Christopher Beem, Pennsylvania State University

Coronavirus reminds Americans that pursuit of happiness is tied to the collective good

At its core, the United States Declaration of Independence argues that all human beings have “unalienable rights.” These include right to “Life, Liberty and the pursuit of Happiness.”

These rights apply to all human beings, and cannot be given away.

What is more, the Declaration says that “to secure these rights, Governments are instituted among Men.” In other words, the primary objective of government is to afford citizens the opportunity to exercise these rights; the right to be left alone and to be free to pursue their own notion of happiness.

These ideas – that all people have the right to freely pursue their own self interest, and that government is concerned primarily with defending that right – show that the United States is, speaking philosophically, a very liberal society.

I have been researching questions about American political philosophy since I was a graduate student studying social ethics in the 1990s and those questions still occupy my research. With the advent of the coronavirus pandemic, one question in particular has emerged as front and center:

Is a society founded on liberal principles able to preserve itself when confronted with an existential threat, such as the coronavirus pandemic?

With the end of the Cold War, Soviet-style communism was banished to what President Ronald Reagan called “the ash heap of history.” Several countries throughout the former Soviet bloc, and throughout the world, embraced the ideals of civil rights, free enterprise, and democratic equality.

This dominance of Western liberalism was also reflected in American political philosophy. In the 70s and 80s, political theorists like Joseph Raz, Robert Nozik and John Rawls all sought to refine the features and implications of liberal thought.

For example, John Rawls (in my opinion, the most important American political philosopher of this time) argued that liberal society required as much freedom and as much equal distribution of resources as possible. Any inequality or restriction of rights was only acceptable when it made society better off.

It’s not about individual rights

This philosophical debate, in my view, is suddenly very relevant again.

As the coronavirus spreads, appeals about social distancing, washing one’s hands and the like appear to be focused primarily on the individual’s self-interest of not falling ill.

But the pandemic is at the same time demonstrating that these kinds of appeal are not enough. Just a few days ago, for example, Today’s Parent magazine offered the following advice about how to talk to children about the coronavirus and washing their hands: “Assure them that kids don’t tend to get seriously ill with it, but other people in society are more susceptible, and they can do this small thing to help others stay healthy.”

Data is still sketchy, but it appears that for young people, the mortality rate from the coronavirus is not much different from seasonal flu. But even so, they can still transmit the virus to those who are more vulnerable – especially older people and those with underlying health conditions.

Also, people are being urged not to load up on hand sanitizer and surgical masks. Neither of these are absolutely necessary to keep the average person from contracting the virus.

But they might be very helpful for someone else – health care professionals, for example, need their patients to wear masks so they don’t get infected. Because of their repeated interactions with those same sick people, they are in more frequent need of the hand sanitizer as well.

Obligations to each other

This crisis makes it all too clear that pursuing one’s own self-interest is not enough. While every one of us has the legal right to purchase as much hand sanitizer as we can find, if that is all we think about, the welfare of others and society itself are at risk.

Like the Communitarians from 30 years ago, Americans need to challenge the idea that everyone is just pursuing their own happiness as individuals. When we live together in society, we depend on each other. And therefore we have obligations to each other.

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Christopher Beem, Managing Director of the McCourtney Institute of Democracy, Co-host of Democracy Works Podcast, Pennsylvania State University

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Neil Shortland, University of Massachusetts Lowell

As the coronavirus spreads and demand for medical gear far outstrips the supplies, doctors in the U.S. may have to choose who among their patients lives and who dies. Doctors in Italy have already been forced to make such moral choices.

In a recent article in The New York Times, six doctors at five of the major city hospitals said they were worried they would soon have to make painful decisions regarding who should come off lifesaving ventilators.

In addition to the moral anguish of this decision, they also outlined their concern about potential lawsuits or criminal charges if they went against the wishes of a patient or family.

The nature of these decisions shares many parallels with those that we studied in soldiers. These decisions not only involve life-and-death consequences, but they involve long-term psychological trauma.

Decision-making against values

After the number of COVID-19 cases in Italy began to overtake the number of available ventilators, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care published guidelines for the criteria that doctors and nurses should follow in terms of deciding who gets life-saving treatment.

The principle of the guidelines were utilitarian or “informed by the principle of maximizing benefits for the largest number.”

