Which Deaths Matter?

Contains both death statistics and ideas that some people may find distressing. Please do not read it if you are of a sensitive disposition.

Which deaths matter? This is an odd question, because most of us have a sense that every death matters, at least to someone. But we do not act in ways that are consistent with the idea that we consider every death important. On the contrary, we are entirely accustomed to ignoring deaths - including a great many that we are partially responsible for.

To explore this strange situation, I want to draw against the ethical thought of the Enlightenment philosopher Immanual Kant. One of the most surprising aspects of his work in moral philosophy is the role he provides for maxims, that is, principles for acting or refraining from acting. Along with Mary Wollstonecraft and several other philosophers of the 18th century, Kant was responsible for helping to craft our thinking about what we now call ‘rights’ or ‘human rights’, and although his moral and political philosophy is far richer than this talk of maxims can do justice, when it comes to thinking about which causes of death matter, the question of the principles upon which we act might be crucial.

If, for example, we say we are acting on a precautionary principle - to take steps that might save lives - we may want to know more about when and how such a principle is to be applied, or if it is always to be applied, we want to know why it appears to be otherwise. Similarly, if we say that we act whenever human rights are violated, we may want to know whether this is for certain rights, or certain violations, and whether we mean in our country or by our government (which is not the same thing).

Now making precisely worded principles is not how we do our moral thinking - Kant knew this, but in his time, the concept of a maxim was a convenient shorthand for moral thought that his contemporaries readily understood, and he used this situation to help get across to his 18th century readership far more complex ethical ideas that helped transition us into thinking in terms of our shared rights. I believe it can still be useful to think about our principles of action in this way.

In the two thought experiments that follow, the idea is for you to attempt to formulate an approximation of the principles that underlie situations where I shall suggest that we are unreasonably focusing on some causes of deaths and not others. Unfortunately, the easiest way to get where we are going is to form crude pairs of death-causes - but to help defend against the risk of misunderstandings, I will in each case add at least one additional (unexplored) cause of death to show there are many others we could also have considered in each case.

Medical vs Environmental Deaths

The first thought experiment considers causes of death of two different kinds, and at first glance it may appear to be an entirely outrageous question to ask:

If the 1.8 million deaths globally attributed to the SARS-CoV2 coronavirus in 2020 required and continue to require extreme measures, why do the 1.4 million global road fatalities every year not require anything but tiny incremental actions? What principle of action warrants immediate extreme action with significant unpredictable side effects in the case of (say) lockdowns, but no action at all in the case of the most deadly environmental health risks? Or to put this another way, why do medical causes of death utterly overshadow environmental health causes of death? Should they? If so, what principle is it that informs us that environmental causes of death don’t matter, while medical causes of death require action, even in cases with severe health (and mental health) consequences?

Lung cancer could be substituted for the novel coronavirus, as it causes 2 million deaths annually and this prompts a variety of interventions in most nations; air pollution could be substituted for cars; it contributes to the deaths of some 7 million people... although cars are, of course, a major contributor to this.

Let us start with some of the less plausible choices. We cannot approach this via the scale of the deaths caused, obviously, as the roads were far deadlier than the pandemic at the time extreme measures were being advocated, but we could potentially use projected deaths. But in the case of COVID-19, the projected deaths were wildly higher than what actually happened in nearly every single case I can find, and this seems to have been true of every pandemic in recent years to varying degrees. Apparently, the computer models of viral spread that have been created thus far do not actually consider anything like the circumstances by which real viruses spread, nor indeed the conditions under which they are fatal. What's more, if we are to formulate a principle for action based on projected deaths, we still have to explain why we would take no action whatsoever in regard to so many actual deaths with environmental causes. Some kind of principle might be possible here, but it would likely be rife with compromises.

Alternatively, we could attempt to distinguish between disease and accident. ‘We ought to take steps to prevent deaths from disease’ and (perhaps unstated) ‘we should minimize accidents where we can’. This amounts to claiming that causes of death we call diseases matter in a way that accidents do not. But ‘disease’ is just a catch-all term for a health risk, and road fatalities are also a health risk, specifically an environmental health risk. All approaches of this kind are tantamount to claiming that accidents don’t matter because if we were using the tools correctly there would be no cause of death to consider. This is a macabre form of legerdemain that conceals the fact that our most deadly tools (cars and guns) are inherently at-risk of 'improper usage' because of their current designs. We could (I would go further and say should) redesign cars so that they cannot exceed 30 mph (we could do this solely in residential areas quite easily, in fact, using only existing technology) and eliminate more than a million global deaths each year. We do not act consistently in this regard.

