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Causality and the Coronavirus

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“Causality” is a difficult concept, yet beliefs about causes are often consequential. A troubling illustration of this is the claim, which is being widely shared on social media, that the coronavirus is not particularly lethal, as only 6% of the 190,000+ deaths attributed to the virus are “caused” by the disease.

We tend to think of causes in too-simplistic terms

Of all of the biases and limitations of human reasoning, our tendency to simplify causes is arguably one of the most fundamental. Consider the hypothetical case of a plane crash in Somalia in 2018. We might accept as plausible causes things such as the pilot’s lack of experience (say it was her first solo flight), the (old) age of the plane, the (stormy) weather, and/or Somalia’s then-status as a failed state, with poor infrastructure and, perhaps, an inadequate air traffic control system.

For most, if not all, phenomena that unfold at a human scale, a multiplicity of “causes” can be identified. This includes, for example, social stories of love and friendship and political events such as wars and contested elections.1

Causation in medicine

Causal explanations in medicine are similarly complex. Indeed, the CDC explicitly notes that causes of death are medical opinions. These opinions are likely to include not only an immediate cause (“final disease or condition resulting in death”), but also an underlying cause (“disease or injury that initiated the events resulting in death”), as well as other significant conditions which are or are not judged to contribute to the underlying cause of death.

In any given case, the opinions expressed on the death certificate might be called into question. Even though these opinions are typically based on years of clinical experience and medical study, they are limited by medical uncertainty and, like all human judgments, human fallibility.

When should COVID count as a cause?

Although the validity of any individual diagnosis might be called into question, aggregate trends are less equivocal. Consider this graph from the CDC which identifies the number of actual deaths not attributed to COVID-19 (green), additional deaths which have been attributed to COVID-19 (blue), and the upper bound of the expected number of deaths based on historical data (orange trend line). Above the blue lines there are pluses to indicate weeks in which the total number (including COVID) exceeds the reported number by a statistically significant margin. This has been true for every week since March 28. In addition, there are pluses above the green lines indicating where the number of deaths excluding COVID was significantly greater than expected. This is true for each of the last eight weeks (ignoring correlated error, we would expect such a finding fewer than one in a million times by chance). This indicates that the number of deaths due to COVID in America has been underreported, not overreported.

Among the likely causes for these ‘non-COVID’ excess deaths, we can point, particularly early in the pandemic, to a lack of familiarity with, and testing for, the virus among medical professionals. As the pandemic unfolded, it is likely that additional deaths can be attributed, in part to indirect causal relationships such as people delaying needed visits to doctors and hospitals out of fear, and the social, psychological, and economic consequences that have accompanied COVID in America. Regardless, the bottom line is clear: without COVID-19, over two hundred thousand other Americans would still be alive today. The pandemic has illuminated, tragically, our interconnectedness and with it our
responsibilities to each other. One part of this responsibility is to deprive the virus of the
opportunity to spread by wearing masks and socially distancing. But this is not enough: we
need to stop the spread of misinformation as well.

 

1 Some argue that we can think of individual putative causes as “individually unnecessary” but as “jointly sufficient.” In the 2000 US Presidential Election, for example, consider the presence of Ralph Nader on the ballot, delays in counting the vote in some jurisdictions, the Monica Lewinsky scandal, and other phenomena such as the “butterfly ballot” in Palm Beach County, Florida. Each of these might have been unnecessary to lead the election to be called for G.W. Bush, but they were jointly sufficient to do so.

“It Wasn’t ‘Me'”: Neurological Causation and Punishment

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The more we understand about how the world works the more fraught the questions of our place in the causal network of the world may seem. In particular, the progress made in understanding how the mechanisms of our brain influence the outward behavior of our minds consistently raises questions about how we should interpret the control we have over our behavior. If we can understand the neurological processes in a causal network that explain the way we act, in what sense can we preserve an understanding of our behavior as ‘up to us’?

