History and Philosophy of Science, University of Cambridge, Cambridge, Cambridgeshire, UK
Faculty of Philosophy, University of Cambridge, Cambridge, Cambridgeshire, UK.
J Med Ethics. 2022 Sep;48(9):643-650. doi: 10.1136/medethics-2020-107103. Epub 2021 Mar 19.
Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis (CBA), a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences-say, for a coffee-might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon's contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges.
为应对 COVID-19 大流行而采取的封锁措施会给社会的某些成员带来巨大的负担,以造福于社会的其他成员。我们应该在什么时候决定这些政策是允许的?许多作家提议,我们应该使用成本效益分析(CBA)来回答这个问题,CBA 是一种广泛的后果主义方法。我们主张采用基于契约论道德理论的替代非后果主义方法。第一节提出了封锁伦理中的关键问题,并概述了在 CBA 框架中解决这些问题的明显吸引力。第二节认为,CBA 从两个方面从根本上扭曲了规范格局:首先,原则上,它允许许多道德上微不足道的偏好——比如说,喝咖啡——可能超过道德上重要的生死问题;其次,它对疾病的受害者和传播者之间的核心道德区别不敏感。第三节概述了我们基于托马斯·谢伦的契约论道德理论的非后果主义替代方案。根据这一说法,自卫的道德含义意味着强烈默认赞成高度限制、普遍的封锁政策:我们然后询问是否有其他政策可供选择,这些政策对所有受影响的各方都是合理的,特别注意对受政策负担最重的人的抱怨。在第四节中,我们反对契约论方法不切实际或违反直觉的指控,指出实际的 CBA 面临着类似的或更糟的挑战。