More plausibly, the exponential (or rather, logistic) aspect of virus spread invites a different maxim: ‘we must act where the cause of death risks growing non-linearly’ or ‘we must act when the scale of potential deaths rise with inaction’. There is something psychologically plausible about this approach, but in the case of principles of this kind: do we really wish to say that the millions who die on the roads each year don’t matter because roughly the same amount die every year? Perhaps we want to say that it is precisely the greater infectiousness of this recent virus that marks it out for special treatment. I cannot agree with this principle personally, but at least it provides a plausible reason for acting in this case. But even so, would it not be a more reasonable to suggest ‘exponential or logistic threats of death require swifter action’, that is, that we should not ignore environmental causes of deaths, as we have done this year and every other, and instead act to minimise fatalities from all causes of death wherever possible?

A crucial problem in identifying a principle of action for SARS-CoV2 is that we must explain why any lives saved by measures such as long-term lockdowns matter so much more than those lives lost as a consequence of long-term lockdowns, whether to heart disease, untreated diabetes, undiagnosed cancer, suicide, or to the fact that depression doubles the risks to all cause mortality. The measurements available for these collateral fatalities will not match the tragic scale of all the deaths attributed to COVID-19 itself, but as the evidence accumulates it seems ever more probable that the unnecessary deaths and health harms of long-term lockdowns will exceed any plausible reduction in fatalities when compared to voluntary measures, which seem to have been almost as effective. Countries like the UK, which locked down for most of a year, caused horrific public health harms in the pursuit of saving lives: that the lives saved by lockdown-type measures were primarily white and wealthy, while fatalities have disproportionately afflicted the poor and non-white, only adds to the painful legacy of these ill-judged policies.

I realise that a great many are still resolute that lockdowns were entirely necessary, and I have all but given up trying to reason with people over non-pharmaceutical interventions, the most disturbingly politicised medical issue since abortion. But as long as we have not fatally undermined the capacities of the sciences to assemble the truth on any given research topic, a reckoning of some kind over what we have done will eventually come. Until then, the challenge of this thought experiment stands regardless: why do those 1.4 million road fatalities every year not matter in the way that COVID-19 deaths matter...? It is hard to avoid the conclusion that a single cause of death was given much greater importance than all others.

National vs International Deaths

The second thought experiment considers deaths of citizens at home, versus deaths caused abroad, and may also seem outrageous at first glance:

Protesters in the United States both honourably and understandably went out in mostly-peaceful protest of the brutal killing of a black citizen, George Floyd. This is far from the only example of brutality by some police forces in the US, a problem which disproportionately affects black citizens - hence the ‘Black lives matters’ mantra, which I take as being broadly the same as claiming 'non-white lives matter' (although this is open to dispute). But which black or non-white lives are we claiming matter? I would like the answer to be ‘all of them’. Yet the United States has killed at the very least hundreds (more likely thousands) of civilians in middle-eastern nations for nothing more than being proximate to people added presumptively to a CIA kill list. How are we to reconcile the justifiable and necessary protests in the wake of one awful killing against the hundreds or thousands of other horrific deaths that spark no protest, that get no mention, and are ongoing?

In place of the killing of George Floyd we can substitute any situation where police officers in any nation used deadly force without any need or justification; in place of the civilian deaths tangential to drone assassinations we can substitute the US sale of armaments to Saudi Arabia and consequent contributions to a quarter of a million deaths in Yemen - although, to be fair, US drones have also directly killed civilians in Yemen.

Here we have many more options for how to respond, in part because our overriding intuition is that deaths that governments bring about against their own citizens deserve greater attention since a citizen is expected to be protected by their government and its agencies - and indeed, is supposed to be so in both national and international law for most (yet not all) nations. But let us never forget that during the Obama administration, a US citizen was executed abroad by drone strike for presumptive status as a terrorist, with no judicial due process. Not to be outdone by the Americans, the British Prime Minister at the time, David Cameron, similarly disposed of an inconvenient British citizen by drone assassination. I made the point immediately - quite furiously - that our nations had withdrawn from their human rights agreements at that point, but mostly, nobody cared.

