Three Neglected Advantages of Controlled Infection

I've increasingly come to think that my previous post on when SARS-CoV-2 Controlled Voluntary Infection is worthwhile was excessively pessimistic.  I previously noted the benefits of low viral load (variolation), timing the burden on the medical system, and enabling people to safely return to normal life.  Three additional factors to consider include:

(1) Controlled infection enables pre-symptomatic treatment, which tends to be more effective (in some cases yielding "virtually total protection" against an illness whilst still developing protective antibodies and subsequent immunity to reinfection).

(2) Reducing accidental spread.  Each person who undergoes CVI (followed by two weeks quarantine) is someone who won't unknowingly acquire an asymptomatic (or pre-symptomatic) infection and spread it to others without realizing.  This makes everyone else much safer.

(3) With reduced spread comes reduced overshoot beyond herd immunity.

It's completely insane that nobody seems to doing the necessary research to find out just how effective CVI could be, especially when some parts of the world are (either deliberately or de facto) pursuing a strategy of herd immunity via uncontrolled infectious spread, which we have every reason to expect to be vastly inferior.

Giving Game 2020 results

This semester, I got my 'Effective Altruism' class to decide how to allocate $5000 in donations between the four EA funds. (Half the funds were provided by UM Ethics Programs, as the result of an internal grant request I submitted for this purpose. The other half were matching funds from my personal charitable budget.)  Our resulting breakdown was as follows:

* Global Health & Development: $2500

* Animal Welfare: $700

* Long-Term Future: $1450

* Effective Altruism Meta: $350

Academic pay cuts vs job cuts

Hopefully the financial situation for universities next year will turn out to be less dire than many fear. And hopefully what cost-cutting measures are needed can largely be achieved by cutting down on non-academic "bloat" together with temporary reductions to discretionary budgets (turning research "travel" virtual, etc.).  But suppose that this isn't enough, and your department needs to spend less on academic salaries.  How should this be done, to minimize harm?

Beneficent Retirement and Academic Successorships

In 'The Paradox of Beneficial Retirement', Saul Smilansky argues that "for a great many people, the best professional action that they can currently take is to leave their profession" (337) -- on grounds that they could reasonably expect to be replaced by someone better (!) -- and, moreover, that the personal costs they'd thereby incur (especially if eligible for a comfortable retirement) would be much smaller than the costs otherwise borne by the un- or under-employed.

In the academic case, I suspect that a similar conclusion may follow without the need for invidious comparisons.  Even supposing that one is above average in philosophical mettle, productivity, and so forth, so long as one has already enjoyed a long career in the discipline, it's likely that in most cases (not all, of course!) one's most valuable contributions have already been made, and the discipline would benefit more from hearing new voices.  (This seems especially likely given the hyper-competitiveness of the job market in recent years: we all know that there's an immense amount of philosophical talent out there, struggling to secure stable academic employment.) 

Op-ed on Pandemic Ethics

Co-authored with Peter Singer, 'Pandemic ethics: The case for experiments on human volunteers' was published online yesterday in the Washington Post!

We begin:

The pandemic has thrown previous moral assumptions into disarray. Most of us now accept restrictions on our freedom of movement and association that would have seemed unthinkable just a few months ago. Yet the research we are willing to do to combat the virus is still governed by assumptions developed in calmer times when less was at stake.

Research ethics normally prohibits exposing human subjects to significant risk. The overriding aim is to prevent their exploitation by researchers whose interests may not coincide with those of the individual patient. But in a pandemic, the overriding aim must be to avoid a potentially catastrophic toll. We all face such heightened risk that restrictions on promising research (beyond the basic requirement of informed consent) could easily prove counterproductive in humanitarian terms.

We discuss three kinds of "risky" research: (i) skipping lengthy animal trials for promising treatments, (ii) human challenge trials for vaccines (though what we say here could also extend to more speculative theories, e.g. using challenge trials to test the possibility of cross-immunity from cold coronaviruses), and (iii) variolation.  Regarding the latter, we argue:

Monotonicity and Inadvisable Oughts

Daniel Muñoz & Jack Spencer have a great new paper, 'Knowledge of Objective ‘Oughts’: Monotonicity and the New Miners Puzzle' (forthcoming in PPR).  In it, they dispute that knowing that you objectively ought to do something entails that you subjective ought to do it, on the basis of non-maximal act-types, which might be performed in multiple ways (some ideal, some disastrous). Their argument depends upon 'ought' being upward monotonic (UM): "if you ought to do a certain act X, and X-ing entails Y-ing, then you ought to do Y."  I think their central case instead demonstrates why we should reject UM (and similar normative inheritance claims, as found, e.g., in Doug Portmore's Opting for the Best).