This has been a concern for those of us with mental illness and neurological disorders for some time: having scientific accounts of depression, anxiety, mania, and dementia can help target treatment and provide us with tools to navigate relationships with people that don’t always behave like ‘themselves’. In serious cases, it can inform how we engage with people who have violated the law: there is a rising trend to use “behavioral genetics and other neuroscience research, including the analysis of tumors and chemical imbalances, to explain why criminals break the law.”

In a current case, Anthony Blas Yepez is using his diagnosis with a rare genetic abnormality linked to sudden violent outbursts to explain his beating an elderly man to death in Santa Fe, New Mexico, six years ago in a fit of rage. His condition explains how he wasn’t “fully in control of himself when he committed the crime.”

Putting aside our increasing ability to explain the psychological underpinnings of our behavior more causally or scientifically, our criminal justice system has always acknowledged a distinction between violent crimes committed in states of heightened emotionality and those performed out of more reasoned judgments, finding the latter to be more egregious. If someone assaults another immediately after finding out they cheated with a significant other, the legal system punishes this behavior less stringently than if the assault takes place after a “cooling off period”. This may be reflective of a kind of acknowledgement that our behavior does sometimes “speak” less for us, or is sometimes less in our control. Yepez’s case is one of a more systematic sort where he is subject to more dramatic emotionality than the standard distinction draws.

Psychological appeals for lesser sentences like Yepez’s are successful in about 20% of cases. Our legal system still hasn’t quite worked out how to interpret scientific-causal influences on behaviors, when they are not complete explanations. Having a condition like Yepez’s, or other psychological conditions we are gaining more understandings of every year, still manifest in complex ways in interaction with environmental conditions that make the explanations fall short of having a claim to fully determining behavior.

It does seem that there is something relevantly different in these cases; the causal explanations appear distinct. As courts attempt to determine the implications of that difference, we can consider the effect of determination-factors in how we understand behavior.

John Locke highlights the interplay between what we may identify as the working of our will and more external factors with a now-famous thought experiment. Imagine a person in a locked room. There seems to be an intuitive difference between such a person who wishes to leave the room but cannot – their will is constrained and they cannot act freely in this respect. On the other hand, something seems importantly different if the person were in the locked room and didn’t know the door was locked – say they were in rapt conversation with a fascinating partner and had no desire to leave. The world may be “set up” so that this state of affairs is the only one the person could be in at that moment, but it isn’t clear that their will is not free; the constraints seem less relevant.

We can frame the question of the significance of the determination of our wills in another way. While not all of our actions are a result of conscious deliberation, consider those that are. When you question what to eat for lunch, what route to take to get to your destination, which option to take at the mechanics, etc., what would result from your certainty that your ultimate decision is determined by the causal network of the world? If, from the perspective of making a decision, we consider ourselves not to be a source of our own behavior, we would fail to act. We would be rendered observers to our own behavior, yet in a perspective of wondering what to do.

Note an interesting tension here, however: after we decide what to do (to have a taco, take the scenic route, replace the transmission) and perform the relevant action, we can look back at our deliberative behavior and wonder at the influences that factored into the performance. It often feels like we are in control of our behavior at the time – say, when we consider tacos versus hamburgers and remember how delicious, fresh and cheap the fish tacos are at a stand nearby, it seems that these factors lead to seeking out the tacos in a paradigmatic instance of choice.

But what if you had seen a commercial for tacos that day? Or someone had mentioned a delicious fish meal recently? Or how bad burgers are for your health or the environment? What if you were raised eating fish tacos and they have a strong nostalgic pull? What if you have some sort of chemical in your brain or digestive system that predisposes you to prefer fish tacos? If any of these factors were the case, does this undermine the control you had over your behavior, the relevant freedom of your action? How do such factors relate to the case that Locke presents us with – are they more or less like deciding to stay in a locked room you didn’t know was locked?

These questions could be worrying enough when it comes to everyday actions, but they carry import when the behaviors in question significantly impact others. If there is a causal explanation underpinning even the behaviors we take to be up to our conscious deliberation, would this alter the ways we hold one another responsible? In legal cases, having a causal explanation that doesn’t apply to typical behaviors does lessen the punishment that seems appropriate. Not everyone has a condition that correlates to violent outbursts, which may make this condition a relevant external factor.