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Incentivizing the Vaccine-Hesitant

photograph of covid vaccination ampoules

Since the beginning of the COVID-19 pandemic, vaccine hesitancy has remained a constant concern. Given expectations that a vaccine would be found, experts always anticipated the problem of convincing those who distrust vaccines to actually get inoculated. A great many articles coming from the major news outlets have aimed at addressing the problem, discussing vaccine hesitancy and, in particular, trying to determine the most promising strategy for changing minds. In The Atlantic, Olga Khazan surveys some of the methods that have been proposed by experts. Attempts to straightforwardly correct misinformation seems to have proven ineffective as they can cause a backfire effect where individuals cling to their pre-existing beliefs even more strongly. Others instead suggest that a dialectical approach might be more successful. In The Guardian, Will Hanmer-Lloyd argues that we should refrain from blaming or name-calling vaccine-hesitant individuals or “post on social media about how ‘idiotic’ people who don’t take the vaccine are” because “it won’t help.” Similar to this “non-judgmental” approach that Hanmer-lloyd recommends, Erica Weintraub Austin, Professor and Director of the Edward R. Murrow Center for Media & Health Promotion Research at Washington State University, and Porismita Borah, Associate Professor at Washington State University, in The Conversation propose talking with vaccine-hesitant people and avoiding “scare-tactics.” Among the things that can help is providing “clear, consistent, relevant reasons” in favor of getting vaccinated while at the same time discussing what constitutes a trustworthy source of information in the first place.

In spite of all these good suggestions, to this day, Pew Research reports that only 60% of Americans would probably or definitely get a vaccine against COVID-19. Though confidence has been on the rise since September, this still leaves a concerning 40% unlikely to pursue vaccination. It is perhaps in light of these facts that a recent proposal is beginning to gain traction: incentivizing people by offering prizes. Ben Welsh of the LA Times reports that the rewards proposed include “Canary home security cameras, Google Nest entertainment systems, Aventon fixed-gear bicycles and gift cards for Airbnb and Lyft.”

But is it right to give out prizes to lure the initially unwilling to seek vaccination?

The answer depends on the moral system to which you subscribe. You might think that given the seriousness of the current circumstances it is especially crucial to get as many folks vaccinated as possible, and that the means of accomplishing this task are of secondary importance. This would be a consequentialist view according to which the moral worth of an action depends on the outcomes it produces. One might feel the force of this line of argument even more when considering that the consequences of vaccine hesitancy can carry dangers not only for the individuals refusing to get vaccinated but for the rest of us as well. Just recently, a Wisconsin pharmacist purposefully made unusable 57 vials of vaccine that could have been used to vaccinate up to 500 people because of a belief they were unsafe. So considering how significant the impact of vaccine-distrust can be, it is understandable that one might employ even unusual methods – such as prizes – to convince those who remain reluctant to join the queue.

On the other hand, if you do not feel the force of this outcome-based argument, you might think that there is something to say about the idea that changing people’s behavior does not necessarily change people’s beliefs. In this sense, offering a prize might not do much to alleviate the distrust they feel towards vaccination or the government. Consider another example. Suppose you do not believe that exercising is good. Yet your best friend, who instead does believe in the positive aspects of exercising, convinces you to go running with her because the view from the hill where she runs is stunning. In that sense, you may eventually elect to go running, but you will not do it because you are now a believer in exercising. You will go running just so that you can admire the view from the hill, without having changed your beliefs about exercise.

What is the problem of not changing people’s beliefs? You might be tempted to think that there is no problem, if you believe that the end result is all that matters. But even in that case, it is beliefs that drive our actions, and so as long as individuals still believe that vaccines are not to be trusted, giving out prizes will only be a marginal and temporary solution that fails to address the deeper, underlying issue. The worry is that someone who may opt to get vaccinated upon receiving a gift card is not deciding to get vaccinated for the right kind of reason. This argument picks out a distinction famously known in philosophy between right versus wrong kinds of reasons. The philosophical debate is complex, but, in general, when it comes to believing something, only epistemic, evidence-based reasons represent good reasons for actions. Should one, instead, come to act on the basis of reasons that have more to do with, say, wishes or desires, those would represent the proper kinds of reasons.

