(a thought experiment inspired by John Rawls)
John Rawls (1921-2002) argued that we could determine just ethical principles by seeing what a free and rational people would choose if they attempted to create a just society from behind a ‘veil of ignorance’.
John Rawls proposed a famous thought-experiment in which a group of humans come together and have to devise a set of principles for their society to work by. The imaginary part of this is that the individuals doing the deciding are told that there will be some people of greater and lesser intelligence, greater and lesser degrees of health, greater and lesser pigment in their skin, ability to lead, to follow, to carve wood, to care for babies, etc etc – in other words, these people would represent a reasonable cross-section of the types found in human society. However, the deciding individuals did not know which attributes they themselves possessed...
This ‘veil of ignorance’ Rawls thought would ensure a just distribution of rights and duties in his hypothetical society – just as if you were in charge of cutting up a pizza to share and only knowing that you would get the last piece: you would do your best to cut it equally. (“Deontological Ethics.” http://www.sevenoaksphilosophy.org/ethics/deontology.html)
Rawls thought that people would likely agree to things that would benefit the population no matter their situation: freedom of speech; a limited role for a government influenced by or answerable to the people; an equitable social system wherein people have equal opportunity, access to resources; a system that encourages virtue, etc.
This veil of ignorance would make people aware that that they could be among the disadvantaged or marginalized, and they would want to make laws that would protect them if they were one of the weaker members of society and not punish them if they were one of the stronger.
With that foundation in mind, let’s apply that idea to COVID-19.
* * * * *
You are going to wake up tomorrow in March of 2020 in the United States a different person than you are right now. You are going to be randomly assigned a number from each of the categories that appear at the end of this article. #1 is either the lowest risk for getting COVID-19 or the lowest possibility of having your income impacted; #4 is highest. When you wake up tomorrow, you will find yourself in a body in which your risk range runs from 10-40, with 10 meaning you’ve won the COVID-19 lottery, and 40 meaning you didn’t.
But today, you have been selected to make COVID-19 policy for the state of Michigan. You are going to look at issues of personal and economic health in making your recommendations. Keep in mind that another panel will decide the constitutionality/legality of your recommendations. Your recommendations will be filtered through the legal system. You are just making recommendations that you believe will best keep people alive, society stable, and the economy afloat.
Once you have reached a decision, you are going to roll a 4-sided dice for each of these categories. This will be who you are when you wake up and begin your life in the context you helped to create.
Then, you will wake up in March of 2020.
These are the categories from which your new life will be formed.
1. Blood Type in the O family (much lower risk of needing a ventilator; mortality 1%)
2. Blood Type A
3. Blood Type B.
4. Blood Types in the A family (1.6 higher chance of serious illness, mortality at 4-5%)
1. You are able to stay at home
2. White collar job (can mostly work from home or in empty offices)
3. Frontline worker (medical)
4. Frontline worker (non-medical)
1. You and your family are healthy
2. You or someone in your family have a significant comorbidity/immune compromise that raises the danger of getting really sick from COVID-19. (COMORBIDITIES OF CONCERN FOR COVID-19: Cancer, chronic kidney disease, chronic lung diseases, including COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), interstitial lung disease, cystic fibrosis, and pulmonary hypertension, demetia, alzheimers, diabetes, Down Syndrome, Heart conditions (such as heart failure, coronary artery disease, cardiomyopathies or hypertension), HIV, weakened immune system, liver disease, obesity, sickle cell disease, smoking, Solid organ or blood stem cell transplant, Stroke or cerebrovascular disease, substance abuse).
3. You and someone in your household have a comorbidity.
4. You and someone in your household have multiple comorbidities.
1. Under 25
3. 45-65 (95% of cases in 45 and older)
4. 65+ (80% of cases in 65+)
E. FINANCIAL STATUS
1. Wealthy (this pandemic is a blip on your financial radar)
2. Upper class (you can take a significant financial hit and be okay)
3. Middle class (you can take a minor financial hit and be okay)
4. Lower class (paycheck to paycheck; a financial hit is disastrous. 2 weeks off to quarantine, and everything goes on a credit card.)
F. HEALTH CARE
1. Great coverage
2. Good coverage
3. Okay coverage
4. No coverage
G. MENTAL/EMOTIONAL HEALTH
1. You are mentally/emotionally stable
2. You are able to cope with mental/emotional health issues with the help of strong and consistent support from friends.
3. You are in counseling/on medication that helps you achieve stability
4. You struggle significantly with mental and emotional health issues, and isolation and withdrawal are not good at all.
1. You live in a cabin in the woods/van down by the river
2. You live in a house in a subdivision
3. You live in an apartment building
4. You live in a congregate setting/group home
1. You make your livelihood from a virtual business
2. You make your livelihood from a brick and mortar business (essential)
3. You make your livelihood from a brick and mortar business (non-essential)
4. You make your livelihood at public venues (musician, athlete, etc)
1. You spend a lot of time outdoors
2. You are generally in well-ventilated and open spaces
3. You are more indoorsy that outdoorsy
4. You spend most of your time indoors
Alright. After the discussion, you are going to roll that four sided dice that randomly determines who you will be when you wake up.
What policies would you like to see enacted? And how are they similar or different to what happened over the past year?
You might wake up as the pastor of a church – and you are waking up on a Saturday, so you need to decide something very important now. Your religious services are exempt from the mandates, so you have to decide if, when, and how to be open.
What will your service look like?
 The US population is not split up into neat quarters like this in terms of the percentage of people, of course. I can only add so much detail to this thought experiment :)
 It appears that “45.4% of US adults were estimated to be at heightened risk of COVID-19 complications due to co-morbidities, increasing from 19.8% for ages 18-29 years to 80.7% for ages 80+ years, with state-to-state variation.”
https://www.medrxiv.org/content/10.1101/2020.03.30.20043919v1 94% of COVID-19 deaths occurred in people with comorbid conditions. https://towardsdatascience.com/covid-19-comorbidities-are-the-elephant-in-the-room-7d185bd6cfe2