Choices, choices

Back in the early days of the debate around the Affordable Care Act, a sizable proportion of the discussion was centered around what the ACA’s critics called “death panels”—groups of bureaucrats that were supposed to decide who does and does not get health care. And while death panels turned out to be a complete fabrication—there is no part of the ACA that specifies anything resembling such a thing—the whole scare indirectly raised questions that are worth thinking about. The reason the idea of death panels is so abhorrent is that we’re placing in the hands of a small group of officials the power to decide who lives. But as a collective and as individuals, we are endlessly and inevitably confronted with life-or-death choices, even if our terror of that responsibility prevents us from seeing them that way.

Congress is a prime example of a group that we don’t think of as a death panel, though that role is implicit in its mission. With the trillions of dollars it gets to allocate, our legislature has the power to do a lot in the name of saving the lives and protecting the total well-being of the citizens it represents. But you can hardly argue that it has devoted itself maximally to this charge. And even if it were devoting itself maximally towards the protection of its constituents’ lives, it would be constantly forced to make the decision between one person’s life versus another’s. A life-or-death decision is implicit in every allocation Congress makes—every dollar that gets spent on farm subsidies is a dollar that doesn’t get spent on health care or feeding the starving.

If you think about it, this argument applies equally well to us individually. Every time we buy a Macbook, say, we are making a choice not to spend the $1,300 to help prevent malaria or other deadly but easily avoidable diseases that plague the developing world. It might not seem like a Macbook means the difference between life and death, but the numbers aren’t actually too far off. One of the most effective charities, by a number of estimates, is the Against Malaria Foundation (AMF), which uses the donations it receives to distribute mosquito nets in the developing world. GiveWell, an independent charity evaluator, estimates that AMF spends on average $3,400 per life it saves. So, every time we spend that much money for other purposes, we’re choosing a world in which one more person dies of malaria in preference to one in which that person doesn’t. We’re making the same decision that a death panel would have to make, even though the choice of someone’s death is hidden in the psychological depths of that decision. And while you may not have known that particular statistic before, you’d have a hard time convincing me that you didn’t know your money could be put to a similar life-saving use—in short, pleading ignorance doesn’t work.

A lot of people argue that we shouldn’t be held responsible for the good we could do but do not do. Choosing not to donate the $3,400 necessary to save someone’s life does not amount to condemning a person to death, they say. Maybe not. But to the extent that such a decision is a conscious one, it amounts to actively choosing between a world where one more life is saved and a world where one is not. You might object—wouldn’t always thinking about the lives that could be saved through the choices we make place an unreasonable burden on us? To this, I respond that the requirement that the demands of ethics be “reasonable,” whatever that means, has no grounds except in some deeply-held conviction that some of us feel.

The point of this whole discussion is not to say that we are all killing machines or to shame anybody that has a Macbook—for the record, I own one. Instead, I simply want to bring attention to the unexpected gravity that underlies many of the decisions we make. Sure, none of us is likely to ever do all the good that we could, but, if anything, I hope this column is a reminder of the surprising degree to which we can make others’ lives better through our own decisions.

To go back to the idea of death panels—the concept would have been unilaterally, unquestionably opposed if it had actually been in the legislation, but what everyone forgets is that a death panel-type choice is hidden in the shadows of nearly every decision that we make, especially those that we make as a collective. The question is—will we let that fact terrify us into ignoring it, or will we face the responsibility head-on?

Eugene Rabinovich is a Trinity senior. This is his second column in a biweekly series during the summer.