So what is the solution here? Well, there is no solution, as is often the case when it comes to philosophical positions that are fundamentally at odds with one another. But here is the good news: looking at the ways in which real life events connect with philosophical issues can help us figure out what we think. Examining issues in this way can prove useful in isolating the features that may help us understand our own particular commitments and convictions. Thinking through these tensions for ourselves is what allows us to decide whether we think the proposal to encourage vaccination efforts by offering prizes is a legitimate one.

Time to Let Up or Double Down?

photograph of woman with face mask sitting in large, empty street dining area

Rollout of COVID-19 vaccines represents a significant step in combating the pandemic, one that will likely alter people’s behavior to this global health crisis in significant fashion. With a vaccine on the horizon, risk assessment can change in two very different ways:

On the one hand, it can alter the risk associated with individual behaviors. For instance, with a risky behavior, the prospect of safety can reduce the perspective of associated risk. Here we could think of jumping out an airplane, which seems less risky because there is a parachute. With a vaccine in circulation, taking one’s chances with exposure can seem a more reasonable thing to do. Vaccination will (hopefully) mean there will be fewer people contracting it, lowering the impact on the societal concerns overall. This means risk is assessed in short-term frames: if every risk of exposure over 4 months compares to 12 months, one could think that they might as well lighten restrictions.

On the other hand, the prospect of a vaccine can alter the way we assess risk in a long-term context. When fighting a disease with a radical course of treatment, having an indeterminate time frame versus a given length of time to “push through” makes a great deal of difference. When the end point is unclear, it makes sense to consider harsh conditions unrealistic or unreasonable. In less dire cases, say a highly demanding and stressful workload at work, the expected length of time makes a significant difference in deliberation. Altering the long-term structure of your life around such demands can seem less than feasible, and compromises in meeting those demands can make a great deal of sense. It can make less sense, on the other hand, if the heightened demands are only for a short period of time and come with an important payoff.

With a vaccine in sight, much rests on how the adjustments to daily life given the risk of exposure are reassessed. One reason many give for not complying with state restrictions is that the virus is just something we “have to learn to live with,” or that it is a new way of life. Treating the vaccine as a parachute, as a dialing down of the harm associated with individual actions that put others at risk of contracting the virus, increases danger until the vaccine can come into effect. Letting up on the adjustments to behavior continues to do all the harms that have been associated with the spread of the virus: the deaths, the long-term effects of contracting the virus, the impact on our healthcare system, the systemic impact on the most marginalized populations, the destruction of our economy due to essential workers becoming ill, etc. These effects will not stop simply because of the prospect of a vaccine. The goals remain the same as they have been since February.

With the prospect of improving the fight against the pandemic, the reasonable choice could actually be to double down because we lose one reason to avoid the restrictions. The counterargument that pushes that long-term restrictions will harm the economy, will undermine the values in daily lives, etc. has been weakened considerably as we are now facing a short-term sacrifice for a long-term reward. But until inoculation reaches critical mass, we can’t point to our parachute to justify a refusal to exert effort in pursuit of our shared end goal.

Why I Am Not like You: The Ethics of Exceptions

photograph of long line of people queuing to enter store

Consider two different arguments. The first that it was okay for me to travel in early December, the second that I should be given early access to a COVID vaccine.

My Travel: I understand that traveling was irresponsible in general, and that it was important that people not do so. Had COVID been happening in any other year I would have not traveled at all during the holiday season. But since it was this year, I had good reasons to carve out an exception for myself. First, it was really important for my girlfriend to meet my parents in person before we could get engaged, most people did not have such major life plans put on hold by the inability to travel over the holidays. Second, my grandfather is not doing well and so the consequences of delaying a visit could not be known. Third, this was the first time in six years my parents were back in the states for Christmas. Fourth, my girlfriend and I could take steps to minimize the risk: we drove instead of flying, we could travel in between the Thanksgiving and Christmas rushes, we both got tested before the trip, and I was able to aggressively quarantine the week before traveling.

