I have been hesitant to submit this letter to Pique, given my profession. For the record, I have a loved one who will likely die of COVID-19. As a physician, I care deeply about the health of all people in this community. I sincerely hope that this letter does not make you think otherwise.
I worry that fear and strong emotions have clouded rational decision-making by our political leaders and public health officials with respect to COVID-19 policy.
Those in charge have chosen to substitute fiscal chaos for healthcare chaos in order to hopefully minimize the death toll from COVID-19. Knowing whether this optimizes well-being for Canada as a whole is extremely difficult as the economy, healthcare, education, social welfare and environment are so interconnected.
One area cannot tumble without repercussions to the other. Lowering the death rate, infection rate or healthcare utilization from COVID-19 are not metrics that really embody what we should be trying to maximize, that being the collective well-being of Canadians. These measures only comprise a portion of that well-being today and an even smaller portion when considering how well-being will be affected in the long term.
When humans play Mother Nature on this level, we tend to make inefficient and irresponsible decisions without clearly considering the ramifications of our actions. This is particularly true when fear and emotion play a role in our decision-making.
I worry that our leaders have not considered what is a reasonable amount to spend to save human lives in this context. Perhaps more relevant would be putting a number on what is a reasonable expense for anticipated years of life saved. Doing this estimate and calculation would certainly be difficult. However, this should be modelled to the best of our abilities.
I do not have the skillset to do this, but I wonder whether the cost of lives or life years gained would be staggering for our current approach. I am not suggesting that a human life is only worth X dollars. If, for example, we had to spend $10,000,000 to save one life, I suspect that the ethical choice as a country is to do it, and have all Canadians collectively throw in 33 cents for the cause.
However, I believe that the ethics change when we have to make this commitment for thousands of people en masse. In a previous Pique opinion column, Andrew Mitchell stated that the total debt obligation when all is said and done will be $1 trillion, or $24,000 for every man, woman and child, not including provincial debt ("The end of the world," April 10). At this point, I believe that our ethical obligation shifts from only focusing on the victims to the collective well-being of the country.
I am not saying that B.C. and Canadian leaders have made the wrong decisions so far. I am not informed enough to make that judgment. As we ease restrictions, we face the possibility of second and third waves of this infection. If this occurs, I hope that our leaders consider allowing for a higher burden of disease, despite the possibility of a higher near-term death rate and hospitalization rate, given the cost and consequences of our current approach.
Many of you will find the notion of placing a dollar figure on human life horrendous. If you feel that way, consider how many lives could potentially be saved if we deployed the trillions of dollars we are spending for this crisis to some other aspect of healthcare, environmental policy or social policy, like cancer research or cardiovascular disease. If we could have saved more lives deploying it elsewhere, is what we are currently doing ethically wrong?
Of course, our government would have difficulty justifying going into enormous debt for cancer or our environment. The population at large would have a tough time justifying giving up months of their lives for these causes as well. But if we would not do it for those causes, and those causes would save more lives, should we be doing it now? And if we blow the bank on coronavirus now, will there be any money left after it's all over to address these other issues in the future?
Perhaps the acuity of COVID-19 compels us to act communally now, whereas the chronic nature of cancer or our environmental woes makes us feel as though we can act more slowly in a way that lacks global cooperation.
Dying from COVID-19 in the next two years is actually quite unlikely for most of us. That any one of us might die from cancer or cardiovascular disease some time in the next 50 years is actually quite likely. Despite this, our brains are hardwired to feel much more fear and emotion for the first possibility.
This fear, based on the timing of possible death and our unfamiliarity with it, should not make a significant difference when guiding our national policy. After all, death is death and tragic no matter how it happens. Our leaders need to be able to look past the fear and emotion to develop policy that will be best for all Canadians in the long run.
Denton Hirsh, MD, FRCPC // Whistler
