And at night a man roused like a dog / And his heart filled with tears
In front of him, stands with a thousand eyes / Staring, an Angel of Death
An angel, who is all eyes, staring / An angel, like water, staring
– Nathan Alterman
Healthcare before the Economy: So Far, We Have Stood the Most Important Test of Humanity
We must immortalize this sublime moment in human history in general, and in the history of the State of Israel in particular. We are so busy counting the number of people infected, sick, and, unfortunately, dead; with the everchanging rules and guidelines of the governmental lockdown; tracking the “curve,” economic data, the availability of respiratory machines, masks and other protective gear for medical personnel, and all of these data points, calculations, and tests obscure the most important event presently occurring—the moral test. Humanity has overwhelmingly decided to place health and human life before the economy—this is the most amazing thing about the COVID-19 crisis. This is a heroic decision, which was not obvious. A miracle. We must immortalize this sublime moment, for it will not last long.
It is truly not obvious that governments from around the world—whether at an earlier or later stage—were willing and ready to allow their economies to collapse by directing their millions of citizens to close themselves off in their homes. Even before the threat of sanctions, billions of healthy citizens agreed to pay a heavy personal price and protect the at-risk population, primarily comprised of the elderly and those with preexisting conditions. This is an extraordinary demonstration of humanity.
I do not know how this type of moral miracle occurs; what variables brought us to this rare moment of global solidarity. Is it that we are all aware that we too will age? Is it that in each and every family we know someone within this at-risk group? Possibly that those dealing with this issue on the global stage are doctors and medical professionals tasked with saving lives and not generals and military personal, who are masters of war, or economists who thrive off the competition for, and not the distribution of, resources? (Obviously, there are those in all camps who break the mold.) Perhaps this miracle occurred because we were not informed from the beginning who the at-risk population is and what are the proportions of the danger? Whether it be for any, all, or none of these aforementioned reasons, in the meantime, there is a marvel of a kind that appears only in moments of local wars or global crises.
In our day to day, we do not ascend to this level of morality. Many more lives could be saved with much less social and economic investment by increasing the medicines included in basic healthcare, by investing more in hospitals and medical faculties in the country, or through more massive government investment in preventive medicine. And this is without talking about investing in areas that are not related to the healthcare system. About two and a half years ago, I was active in the fight for pediatric oncology in Jerusalem. At one of the rallies, I found myself barred from speaking to who was then, and still is, the Director-General of the Ministry of Health. I argued that the authorities had knowingly sacrificed a certain number of children who would not receive proper medical care to allow reforms at Hadassah Hospital. Admittedly, my stomach turned over when I came to this realization, and since that evening I have been accompanied by many guilty feelings and regrets that perhaps I was wrong. But due to the pain I felt for a sick girl whose treatment at the hospital ceased, I could not hear from one side the lip service, “We will do everything for the children,” and from the other, that “there is no money to open another department in Jerusalem,” the most needy city in Israel. The economic consideration was only one of many in this debate, at least to some of us it seemed to be the decisive consideration. Now, in the COVID-19 crisis, everything or almost everything is being done. After we recover from this crisis, when we are told that there is no money in the public healthcare budget to save patients, we must point out this stage of the crisis—the stage where most of the world governments and the Israeli government did almost everything they could to protect the public’s health.
“Neither Bring Us into Temptation, Nor into Scorn”: The Fear of Losing Control
However, if we analyze further, we will find that this is not just the victory of the epidemiologists over economists, of healthcare over the economy. There is also a crucial argument here about the nature of moral decisions. On the subject of moral decisions, there is an endless dispute between two major schools of thought: the utilitarians and the deontologists. The utilitarians—such as Bentham, Mill, Singer and many others—believe that the consideration guiding the moral act should be “the greatest good for the greatest number of people.” By contrast, deontologists—such as Kant, Locke, Rawls and many others—argue that morality is based on absolute moral duties and values that are not circumstantially-dependent. In the COVID-19 crisis, utilitarian considerations were rejected. Not only did health prevail over the economy, but imperative morality prevailed.
But what exactly is the categorical imperative that has so far prevailed? At first glance, the value of the sanctity of life seems to have prevailed. One of Kant’s formulations of the “categorical imperative” is to “See in each person a purpose and not just a means.” This principle, which sees every person as a purpose, is formulated brazenly in the Mishnah:
Therefore but a single person was created in the world, to teach that if any man has caused a single life to perish, he is deemed by Scripture as if he had caused a whole world to perish; and anyone who saves a single soul, he is deemed by Scripture as if he had saved a whole world.
And for the sake of peace among humankind, that one should not say to another, “My father was greater than your father.”
And to proclaim the greatness of the Holy Blessed One; for humans stamp many coins with one seal and they are all like one another; but the King of kings, the Holy Blessed One, has stamped every human with the seal of the first man, yet not one of them are like another.
Therefore everyone must say, “For my sake was the world created.”
- Mishnah Sanhedrin 4:5 (MS Kaufmann)
If so, perhaps the epidemic brought from the abyss of repression the endless value of the life of every individual. Faced with the angel of death, a thousand-eyed angel, humanity looks inward and discovers the most primal moral intuition—the sanctity of life.
However, public discussions point to another value. Public discourse, which deals with “flattening of the curve,” is troubled by another aspect of the human condition. Epidemiologists and decision makers neither talk about saving one person, nor even the desire to save as many patients as possible. Unfortunately, doctors are very familiar with the situation in which they are forced to announce the passing of patients. The fear of death in this current situation does not appear to be from death itself. It is clear to me that Dr. Yoram Lass—the outspoken critic of the current policy—is morally wrong. Yet, the statistical models he presents, and on which Britain relied at the beginning of the crisis, are true: We are prepared to pay the price every year of thousands of deaths, hundreds of casualties, and more in order to have a normal life.
So, what are we scared of, if not death? Some may reply: the estimated number of dead. But we hardly hear about it. More than the expected deaths, we are frightened by the terrible scenario in which it will not be possible to provide treatment to patients due to lack of respiratory machinery and manpower. The healthcare system fears the tribulations of life and death decisions—who is and who is not to be treated. This terrifying circumstance, in which patients will die not because there is no way to treat them, but because there are no means to treat them, is described as “the collapse of the healthcare system.” Existentially, it is unclear whether the situation of prioritizing care for patients is so daunting because it means to take on the role of God or because it means to take on the role of the angel of death. In such a situation there is no large difference between the two.
What underlies this fear is an existential insult. We are prepared to accept the death of people in hospitals as long as they have received the best possible care. The human condition includes death and we come to terms with it. But we refuse to submit to death without a fight; we are shocked far more by the dead in the corridors than the dead in the inpatient rooms. And rightly so. We are ready to die when the time comes, but we want to die with respect; with dignity. In countries where the COVID-19 epidemic is out of control, death is no longer confined to the spaces we have allotted to it. It comes out of the areas where we are willing to endure it and dances its macabre dances. The moral decision made at this stage and the global willingness to pay the heavy economic price reflect our need to protect not only human life but also, and above all, human dignity.
We must be proud of the moral decisions that characterize our lives now. We have placed the sanctity of life and the value of human dignity before personal and global interests. We pay a heavy price for it, which will increase as the crisis continues. Often in human history a great moral accomplishment has emerged as a prelude to a severe moral failing. We must prepare for the next stages of the epidemic and policy, not only technically but also morally. Thoughts on this in the next article.