My Vaccine: While I should not get the vaccine before the elderly, I should get it before it is open to the general public. First, I am teaching an in-person class in the spring and doing so, at least in part, because the state government of Florida is pushing to increase the percentage of college classes taught in-person in the spring. I offered to teach in person to help out, but it seems like the least that the state government could do after I agree to be around (I expect) irresponsible undergraduates is help make sure I have access to a vaccine. Second, I have been extremely aggressive in my social distancing. This means I should get the vaccine early since a) I have already taken on more inconvenience than most to help protect the public good and b) I’m more responsible than most, so I’ll be a larger drain on the economy if I remain unvaccinated. Third, I’m hoping to get married fairly soon, and that is an important life event that should qualify me for some priority.

— — —

I think the first argument is pretty good and the second one pretty bad. I really should not get priority vaccine access, but I think it was OK for me to travel in early December. But what I want to discuss in this post are some of the challenges in identifying when you should be an exception to a general rule.

Each argument tries to make out that I am, in some sense, special. And if you are going to exempt yourself from a rule you think others should generally follow, then you need to provide a compelling explanation for what makes your case unique. This follows from a deep moral principle about the moral equality of persons (one of the principles Immanuel Kant was getting at in his first formulation of the categorical imperative).

Suppose I don’t want to wait in line at the coffee shop. Can I jump the line? No. If ‘not wanting to wait’ was an adequate reason for anyone to cut in line, then everyone would cut in line (since basically no one wants to wait). But if everyone cut in line, then there would no longer be any line at all. My impatient cutting in line relies on the patient waiting of everyone else.  But here we bring in our deep moral principle: I am not special, which is to say that if I should get to do something, other people should as well. So if ‘not wanting to wait’ is a good reason for me, it must be a good reason for everyone. Since we have already seen it cannot be a good reason for everyone, we can conclude it is not a good reason for me.

So, if I want to cut in line, then I had better have a special reason to do it — a reason that will not apply to everyone else as well. Suppose I arrive at the hospital with a child suffering an anaphylactic shock. I see there is a long line of people waiting to get their severed thumbs reattached (I’ll leave it to you the reader to explain the sudden epidemic of thumb severings).

Here it is permissible for me to cut in front of people waiting to get their thumbs reattached. It is permissible because my reason for cutting will not generalize. If we changed the case so the line was all other parents with children suffering anaphylaxis, then it would not be permissible to cut (since we would otherwise return to our original problem).

Okay, so to carve out an exception there must be something unique about me. Well, there are things that are fairly unique about me, does that mean I should get to jump the vaccine line?  Well no. It was not just that anaphylaxis was different from a severed thumb, it also needed to be  more important. A broken leg, just because it is a different injury, would not make it okay to cut in line.

And here we come to a problem. While there are some things unique to me that suggest I should take precedence, basically everyone has some reason why they should be an exception. Sure, I’m hoping to get married but others, who are about to have their first child, will need to spend some time in a hospital and could really use the in-person support of grandparents. Sure, I’m teaching in person, but others are taking (more than one) classes in person. Syndrome was right, if everyone is special, no one is — at least in the sense that if everyone can identify reasons why they should be able to skip to the front of the line, then no one gets to skip.

And indeed, even if I decided I really was more special than others, it is still probably a bad idea to let me jump in line. That is because we, as a general rule, do not want society making thousands of fine-grained decisions comparing every possible special exception. It opens up far too many possibilities for bias and corruption, and besides that, it becomes democratically problematic because it is impossible to adequately articulate the thousands of priority decisions to the citizenry.

Alright, so I should not get to cut the vaccine line.

But what about my choice to visit my parents in early December? I think most people should stay home, but I also really thought I had a better reason to travel than others. Is that enough to justify my exception.

Not quite, there are two complications I need to consider.

First, I need to factor in my biases. Lots of biases may play a role, but let’s just look at an availability bias. I know the details of my life quite well; I do not know the details of yours. Thus even if my case looks more exceptional to me, that might not be because it is, but just because my own specialness is easier to see.

Second, even if I factor in all those biases and still think I’m exceptional, there is a problem with taking that as sufficient to make an exception. That is because I’m not only making a first-order decision, I’m also making a second-order decision. I’m not only deciding that my case is exceptional, I’m also regarding myself as a competent judge to decide on my own exception. This creates a problem because I expect most people are biased, and so if most people decide for themselves whether they should be an exception, far too many will make the wrong choice.

