President Trump’s daily press conferences for his coronavirus task force have become one of the centerpieces of commentary on the crisis. Critics have bashed his optimistic riffs on potential cures or when normal life can resume. But as crowded as the stage has been, and as much as the administration’s response has become a source of partisan division, there is someone crucially absent in the public effort to deal with the pandemic: a bioethicist. The lack of someone who is qualified to speak specifically to the moral and ethical issues raised by the pandemic in terms of dealing with shortages and the treatment of the elderly — who remain the group considered the most vulnerable to the disease — is potentially leaving the president without the sort of advice he desperately needs as the crisis becomes more acute.
Absent from the debate about the administration’s response to the crisis has been a discussion of the key ethical questions whose answers must inform decisions about the shutdown of normal life and how to cope with the growing numbers of coronavirus victims. While Trump’s top coronavirus advisers are well qualified to deal with questions relating to immunology and infectious diseases, the lack of a leading figure on the response team who can speak to bioethical dilemmas not only is unfortunate, but also may be setting up the administration for more problems.
The nation’s focus has been largely on the mechanics of the spread of the virus and how to ensure that medical facilities are not overwhelmed by a surge of patients as the contagion spreads. But the core issue that influences decision-making when shortages of equipment such as respirators arise is more ethical than medical.
The example of Italy illustrates this problem.
About 23 percent of the Italian population is over the age of 65, making it the second-oldest country in the world after Japan. Thus, Italy has been particularly vulnerable to the coronavirus outbreak. While cases are not restricted the elderly, to date, 85.6 percent of those who have died from the illness there have been over 70. Numerous reports show that Italian medical facilities are overwhelmed. Doctors can’t care for everyone seeking treatment. There is also a critical shortage of ventilators needed to help those in the greatest danger. As the number of those afflicted rose in recent weeks, that shortage has worsened. Published guidelines of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care for nurses and doctors to follow provide a shocking preview of what awaits those most vulnerable to the disease: the elderly.
Their prescription for coping with the crisis is strictly utilitarian: “It may become necessary to establish an age limit for access to intensive care.” Those who are too old to have a good chance of recovery, or who (probably) have a few years left to live, will be allowed to die.
It isn’t yet clear how many Italian coronavirus deaths are due to inadequate care. But as the number of victims rises, the shortage of respirators — whose manufacture is being accelerated, but not in time to help those currently suffering — may soon present U.S. hospitals with the same impossible moral choices amid battlefield triage faced in Italy. Health-care providers may allocate respirators by criteria we already accept with organ transplants, which have always considered age and likelihood of recovery.
If so, then it becomes necessary to ask whether Americans — and in particular, an administration that has prided itself on its pro-life stance — will be willing to ignore Judeo-Christian traditions about the sanctity of life, including that of the elderly, to manage this crisis.
The debates about how to administer government-funded health care, conducted when the nation was not threatened by a pandemic, have already prepared us to ration care to the elderly. Rationing was integral to the debate about Obamacare. One of its architects was Dr. Ezekiel Emanuel, who is now also the most prominent member of a committee formed to advise former vice president Joe Biden, the likely Democratic Party presidential nominee, about the coronavirus crisis.
Emanuel has been a prominent advocate not merely of rationing, but of more generally utilitarian attitudes about health care for the elderly. In 2014, the then-57 year-old bioethicist wrote in The Atlantic about how he only wished to live to the age of 75, which he saw as the optimal life span for Americans. While in no way explicitly advocating eugenics or denying care to the elderly, Emanuel argued that people are living too long and becoming burdens not only to themselves but also to their children and society.
Chillingly in light of today’s crisis, he recommended that those over 75 should not have flu shots, especially in the event of a pandemic where shortages might occur. He quoted approvingly a classic medical text that spoke of pneumonia as “the friend of the aged” since it allows the elderly to escape distressing years of “decay.”
That such attitudes may be informing the 77-year-old Biden about health care is alarming as well as ironic. Yet while Republicans have long embraced critiques of health-care rationing as part of their opposition to government health-care programs, the Trump administration has yet to put forward any coherent response to questions about how the elderly will be treated if the coronavirus crisis should overwhelm American health-care facilities. Republicans argued against Obamacare in part because of the prospect of “death panels” deciding who should be given life-saving treatment. Yet as the crisis worsens, arguments framed very much along the same lines as those articulated by Emanuel will win out on Trump’s watch in the absence of an opposing and coherent bioethical vision.
Yet there’s no evidence that the task force led by vice president Mike Pence is any more prepared to make informed ethical proposals about rationing than were their counterparts in Rome. Part of the problem is that the Trump administration has no standing commission ready to supply such guidance. Presidents Bill Clinton and George W. Bush had bodies that formally advised them on bioethics, while Barack Obama chose to have a Commission for the Study of Bioethical Issues. But Trump chose not to have any group working on the topic.
The White House has understandably focused on mobilizing resources to deal with the pandemic. But there has been relatively little said by the president or those in charge that spoke about the need for a compassionate response to victims and how medical facilities should cope with the possibility of shortages of resources should the number of those seriously ill start to soar to Italian levels.
That makes it all the more vital that Trump appoints his own national bioethics commission. That body should advise Pence — a man whose public devotion to faith has made him a target for the Left — and help craft a response to the crisis that will be informed by moral and ethical considerations that will ensure that the needs of elderly victims are not sacrificed to expediency.
Treating the lives of older citizens as a precious and loved resource rather than as the property of a group that has lived too long to be of any use is an imperative for an ethical society, especially one that values faith as much as the United States. As the Trump administration copes with the pandemic, it must reaffirm religious and ethical values that ensure that respect for life also applies to the elderly.