In a classic mineshafts case, you know that (to save the most lives) either you objectively ought to block shaft A, or you objectively ought to block shaft B, but you don't know which.  Because blocking the wrong shaft would be disastrous, you rationally (or "subjectively") ought to block neither. M&S now highlight that the above disjunction, together with UM, entails the less-specific prescription that you objectively ought to block a shaft.  You could know this to be true, they argue, but still you (rationally) shouldn't block a shaft, given the risk of disaster.

UM violates a plausible constraint on the objective ought: that if it would be morally worse for you to ϕ, then it is not the case that you objectively ought to ϕ.  Since you might block the wrong shaft, we cannot know that you objectively ought to block a shaft: depending on how you did it, you might kill everyone!  And it's certainly not the case that you objectively ought to do something that would kill everyone.  So we should reject UM.

M&S write: "UM is backed up by some formidable arguments, and the objections to it, even if they work, don’t apply in the Miners case." (p.8).  Let's take a closer look.

Against Conventional Moral 'Decency'

"It’s obviously horrible to value the economy over human lives." - Regina Rini echoes a common moral conviction.  I am so deeply baffled by this.  As though "the economy" was nothing but a number on a spreadsheet, mere "corporate profits", disconnected from human lives and livelihoods. (Progressive-approved history textbooks will no doubt have to cut all mention of the Great Depression on grounds that it was no great tragedy, of interest only to fat cats and their cronies.)

The real, underlying moral question is instead how we should weigh specifically medical interests against human wellbeing more broadly.  If anything is "obviously horrible", to my way of thinking, it is to claim that nothing matters beyond sheer existence -- that happiness, mental and emotional wellbeing, quality of life, prosperity, and human connection, all count for naught in comparison to keeping our bare biological mechanisms running smoothly.  I think few people would really endorse such a claim on reflection, but it seems to be implied by the unthinking prioritization of "saving lives".

When is CVI worthwhile?

My previous post outlined some reasons to think that Robin Hanson's idea of low-dose controlled voluntary infection (CVI) should be explored further, despite widespread knee-jerk moral discomfort with the idea.  That's not to say that anyone should be attempting to implement this themselves right now.  Rather, careful experimentation (with consenting volunteers who understand the risk) is urgently needed to gather more data and allow us to better judge whether or not CVI would be a worthwhile policy to roll out more broadly.

Pandemic Moral Failures: How Conventional Morality Kills

If invited to consider moral errors people have made in relation to the current pandemic, some obvious candidates likely to spring to mind (in an American context) include:

• General failures of pandemic preparedness (in the CDC and federal government more broadly) before the crisis hit.
• The specific failure to immediately ramp up production of essential medical supplies, and especially coronavirus testing capacity, as soon as the threat became clear.
• Lies and misleading messaging from the President and certain other politicians downplaying the need for any such preparations (including from some who privately made stock market trades at odds with their public reassurances that all was fine).
• Reckless behaviour by private individuals, e.g. Spring Break party-goers who risked infection in large crowds and then returned home to potentially spread it to vulnerable family members and other community-members.
• Hoarding toilet paper.

But I'm more interested in less widely-appreciated mistakes.  The most important of these may be the failure to adequately explore our option-space, stemming from the conventional moral thinking of many well-meaning people (including public health experts who are leading the response to the pandemic).  Narrow-mindedness may leave us susceptible to uncontrolled, high-risk infection when a lower-risk, more carefully controlled alternative is available.

"Lives" are the Wrong Measure

When thinking about triage situations, it's common for people to assume that saving lives (as many of them as possible) should be our moral goal.  But this is wrong, for the straightforward reason that some deaths are vastly more tragic than others.

It's worth bearing in mind that lives can't be saved, but only extended.  So "saving lives" is not even a coherent goal.  You can aim to maximize the number of lives extended (for any period whatsoever), but we can now see that this is akin to trying to blindly maximize the number of patients treated.  By ignoring how much the patients gain from different treatments, you're clearly neglecting what actually matters -- the underlying health benefits that are the whole purpose of medical interventions in the first place.  Willfully blinding yourself to the magnitudes of different interests will lead to predictable injustice: you might foolishly prioritize two patients' papercuts over another's spreading gangrene, for example.  Raw numbers helped is not the important thing.  Moreover, this principle is as true of life-extending treatments as it is of any other.  (This is most obvious if you imagine a treatment that will extend life by mere minutes.)  I don't see how any remotely sensible person could possibly deny this.