One way to see this problem is to note that others will disagree with me about what is an important reason for an exception. Let’s explain this with an analogy. Something like over 90% of teachers believe they are above average. Now, this might be that teachers are biased (I expect that is likely), but there is another explanation. Perhaps Anne and Barnie are above average lecturers and Chloe and Darius are above average mentors. Anne and Barnie think lecturing is the most important part of teaching (thus why they spent time getting good at lecturing) and Chloe and Darius think mentoring is the most important part of being a good teacher (thus why they invest so much in mentoring students). Here, even if each of them accurately judges how good they are at various teaching techniques, we will still get everyone thinking they are an above average teacher.

Similarly, if everyone decides for themselves whether they should be an exception. We could well end up with many people thinking they are one of only a few who deserve an exception. Not because they are wrong about any of the details, but simply because different people have different priorities. So even if 100% of people think only the 5% of people with the most pressing reasons to travel should travel, you could still easily get 30% or 40% people honestly deciding they fall in the 5%.

Of course, I think my priorities are right. I think I am better at thinking these things through then the average person. But is that enough to let myself treat myself as an exception? Probably not, since I also think that others think their priorities are right, and I expect that others think that they are better than average at thinking these issues through. So the question I am forced to ask is not just, am I better at making decisions, but rather should anyone who thinks they are better at making decisions be allowed to decide for themselves. If my answer to that latter question is no, then it might still be wrong to carve out the exception.

So was I wrong to travel in early December? It is hard to say. On the one hand, I really do think I had a good reason to do so. But on the other hand, I do not think most people should get to carve out their own exceptions just because they think the exception is warranted (of course, maybe it is not actually hard to say but I just do not want to admit I made the wrong choice).

Jane Austen and Moral Instability

portrait engraving of Jane Austen

“Instability” is not a word many would associate with Jane Austen. Film and television adaptations have cemented her reputation within pop culture; we picture rolling hills, country balls, and restrained drama played out in charming domestic interiors. She seems uninterested in the Napoleonic wars, which were playing out just across the channel, or any of the weighty political matters that concerned the more “serious” writers of her day. She does seem interested in social unity, usually represented by a wedding, which punctuates the end of each narrative. Just desserts are always doled out by the narrator, and we always know which characters to root for. For these reasons, her name has become a byword for moral stability, and her version of the English countryside has come to represent a time when society wasn’t subject to rupture and confusion, as it is today.

If the wide array of contemporary Austen-themed conduct books indicates anything, she’s still seen as a touchstone for moral behavior. Her words have been used to demystify cooking, sex, and everything in between. This flourishing industry casts her as a sweet and world-savvy aunt, and further suggests that her novels can be pulverized into idiomatic quotes without context to serve a unified (if somewhat patchwork) Austenian ethic of the everyday.

And yet, beneath this seemingly tranquil surface lies a battleground for radical and conservative academics. Looking more closely at her works, it’s easy to see why; what at first appears a unified moral vision is anything but.

Attributing a single moral philosophy to Austen is notoriously difficult. There are overarching moral messages that connect her novels, but what may be the subject of mockery in one text is celebrated within another, or even within the same text. The unstable positioning of the Gothic in Austen’s first published novel, Northanger Abbey, is just one example. The novel’s heroine, Catherine Morland, is a voracious reader of pulpy romances, which leads her to commit a series of social blunders. She suspects that her love interest’s father murdered his own wife, in a plot lifted directly from the sensational literature of her day. But even though Catherine’s suspicions are proven false, the widowed gentleman proves to be cruel in other ways, which indicates that there is a glimmer of insight in even the most ridiculous Gothic fiction.

Even Austen’s engagement with class is hardly as black-and-white as it may appear. Often cited as the most fundamentally conservative element of her fiction, social and economic distinction are generally portrayed as the natural state of society, even beneficial to those at the bottom. Members of the landed elite like Mr. Darcy of Pride and Prejudice and Mr. Knightley from Emma especially embody this paternalism. And yet Austen’s final published novel, Persuasion, celebrates the meritocratic royal navy, and denigrates the landed elite as undeserving of their wealth and privilege.

