The New York Times corroborated something I have long thought to be true: no one who has suffered from the novel coronavirus in America has been denied a respirator due to scarcity. That being said, why has so much energy and rhetoric been spent on the topic of ventilator triage? Ventilator scarcity and the looming prospect of triage was a leitmotif of almost every Cuomo news conference in the early days. The Hastings Center Forum, an edited blog on bioethics, had numerous essays on denying people scarce ventilators due to “ageism,” ‘ableism,” racism, and their DNR status. All this talent and energy focused on something that never happened. Why?
I think the answer has something to do with a bioethics syndrome my friend and fellow bioethicist Laurie Zoloth called “running to Tarshish”, from the Book of Jonah. Jonah, we recall, was a biblical figure who was called on by God to go to Nineveh, and tell the people there to repent. Jonah didn’t want to do that, because he knew that the people would indeed repent and God would spare them. Jonah thought the Nineveh inhabitants were a bad lot and he had no interest in saving them. Instead, Jonah turned in the other direction and booked passage on a ship headed for Tarshish. We know what happened then: God causes a terrible storm, the sailors throw Jonah overboard, and he is swallowed by a giant fish. Jonah repents, the fish disgorges him, and he takes on the original task. He goes to Nineveh to warn them of God’s anger if they do not change their ways. The people do repent and God has mercy on them. Jonah, meanwhile, is sulking under the meager shade of a gourd vine, which God has caused to grow. When God kills the vine, Jonah is furious, not to mention in imminent danger of sunstroke, so furious that he asks to die. God says: “Thou hast had pity on the gourd, for which thou hast not laboured, neither madest it grow, which came up in a night, and perished in a night; and should not I have pity on Nineveh, that great city, wherein are more than sixscore thousand persons that cannot discern between their right hand and their left hand, and also much cattle?” (I love God’s grasp of the practical–don’t forget to mention the cattle.)
Laurie’s point was that bioethicists “run to Tarshish” by focusing on sexy and speculative issues and turning from the difficult, systemic ones. As I recall, she was talking about our propensity (herself included) to be fascinated by the pros and cons of advances in genetics, which at that point had helped very few people, while paying too little attention to access to health care, food deserts, poverty and the like, all of which we have the technical ability to fix now.
Obsessing about ventilators is an example of running to Tarshish. It’s an easy problem to think about, the kind of thing one would put on an ethics exam. There are 5 ventilators, and 6 people of various ages, occupations, and states of health: how do we choose? Be sure to defend your choice. It also suggests that the necessity for triage is a neutral fact, not itself a communal choice to spend less money on healthcare and more on the military.
So instead of running to Tarshish, maybe we should be thinking more about why we don’t have enough ventilators. Or why such an outsize proportion of virus deaths occur among people of color. Or the best way of getting universal access to healthcare.