However, the document did not hide from the fact that the moral choices that the Italian doctors now faced were similar to wartime triage required in “catastrophe medicine.”

These kinds of decisions could mean that people are forced into making choices that go against their values, or beliefs that are deeply important to them.

In the training of doctors, one value that is especially pronounced is to “do no harm.” Marco Metra, chief of cardiology at a hospital in one of Italy’s most significantly affected regions, stated in The New York Times that choosing between patients “goes against the way we used to think about our profession, against the way we think about our behavior with patients.”

Patients’ lives are paramount, and the professional responsibility of acting for the benefit of the patient is viewed as a sacred duty that all physicians owe their patients.

In choosing who gets treatment, doctors will be forced to sacrifice a deeply held belief. This will likely carry long-term trauma.

Moral injury

The nature of these decisions is analogous to what I, along with fellow psychologist and long-term collaborator Laurence Alison, have studied on military decision-making. Our work looks at how people make decisions that involve multiple potentially negative outcomes.

We look at how to train people to make the “least-worst” decisions, rather than avoid the decision. Our research has also highlighted the link between having to make a least-worst decision and a form of psychological trauma referred to as moral injury.

Moral injury happens when soldiers witness or engage in acts that transgress their own morals or beliefs. These could include using deadly force in combat and causing harm to civilians, or failing to provide medical aid to an injured civilian or service member. It could also be that a soldier changes beliefs about the necessity or justification for war, during or after serving.

Researchers are increasingly focusing on the psychological harm that can occur when such action damage the sense of right and wrong and leaves soldiers with traumatic grief.

The invisible costs of COVID-19

The threat and costs of COVID-19 are increasingly being likened to being “at war” with the disease.

President Donald Trump has vowed to “win this war” against the coronavirus, and U.K. Prime Minister Boris Johnson has declared himself head of a “wartime government.” French President Emmanuel Macron too has repeatedly declared that “We are at war.”

Some projections show that COVID-19 could kill more Americans than died in combat in either World War I, Vietnam or the Korean War.

As the “war” against COVID-19 continues, and if efforts to flatten the infection rate curve falter, medical professionals who are on the front lines will increasingly be forced to make life-altering, least-worst decisions. It would require many of them to violate values that are held as sacred.

Director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center at the VA Boston Healthcare System Brett Litz, who was the first to conceptualize moral injury in soldiers, argued in the past about the need to realize the lasting damage of decisions, or bearing witness to those that “transgress deeply held moral beliefs and expectations.”

To this date, however, experts do not fully understand moral injury, or how to treat it.

But even with this limited understanding, I believe, it is important to support the medical staff fighting against COVID-19 and their decisions.

The decisions doctors will be making are perhaps unavoidable given the size and scale of the current pandemic. But what is critical is that the costs of making these decisions on those who have to make them are not forgotten, nor diminished.

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Neil Shortland, Director, Center for Terrorism and Security Studies; Assistant Professor of Criminology and Justice Studies, University of Massachusetts Lowell

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ashley Rubin, University of Hawaii

Jails and prisons around the United States are considering freeing some of their inmates for fear that correctional facilities will become epicenters in the coronavirus pandemic.

COVID-19 has infected hundreds of prisoners and staff in city jails, state prisons and federal prisons.

New York, California and Ohio were among the first to release incarcerated people. Other states have followed, saying it is the only way to protect prisoners, correctional workers, their families and the broader community.

Jails and prisons often lack basic hygiene products, have minimal health care services and are overcrowded. Social distancing is nearly impossible except in solitary confinement, but that poses its own dangers to mental and physical health.

As a prison scholar, I recognize a sad irony in this public health problem: The United States’ very first prisons were actually designed to avoid the spread of infectious disease.

Early American jails

The first U.S. prisons emerged in reaction to the overcrowded, violent, disease-infested jails of the colonial era.

Prisons as we understand them today – places of long-term confinement as a punishment for crime – are relatively new developments. In the U.S. they came about in the 1780s and 1790s, after the American Revolution.

Previously, American colonies under British control relied on execution and corporal punishments.

Jails in America and England during that period were not themselves places of punishment. They were just holding tanks. Debtors were jailed until they paid their debts. Vagrants were jailed until they found work. Accused criminals were jailed while awaiting trial, and convicted criminals were jailed while awaiting punishment or until they paid their court fines.