Academics from both sides of the political spectrum have claimed her as one of their own, a conflict which came to a head with queer theorist Eve Kosofky Segwick’s groundbreaking article on Austen, “Jane Austen and the Masturbating Girl,” in which she explores the cultural history of masturbation through Austen’s Sense & Sensibility. The mere title (the actual paper had yet to be published) prompted conservative academic Robert Kimball to write Tenured Radicals, a pearl-clutching polemic on the moral bankruptcy of leftists in the academy, who dared link a bulwark of old-fashioned English morality like Austen with such a depraved topic. Kosofy’s article, and Austen by association, clearly came to represent something much larger within intellectual discourse. Both Kosofky and Kimball had completely different views of this body of work, which again speaks to Austen’s versatility as a writer and as a moral touchstone.

Like all great literature, her work opens the way for a myriad of interpretations. She was a novelist, not a philosopher, and was therefore not obliged to lay out her understanding of the world in treatise-form. As Thomas Keymer mentions in his book Jane Austen: Writing, Society, Politics, Austen recoiled from moralizing novels of her contemporaries, like those of Hannah More, for their Evangelical zeal and purely didactic approach to fiction. She herself wrote to her sister Cassandra, “I do not write for such dull Elves As have not a great deal of Ingenuity themselves.” She is not calling for moral and imaginative complacency, but for wide-ranging sympathy and understanding.

Helena Kelly’s 2016 book Jane Austen, the Secret Radical, is described by Google Books as “A brilliant, illuminating reassessment of the life and work of Jane Austen that makes clear how Austen has been misread for the past two centuries and that shows us how she intended her books to be read, revealing, as well, how subversive and daring — how truly radical — a writer she was.” The impulse to claim her as a “secret radical” is perhaps as misguided as Kimball’s attempt to claim her for conservatives, compelling as Kelly’s interpretation may be. We can never completely reconstruct how Austen understood the world through her novels and surviving letters, but we can understand her as a three-dimensional person who may have had radical thoughts while still being a product of her time. When we move past our preconceived notion of her as a fixed moral touchstone, we can engage with her work in exciting new ways, which ultimately sharpens our understanding of how to be a person in an increasingly complicated world.

Disagreements in Ethical Reasoning: Opinion and Inquiry

photograph of graffiti image on building with two arms pointing in opposite directions

With the school year about to begin there are going to be plenty of students entering colleges and universities who have never taken an ethics course before. When I teach introductory philosophy courses the common response that I get when I ask students about ethical issues is “it’s all a matter of opinion.” This is part of a general attitude that when it comes to ethics there is no judgment that is better than any other. This habit of thinking can be so hard to break that even after an entire semester of talking about moral problems and debating the merits of different moral theories, students will still report that it is all just a matter of opinion. Why is this a problem? The habit of thinking that ethics is just a matter of opinion ultimately serves as a roadblock to ethical thinking and moral inquiry.

Moral relativism can be a complicated topic in philosophy, but for our purposes we can define it as the view that moral judgments are not true or false in the same way as factual judgments. Instead, morality is dependent on groups or cultures, each with their own incompatible ways of understanding the world. J. David Velleman has argued that based on data collected from various communities, different communities understand moral actions differently. Jesse Prinz argues that emotional sentiment plays a strong role in moral judgments; an action is wrong if it stirs a negative sentiment. Moral relativism is also often connected to tolerance; if there are no universal moral principles, the moral principles of one culture are not objectively superior to others so we should be tolerant of other cultural practices.

Relativism would seem to offer support for the idea that ethics is all a matter of opinion. Being tolerant of other moral worldviews is generally considered a good thing. Often moral issues can strike different emotional chords with people and it can seem disrespectful to tell people that they are wrong. If ethics is about how we feel about moral problems, then it seems hard to claim that it can rise above mere opinion. However, the view that ethics is all just a matter of opinion and relativism are not necessarily the same. If one believes that morality is dependent on culture, it would not warrant the claim that morality is all a matter of opinion, especially if we are only talking about a single person. Littering is considered a cultural faux-pas in North America so an individual would not be able to claim they are morally okay littering merely because it is their personal opinion that it is morally okay.

