to choose.

After all, any artist or lover or adventurer or celebrant or idealist or patriot or parent – or, indeed, anyone who has just finished a particularly fine meal or experienced the thrill of cheering on a winning team or heard a particularly moving story or piece of music – can tell you, there is more to living than merely being alive.

During the Vietnam war, the military was derided and condemned for reportedly taking a position that it was justified in “…destroy[ing] the town in order to save it.”[8]  That attitude was rooted in a particularly parochial – and narrowly military – notion of what it meant for a town to be “saved”: to wit, denying the enemy the benefit of its strategic or tactical utility.  But, of course, to most people, that was only a part – and the least part, at that – of what “saving” a town could and should mean.  Destroying the utility of the town to its own residents – and, indeed, perhaps destroying those very residents in the process – was simply not an acceptable cost in trade for the benefit of achieving the narrow military purpose of denying it, as well, to the enemy.

Many people feel much the same about the effects of our current efforts to battle the Covid-19 epidemic: they feel we are, by focusing on a particularly parochial and narrowly biological notion of utility, at grave risk of destroying our lives in order to save them.  They don’t want to die of Covid-19; but they also don’t want to be saved from it only to find they have accepted a life of captivity and isolation.  They don’t want to die of Covid-19; but they also don’t want to be saved from it only to be condemned to a life of abject and interminable poverty.  They don’t want to die of Covid-19; but they also don’t want to be saved from it only to find they have surrendered their liberty to a government that has assumed the authority to confine and impoverish them at the slightest provocation, at the first sign of impending danger or as the default response to an unwarranted public panic.  Do they feel that way because they don’t care either about their own lives or about the lives of others?  Perhaps some do.   But many feel that way for the same reason that people have always risked their lives in the service of some greater cause: because they believe there are things outside of their own lives that are worth defending, even at the risk of those lives.  That, too, is a value judgement.

How many people is it worth putting at some degree of risk, and at what degree, in order to prevent a widespread economic catastrophe?  How many people must be at risk, and at how much, before a wholesale suspension of basic civil liberties is justified in the name of “public health” or, more vaguely, “the public good”?  Is it the 40,000 or so people killed every year on the nation’s highways?  Fewer?  More?  I don’t know the answer, but I’m pretty sure it isn’t zero in the first case or one in the second.  It is certainly worth a rational debate.

 

Information we have to date on Covid-19 suggests that this particular disease, while perhaps neither as contagious nor as virulent as originally thought, is, nonetheless, extraordinarily so on both counts and is, therefore, reasonably to be feared.  And, early in the outbreak, with far less information, our estimates of both were much greater and our concomitant perception of the risk was also greater.  Faced with plausible projections of millions dying and emergency rooms overwhelmed, drastic measures seemed, indeed, in order.

Now, though, experience has given us a somewhat better understanding of its virulence, of its propagation, and of who is most at risk for suffering the worst of its effects.  And we have, as well, a fairly good understanding about the deleterious economic and social consequences of those drastic measures and of how much more harm they may do if we allow them to continue indefinitely.  As a result, we have a much better chance of coming up with alternative measures that can mitigate the worst of Covid’s risks while being significantly less draconian to our economic, social, and political welfare than those we have been living with for the past 2 or 3 months.  Working out what those measures might be and putting them into practice should be guided by science, yes, but not in the absence of guidance from other realms of knowledge and expertise.  It cannot be divorced from politics because politics is, in the end, the way we most often come to answers, in the realm of public policy, about what value judgements we have made and will accept.  We might hope, however, that we can work through the politics without making it excessively partisan.

For those who have taken the position that no relaxation of the lockdowns should be even contemplated while any significant risk remains, that means accepting and acknowledging that zero risk is an unrealistic and unachievable standard.  It means acknowledging that reducing risk for some causes real and consequential harm to others and that, at some point, the harm of incremental gains in risk reduction exceeds the incremental harm of the virus, itself.  We can’t live in lockdown forever; and, in the absence of an effective vaccine or a cure, widely deployed to create widespread immunity, the lockdown will, indeed, stretch on forever because there will never be a time when releasing it will seem propitious and wholly safe.

For those who have been advocating for a quick and complete re-opening – and especially for those actively protesting the imposition of various modest public safety measures like the wearing of masks – that means accepting that we all have responsibilities commensurate with the rights we so self-righteously defend.  What we do affects the community.  Yes, we have the personal right to accept a risk of catching the virus in pursuit of some other reward.  But, assuming risks for yourself – by exposing yourself to disease carriers – and imposing risks on others – by carrying the disease to them despite their own best precautions – are two very different acts and should fairly be judged by different criteria, the latter more stringent than the former.  Whether you like it or not, in a world of pandemic you have a moral responsibility to protect others against the possibility of your own contagion.  If you cannot willingly and diligently assume that responsibility, then your moral claim to a “right” to be free of restraint is little more than a hollow defense of self-indulgence.

And for all of us, that means taking each other’s concerns seriously, with empathy rather than with contempt.  The pain people are expressing is real, not imagined.  What you find comforting, others may find distressing.  What you find to be reasonable precaution others may experience as destructive overreaction.  Neither side may or should presume they hold a monopoly on truth or on wisdom.  We are, indeed, in this together because this is a contagion.  But that doesn’t mean we all experience that contagion in the same way or bear its burdens in the same forms or to the same degree.  The fact that someone disagrees with your value judgements about those burdens means they and their circumstance are different than you and yours.  It doesn’t mean they are right.  But, it also doesn’t mean they are wrong.

 

[1] https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year, pulled 27 May 2020 @12:25 pm EDT

[2] https://www.nsaa.org/media/68045/NSAA-Facts-About-Skiing-Snowboarding-Safety-10-1-12.pdf, pulled @8:13 pm EDT, 12 May 2020

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969030/, pulled @8:17 pm EDT, 5/12/2020

[4] https://www.cdc.gov/homeandrecreationalsafety/water-safety/waterinjuries-factsheet.html, pulled @8:26pm EDT, 5/12/2020

[5] https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm, pulled @4:49pm  EDT, 5/13/2020

[6] https://www.arnolditkin.com/personal-injury-blog/2019/august/the-latest-workplace-fatality-statistics-in-2019/, pulled @11:35am EDT, 5/13/2020

[7] “How Many People Will Die for the Dow?”, by Paul Krugman, The New York Times, 21 May 2020 (https://www.nytimes.com/2020/05/21/opinion/trump-coronavirus-dow.html, pulled 5/25/2020 @11:36 am EDT).

[8] See https://www.bloomberg.com/opinion/articles/2018-02-09/destroying-a-quote-s-history-in-order-to-save-it, pulled 5/25/2020 @5:42 pm EDT.

 

© Copyright 2020, Augustus P. Lowell