Consequently, early American jails were not designed for long detentions, even if people sometimes stayed for months or longer.

The physical structure of these unregulated local facilities – often run by sheriffs or private citizens who charged room and board fees – varied. Jail could be a spare room in a roadside inn, a stone building with barred windows or a subterranean dungeon.

Fear of disease

Disease, violence and exploitation were rampant in these squalid American colonial and British jails.

John Howard, a British aristocrat whose ideas influenced American penal reformers, became concerned about living conditions in these “abode[s] of wickedness, disease, and misery” when he became a sheriff. In a 1777 book, Howard recounts smelling vinegar, a common disinfectant of the era, to protect against the revolting smell of the jails he visited.

Howard warned readers that jails spread disease not only among inmates but also beyond, into society. He recalled the so-called Black Assize of 1577, in which prisoners awaiting trial were brought from jail to an Oxford courthouse and “within forty hours” more than 300 people who had been at court were dead from “gaol fever” – what we now call typhus.

He also wrote of infected prisoners who, once released, brought diseases from jail into their communities, killing scores.

Disease also shaped Howard’s understanding of how criminality spread.

He described how young “innocents” – the children of people jailed for debt or those awaiting trial for a petty offense – were seduced by dashing bandits’ stories of crime and adventure. Thus “infected,” they went on to become criminals themselves.

America’s first prisons

Howard’s ideas, particularly the realization that jails posed a threat to the public, were brought to the U.S. by Philadelphia reformers like Benjamin Rush, a physician and signer of the Declaration of Independence.

Following the recommendations in Howard’s book, American penal reformers pushed for new jails designed to ward off disease, crime and immorality of all kinds.

Howard envisioned new facilities that would be well ventilated and cleaned daily. Clothing and bedding should be changed weekly. There would even be an infirmary staffed by “an experienced surgeon” who would update authorities on the state of prisoner health.

American reformers followed Howard’s advice that “women-felons” should be kept “quite separate from the men: and young criminals from old and hardened offenders.” Debtors, too, should be kept “totally separate” from the “felons.”

Prisoners should be separated from one another, ideally in cells. Crowding should be avoided. All this would prevent the spread of disease and enable the prisoners’ repentance – and thus their rehabilitation.

Using Howard’s book as their guide, Rush and his colleagues transformed Philadelphia’s aging and overcrowded Walnut Street Jail into one of the country’s first state prisons by 1794. The Walnut Street Prison model was soon adopted nationwide.

Health care in prisons today

The U.S. long ago departed from the idea that prisons should protect both prisoners and society.

The biggest shift in prison health care occurred between the 1970s and today – the era of mass incarceration. The U.S. incarceration rate doubled between 1974 to 1985 and then doubled again by 1995. The number of people in American prisons peaked in 2010, at 1.5 million. It has declined slightly since, but the U.S. still has the world’s largest incarcerated population.

Prison building, although unprecedented in scale, has not kept pace. Many corrections facilities in the U.S. are dangerously overcrowded.

In 1993, 40 states were under court orders to reduce overcrowding or otherwise resolve unconstitutional prison conditions. Many more lawsuits followed. Still, the prison population grew.

One consequence of overcrowding is that prison officials have a difficult time providing adequate health care.

In 2011 the U.S. Supreme Court ruled that overcrowding undermined health care in California’s prisons, causing avoidable deaths. The justices upheld a lower court’s finding that this caused an “unconscionable degree of suffering” in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment.

Amid a worldwide pandemic, such conditions are treacherous. Some of the worst COVID-19 outbreaks in U.S. prisons and jails are in places – like Louisiana and Chicago – whose prison health systems have been ruled unconstitutionally inadequate.

Criminologists and advocates say many more people should be released from jails and prison, even some convicted of violent crimes if they have underlying health conditions.

Opponents of coronavirus-related releases, including state officials in Louisiana, contend that the move poses a high risk to public safety. And victims of violent crimes complain that they have not been notified when their victimizers are set to be released.

The decision to release prisoners cannot be made lightly. But arguments against it discount a reality recognized over two centuries ago: The health of prisoners and communities are inextricably linked.

Coronavirus confirms that prison walls do not, in fact, separate the welfare of those on the inside from those on the outside.

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Ashley Rubin, Assistant Professor of Sociology, University of Hawaii

This article is republished from The Conversation under a Creative Commons license. Read the original article.