Indeed, while the justification for the view that ethics is just a matter of opinion and the moral relativist view can overlap, the position that ethics is just a mere matter of opinion (especially personal opinion) is especially problematic. For starters, one can be tolerant of other cultures and their moral views without having to believe that ethics is merely opinionated. For instance, a moral pluralist may claim that there are objectively correct and incorrect ways to react to moral problems and that moral answers can vary depending on local concerns. Second, while ethics does contain an emotional component, we are not therefore obligated to accept that ethics is merely emotional. Just because you or many others feel something about a moral issue does not mean that that feeling justifies any possible response.

The biggest problem, however, with the view that ethics is merely a matter of opinion is that more often it becomes an excuse to not think too deeply about moral problems. Consider this example: You have a strong desire to help others and are trying to determine what charities you wish to donate to and how much. You could investigate how effective each charity is, who may need it the most, and how much money you wish to give relative to other financial needs and desires you may have. But instead, you decide to take your cash and shred it.

Certainly, we can debate what might be the right thing to do in this situation, but it would require a fairly idiosyncratic person to decide that shredding money was the moral thing to do in that situation. We may not all agree on what the right thing to do in that situation is, but we can establish a fairly broad consensus on what is the wrong thing to do in that situation. Someone who is genuinely interested in helping others and is genuinely conflicted how to do it is not justified in shredding their money. Objectively, this is because it doesn’t solve their own moral problem. In other words, mere opinion is insufficient to justify any possible answer.

Now let’s say that in the same situation I decide that the most moral thing to do is to give money to an animal charity. You may disagree and opt instead for a charity that alleviates hunger. Should we conclude that our disagreement is a mere matter of opinion? Two moral people can come to different conclusions, with each trying to secure different goods and avoid certain problems. Each can also recognize the moral reasoning of the other as being legitimate without having to conclude that the other was morally wrong for doing what they did. This is not merely because the two have a difference of opinion. It is because each appreciates the moral reasoning of the other; they are capable of recognizing the legitimacy of other courses of action. However, they may not recognize the morality of a mere opinion that hasn’t been thought through. Both could agree that shredding your money is morally wrong action and both could recognize the importance of moral reasoning as a means of revising and refining a proposed course of action.

American philosopher Charles S. Peirce believed in the importance of inquiry for settling disagreements and disputes of opinion, not only between each other but with ourselves. If we could only inquire long enough, he argued, we could test our ideas in practice. Because of this, he claimed that part of the bedrock of reasoning is that we do not take steps to block the path of inquiry. The instinct to look at any moral problem and claim that it is all a matter of opinion does exactly this. The immediate response that the answer to any moral problem is a matter of opinion cuts off inquiry before it begins. If we accepted that there is no better answer, we will not seek it. It is an excuse to not look for a better answer, to not rely on our reasoning, to not discuss our proposed solutions with others, and to not seek consensus by refining our ideas.

The notion that the answer to any moral problem is a matter of opinion and that is all there is to say about it is intellectual laziness. If you are a new student who is taking their first ethics class, I urge you to look beyond such an attitude and to inquire further. We may end up concluding that our answers are only opinionated, but we have no justification for starting with that answer. Instead, we may find that we have missed several better responses that can only come from a willingness to inquire further.

Ethical Questions about Poverty Tourism

If you choose to visit one of the world’s big cities, a sightseeing option that may be available to you is what is frequently referred to as “poverty tourism.” If you look hard enough, you’ll be able to find tour buses that will drive you through the poorest parts of the city—places that you wouldn’t see if you hitched a ride on the standard hop-on-hop-off tourist bus.  Poverty tourism is common in places that have been hit hard by natural disaster. Tourists tend to be curious about the extent of the devastation. Continue reading “Ethical Questions about Poverty Tourism”

Feel This

Much has been written about the appalling, depressing and infuriating case concerning Brock Turner and his unnamed victim. I won’t rehearse the case, nor the dialectic it has sparked between those sympathetic to the victim and those outraged that sympathy can ever be extended to crime perpetrators, especially when such perpetrators are member of a hyper-privileged class such as that to which Turner belongs.

Continue reading “Feel This”