F M Kamm on comparing deaths.
When the number of people who have died of COVID-19 in the U.S. reached 500,000 special notice was taken of this great tragedy. As a way of helping people appreciate how enormous an event this was, some commentators thought it would help to compare it to other events that involved a comparable number of people losing their lives. For example, it was compared to all the U.S lives lost on the battlefield in World Wars 1 and II and the Vietnam War (or World War II, the Korean War, and Vietnam). Such comparisons raise questions, concerning dimensions of comparison, some of which are about degrees of harm, wrong, and meaningfulness which are considered in this essay. (Since the focus in the comparison was on the number of soldiers who died rather the number of other people affected by their deaths, this discussion will also focus on the people who die in a pandemic rather than those affected by their deaths.)
1. Harms. Philosophers typically distinguish between harms and wrongs. Harms have to do with how much worse off people are made relative to either how they were or would otherwise have been. Wrongs involve violations (and possibly even permissible infringements) of persons’ rights. These rights give others duties owed to those persons, and when there is a failure to perform the duty the right-bearer may be wronged. Harms can occur without wrongs (as when a storm destroys one’s property) and wrongs can occur without harms (as when we interfere with someone’s privacy even as we benefit him). Wronging should also be distinguished from doing something wrong; it can be wrong not to be generous but that does not mean that one will have wronged the people to whom one has failed to be generous (for one has not denied them that to which they had a right).
Suppose COVID-19 was the cause of 500,000 people dying just as they were about to die of a multiplicity of other conditions. Presumably, we would not consider this pandemic as serious as the one we have experienced because COVID-19 would not rob people of much if any life they would otherwise have had. This suggests that one thing that is missing in the comparison of deaths is consideration of what harm befell those who lost their lives and what this implies about the badness of their deaths. Most deaths in wars were of young, healthy soldiers each of whom could have been expected to otherwise live much longer and who also died at a young age having had few years of life. They were greatly harmed by their deaths in part because it made them much worse off than they (probably) would otherwise have been in terms of having lived much longer lives. By contrast, it has been said that 81% of all deaths due to COVID-19 have occurred in people 65 or older who died having already had longer lives and for the most part losing out on fewer future life years per person than each of the soldiers who died. Arguably, a pandemic would have caused much more harm to the people who died in it if it had targeted mostly otherwise young and healthy people. Of course, this does not mean that the actual deaths from COVID-19 were not tragic and terrible (in the way the extinction of one’s person present in all death is).
Another comparison made (by a television journalist) to the 500,000 deaths from COVID-19 was the disappearance of the entire population of Sacramento, California. This comparison as well ignores the fact that many in that population may have lost out on more years of life or would have died having had fewer years of life than those who died of COVID-19. People with pre-existing conditions (such as diabetes and obesity) are said to have accounted for 78% of COVID-19 hospitalisations and at one point 20% of those hospitalised died. Like the elderly who die, those with pre-existing conditions might have lived fewer future years of life than healthy people even if COVID-19 had not killed them, but unlike the elderly they are likely to die having had fewer years of life by the time they die. In this way their deaths are as bad for them as for the young.
There is another distinction to be drawn. That is between death (understood to be the permanent end of someone’s existence) and dying which is the process that leads to death (when death is not sudden). A comparison of deaths is different form a comparison of dyings. It is entirely possible that those who have died from COVID have been harmed by the process of dying more than if they had died at the same time from other diseases or more than soldiers in wars. Indeed, if death ends the badness of their dying, it can fail to harm them because it helps them avoid continuing life that may be worse than death because of the dying process. But we should still consider whether harms in dying are as significant as dying young having had few years of life or losing out on many years of good future life.
2.Wrongs. Were U.S. soldiers who died in wars not only harmed but wronged? They usually died because they were intentionally killed by soldiers on the opposing side. Those who died of COVID 19 were not intentionally killed by others. Does this mean soldiers who died were wronged but not those who died of COVID? Suppose the U.S. soldiers fought on the just side and were killed by those on the unjust side. On the traditional view of jus in bello (justice in carrying out the war) it is thought that soldiers are not wronged by the opponent soldiers (even on the unjust side) who intentionally kill them. This is because there is said to be an equal legal and moral right on the part of each side’s soldiers to kill soldiers on the other side. (The traditional view is described and defended by Michael Walzer in his Just and Unjust Wars. Objections to this view are due most recently to Jeff McMahan in his Killing in War.) They could be wronged by those who kill them if this killing is what is known as a war crime (e.g., intentionally killing captured soldiers) but it is not war crimes that constitute most deaths of soldiers in wars.
Consider other issues related to whether soldiers were wronged. If they volunteered for service or are legitimately sent to defend their country or its principles in a just war, then they would not be wronged in how they initially came to be exposed to being killed. They would have been wronged by the leaders of their own country if the war violated conditions of jus ad bellum (justice in starting war). This could happen, for example, if the war was unnecessary or futile -- which would make their deaths unnecessary and avoidable -- even if the war’s goals were just. Even if such injustice was not present and (as we assumed) they were fighting in a just war, they could still be wronged by leaders on the unjust side who began an unjust war in which U.S. soldiers die. They could also be wronged if they were unnecessarily exposed to risk of death by poor decisions by their military commanders in deploying them in the war, though it is commonly held that the U.S military takes avoiding harm to its own soldiers very seriously.
When the cause of one’s death is a disease due to nature one is not wronged by nature or the disease. We have no rights against nature or diseases per se; they do not have duties to us not to harm us that they violate. However, if diseases are due to some people’s negligent or unreasonably risky behaviour (let alone intentional wrongdoing), then those who died of the disease may be wronged by those people. This includes those in national and international organisations that are responsible for early warnings and containment of spreading disease. Wronging can also come about by a reasonably avoidable failure to provide assistance or resources to which people have a right. If the absence of medical testing, inadequate provision of protective equipment, and failure to provide available treatments result in deaths and this is due to negligence there may be wronging.