If citizenship does not provide a working basis for a principle of action in this case how about terrorism itself? Well, around the time I was first drafting this piece, President Trump declared Antifa a domestic terrorist group - I presume meaning that they can now be bombed by ‘precision strike’ like other terrorist groups. Ah, but there’s the rub, for doing so at home would not only provoke the same kind of justified outrage as the killing of George Floyd but also reveal the lie that ‘precision strike’ means something other than destroying entire buildings with automated missiles that are marginally more accurate than bombs dropped from airplanes.

I trust nobody is contemplating a principle that relies upon the claim that black lives are worth more than Muslim lives, or that the lives of US citizens are worth more than 'foreigners', although at times it does feel as if there is precisely this kind of grotesque pecking order at work. It is one thing to care for your own neighbours in preference to those people who live farther away, but it is quite another to condone the murder of strangers whose deaths we can not even be bothered to hear about, much less prevent.

When I raise my concerns about drone assassinations, a common retort is: "They were terrorists, so I have nothing to fear because I'm not a terrorist". Yet of course what made them a terrorist in both the above cases was merely the government deciding that they were terrorists. Literally no judicial process was involved at all, there was no possibility of appeal or review. Without enforcing human rights agreements, nothing prevents your government labelling you as a terrorist whenever you become sufficiently inconvenient. Thus any attempt to formulate a principle of action with respect to terrorism is going to risk permitting tyranny and state-sponsored murder to flourish. That many of the casualties of these attacks are people who have never been associated with terrorism, and who were merely the neighbours of those who were, makes it all the more despicable to hide behind the excuse that killing people accused of terrorism is permissible.

A more plausible approach might be to buy into the rhetoric of warfare; civilian deaths matter more than war deaths, even civilian war deaths. But I’m not at all convinced that all these expensive killings warrant the name ‘war’... We do not go to war against mice and cockroaches, we merely exterminate them as vermin - and the hateful rhetoric that justifies assassinating anyone presumed a terrorist without due process - along with every innocent bystander nearby - is all too akin to the logic of extermination. The law is not there solely to protect 'good people'. It protects everyone or else it protects no-one, and this is just as true in warfare as at any other time.

It has been said during the protests following the killing of George Floyd that if you stand by and do nothing you’re implicitly saying that this terrible event was acceptable - but this maxim would surely apply to the murder of people abroad as well as those at home. And except for a few immensely brave military veterans and their allies who have spoken out in the US against the replacement of soldiering with robotic assassination we have done nothing to protest the horrors that have been conducted against far poorer, far more marginalized, far ‘less white’ people slain in our name.

Unlike the first thought experiment, I am doubtful of any kind of plausible maxim in this case that explains to any reasonable degree why no mass protest against the murder of innocents and citizens-presumed-inconvenient ever occurred. The best hope might be to rely upon the distinction between home and away - but the idea that governments lose their obligations to their own citizens based on whether they are inside their borders or outside is not merely problematic, it is outright disgusting. More likely by far, journalists opted not to cover these stories because of the inherent (and readily understandable) bias of every news organisation, namely that what happens at home is news and that what happens abroad is filler, a maxim that at least seems to have the implicit endorsement of everyone consuming the news media.

But then, what if as well as the necessity of asserting that ‘black lives matter’ we ought also to be insisting that ‘non-white lives matter’, that ‘lives in other countries matter’, in short, that there are no lives that do not matter. I know all too well the scorn that meets those who say ‘all lives matter’, but that objection does not hinge upon this particular proposition being false, but rather upon the perception that this phrase is used as a denial of the ways the deck of justice is stacked against black citizens of the United States. It is indeed the case that these citizens suffer disproportionate degrees of injustice, and therefore it can be worth emphasising that ‘black lives matter’. But unfortunately, given the terrible actions of the United States and her allies around the world, even this simple attempt at justice runs a terrible risk of coming to mean something that ought to be false: that ‘American lives matter more than any other lives’.

The only just answer to the question ‘which deaths matter?’ must be ‘all of them’. But alas, we are so very far from accepting the moral implications of that principle that I can only weep at how far from the ideals of the Enlightenment we have already fallen.

Next week: Every Cause of Death Matters

This piece was originally drafted on 28th July 2020, in a longer form including material I have broken out into next week's post. However, I felt it was far too soon to run such a discussion. It may still be too soon. But it is also far too late. I could not in good conscience wait any longer to say what needed to be said.