[Editor’s Note: Robert P. George is McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. He has served as Chairman of the U.S. Commission on International Religious Freedom and on the U.S. Commission on Civil Rights and the President’s Council on Bioethics. He has also served as the U.S. member of UNESCO’s World Commission on the Ethics of Scientific Knowledge and Technology. His books include Making Men Moral: Civil Liberties and Public Morality and In Defense of Natural Law. He spoke to Charles Camosy about the current COVID-19 pandemic.]
Camosy: First of all–and I don’t think this is a question that is asked often enough about those of us who study, teach, and write about ethics–can I ask how are you doing emotionally throughout this crisis? Speaking for myself, it is sometimes difficult to alternate between trying to think objectively about the ethics of often terrible situations and actually allowing myself to engage my feelings about them.
George: For better or worse (sometimes the former, I suppose, and sometimes the latter), I’m not a person who tends to have strong emotional reactions — at least I don’t tend to have strong emotional reactions to things like the crisis we’re going through, grave though it certainly is.
Please don’t get me wrong: It’s not that I don’t care. I do, of course. I want us to get through this ordeal with as few deaths and as little grieving and suffering as possible. And I very, very much want us, as a society, to handle the ethical issues (such as those having to do with the allocation of limited health care resources) correctly. But I’m not personally on edge, nor do I find myself focusing much on my feelings or needing to tend to them.
Of course, this is an area in which different people are simply different. We human beings don’t all process dangers, tragedies, crises and the like in the same way. And that’s fine.
There is lots of discussion right now about which policies and practices may limit the spread of novel coronavirus so that our medical capacity is not overrun. But there is less discussion about what will happen if certain places in the United States run out of medical capacity to treat victims of this disease. Why do you think we aren’t talking more about this increasingly likely scenario?
Although our grandparents and great-grandparents experienced the Great Depression, it was followed by victory in WWII, superpower status, sending men to the moon, cultural hegemony, triumph in the Cold War (despite the debacle in Vietnam), and an extraordinary economic expansion. Although, alas, some of our fellow Americans have experienced deprivation — true want — most who are alive today have not.
Moreover, we have come to expect that we will ultimately prevail over adversity, whatever it is. We take it for granted that things will turn out alright in the end. We can scarcely believe that it’s possible that they won’t. When we hear about a possible catastrophe — such as running out of medical capacity in a pandemic — we tend to assume that “somebody will do something to make sure it doesn’t happen.”
Some protocols for rationing limited health care resources focus on the relative need of patients and their relative chances for getting better. Others focus on things like age, cognitive ability, and physical capacity. What sorts of ethical considerations should guide hospitals, medical groups, and other institutions who are trying to decide how they will distribute their limited medical resources?
At the core or foundation of the answer to just about every important ethical question is the principle of the profound, inherent, and equal dignity of each and every member of the human family. In making decisions — including hard, even tragic, decisions about distributing limited medical resources — it is critical that we treat every person as equal in inherent worth and dignity to every other person.
We must avoid the temptation to treat some as superior (and others as inferior) because, for example, they are young and strong (rather than old and frail) or able-bodied (rather than physically disabled or cognitively impaired). The temptation to discriminate invidiously will present itself — about that I’ll give you a money-back guarantee.
Some people will want to throw over the radical egalitarianism (all human beings are “created in the image and likeness of God”; “all men are created equal”) of the sanctity of life ethic and replace it with a “quality of life” ethic that is amenable to decision-making by utilitarian calculation. We must be firm in our resistance to anything of the sort.
If some institutions decide to ration health based purely on age or disability, might they face lawsuits for violations US civil rights law?
Yes, our federal civil rights laws (as well as many state statutes) forbid discrimination based on age or disability. To its credit, the U.S. Department of Health and Human Services’s Office of Civil Rights, under Roger Severino, has already spoken forcefully about the applicability of these laws when it comes to the care of patients and the allocation of health care resources. I’m glad they are getting out ahead on these issues, because, as I noted, the temptation to discriminate invidiously will come.
Some people will say, “why should that Down Syndrome person be given a ventilator when it could be given to someone who’s not ‘retarded’ and who can contribute more to society?” A fully sufficient answer should be: “because in fundamental worth and dignity, the Down Syndrome person is every bit the equal of any other person.”
But for some people, that will cut no ice. But here is an answer that will: “Because federal law forbids discrimination based on disability and you or your institution will be sued or prosecuted if you engage in such discrimination.”
How do you think should Catholic bishops with hospitals and other health care institutions in their dioceses be thinking about these matters?
By allowing themselves to be guided by that central principle of the profound, inherent, and equal dignity of each and every member of the human family. Catholics understand this as a principle of natural law, accessible to all reasonable men and women of goodwill—not just to Catholics or other Christians; but the Church also understands it as a divine mandate and an unchangeable element of the deposit of faith. It’s what motivates us to do the good we do, be it in our schools, our orphanages, our food pantries, our hospitals.
We see Christ in all — however poor, weak, compromised, addicted, disabled, impaired, suffering, vulnerable. Indeed, we believe in the “preferential option for the poor” — we prioritize the least, the last, and the lost. That’s who we are as Christians, as Catholics.
In this crisis, as in the face of all challenges, the first thing we need to do is recall —and call on — our first principles, our foundational commitments. They remind us of who we are and why we do what we do.