In addition, when individuals can transmit disease to others, the failure to use simple measures that would prevent such transmission (such as use of masks) can violate others right not to be harmed and so wrong those people. In an interview Drew Faust has claimed that “the sense of mastery over nature” has been seriously challenged by the pandemic. In what sense might this be true? At the time prior to the development of vaccines, science could not provide a simple shot that would prevent the disease without interfering with people’s “normal” routines. But that does not mean that there were no means available to people to “master the disease”. For example, it is said that when all people who interact use masks (even below the N95 grade), transmission is reduced by 96%. The problem is that this means of mastery the disease requires individuals to be responsible for altering their conduct away from what it had mostly been previously.
However, wronging by those who fail to easily contain or prevent transmission of COVID-19 would occur only if it is reasonable to expect them to know about the means to contain or prevent its transmission. They may not know because those responsible for acquiring such knowledge in the first instance have not yet discovered it. For example, suppose it is true that eating raw papayas actually prevents death from COVID-19, but there is no reason for anyone to believe this is true at the current time. Then the deaths from COVID-19 could have easily been avoided but no one was wronged in the failure to provide raw papayas to the public. Those responsible for acquiring and transmitting knowledge may or may not be at fault in not yet knowing, but if they are at fault they may have wronged those who die from the disease which could have been prevented. Similarly, those who were at a certain time informed about the efficacy of using masks and yet did not prevent their transmitting disease by using them may have wronged some of those who died from COVID-19 by violating their right not to be harmed.
The seriousness of a wrong can be a function of the harm that is done; that is why though one can wrong someone by kicking them as well as by killing them, it is a more serious wrong to kill someone than to kick someone. So the earlier discussion of the harm of death to different people can bear on how serious a wrong may have been done to those who died from COVID-19. However, one could seriously wrong someone by violating an important moral right even if this does the person little or no harm (e.g., intentionally killing someone against his will even when the person has only a few days to live).
On the whole, it is possible that there may have been more wronging by U.S. entities and persons of many who died of COVID-19 than of U.S. soldiers who died in wars in the twentieth century, even if the latter group were harmed to a greater degree than those who died of COVID-19 and wronged by non-U.S. entities that engaged in unjust wars. This is because the care of political and military leaders, as well as fellow soldiers, to see to it that soldiers did not die unnecessarily may have been greater than the care taken by the U.S. government and individual U.S. citizens to see to it that their actions did not cause U.S. citizens to die unnecessarily.
On the other hand, suppose many of those who died of COVID-19 bear some moral responsibility for becoming infected when the alternative was remaining uninfected. For example, they may have exposed themselves for no adequate reason to risk (e.g., going to parties where they knew others would not be masked) or have agreed mutually to risk exposing each other. These victims of COVID-19 may be at least partially to blame for their own deaths and so their complaint at being wronged is not very strong even when others failed in their duty not to harm them. These people are unlike soldiers (and essential workers) who exposed themselves to risk as a matter of duty. Many ordinary U.S. citizens let each other and themselves down which probably cannot be said of U.S. soldiers in past wars.
3. Meaning. Soldiers in at least some of the wars in the twentieth century may have had good reason to believe that they would die for a worthy cause and that their risking their death was necessary to achieve the worthy cause. In this sense, their sacrifice at least seemed meaningful to them. Suppose at least some of the wars were in fact for a worthy cause that was great enough to justify many deaths and killings, and there was no other way less bad way to achieve that cause. Then whether or not their sacrifice would have seemed meaningful to those who died, their deaths could have been meaningful. It is whether their deaths were meaningful (as an objective matter) rather than whether they (merely) felt that they would be (as a subjective matter) that is most important. However, many wars may have failed either the subjective or objective test.
Many who died from COVID-19 could not similarly be said to have risked or sacrificed their lives for some important, justifying purpose that was either subjectively or objectively meaningful. Their deaths were unnecessary not only in the sense that they were avoidable but in the sense that they were not needed to achieve some justifying purpose that those who died could accept as making their deaths meaningful. Exceptions would include someone who voluntarily and supererogatorily (i.e., beyond the call of duty) participated in a challenge trial (in which she was injected with COVID-19 in order to see if a vaccine would protect her) and died from that COVID-19 injection. Essential workers did not intentionally expose themselves to risk of death in this way and their death would not provide the useful information about the lack of efficacy of a drug. Rather, they deliberately accepted the foreseen risk of death from COVID-19 in order to perform their essential duties or to provide income for their families. From a subjective and objective point of view the risk all these people took and their ensuing deaths might have been meaningful because the risk was worth the good brought about by their supererogatory or dutiful actions. We can sometimes make it true after the fact that people “did not die in vain” by arranging for their deaths to have some instrumentally valuable role, such as teaching us how not to repeat past mistakes. However, this is not the same as that role providing a justifying purpose for their death from the perspective of those who died.
My aim here is not to render an overall judgment on the relative seriousness of deaths in COVID-19 by comparison to those in U.S. wars in the twentieth century. I am just concerned to emphasise that the meaninglessness, reasonable avoidability, and wronging involved in many deaths are factors in addition to the degree of harm to those who died that should be considered in evaluating and comparing different deaths. Some deaths are worse harms than others for those who die and there are different ways of thinking of the harm. Some deaths are wrongs, and some are meaningless. Numbers of deaths count but they are not all that count.
F M Kamm is Henry Rutgers University Professor of Philosophy, Rutgers University. Her most recent book is Almost Over: Aging, Dying, Dead (OUP, 2020).