Maxwell J. Smith argues that choosing to keep businesses and schools open to prevent economic deprivation could have negative economic consequences in the future, and perhaps on even more adverse terms than at present.

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In 1938, Winston Churchill famously wrote: “We seem to be very near the bleak choice between War and Shame. My feeling is that we shall choose Shame, and then have War thrown in a little later, on even more adverse terms than at present.”

COVID-19 case numbers—and crucially, deaths—continue to rise across Canada. Despite this, many leaders, including Saskatchewan’s Premier Scott Moe, are hesitating to take swift and aggressive action to prevent further transmission, illness, and death, largely because of the significant economic implications of doing so. The decisions that premiers and other leaders must make are often characterized as a bleak choice between greater numbers of illness and deaths, which would be expected if businesses and schools are kept open during surges in cases, and economic deprivation, which would be expected if businesses and schools are closed.

Photo Credit: geralt/pixbay. Image Description: Covid-19 symbol on a background of Dollar bills.

Yet, much like as Churchill warned, if we choose greater illness and death—that is, if we choose to keep businesses and schools largely open as COVID-19 cases reach new heights—it is possible that we will have economic deprivation thrown in a little later, and perhaps on even more adverse terms than at present. This is because more illness and death, not to mention the associated fear the public will have about going about business as usual, is likely to have grave economic consequences. For instance, if Ontario were to hit its worst-case scenario of 6,500 cases per day projected by mid-December, one can only imagine the negative effects on restaurants, bars, gyms, and other businesses.

It is therefore important that we stop characterizing possible responses to record-breaking COVID-19 cases as a bleak choice between death and the economy. The lives and well-being of the public and the economy are inextricably linked. It is time that we ensure that this is meaningfully reflected in our decision-making.

The implications are clear. A failure to take swift action to prevent serious illness and death is likely to have dire economic consequences. Similarly, implementing measures that jeopardize the livelihood of Canadians and Canadian businesses will likely take a toll on the well-being of Canadians. So, what is the ethical way forward if we take the relationship between the health of Canadians and the economy seriously?

Preventing deaths is particularly ethically urgent because death is irreversible. Obviously, those who die cannot be compensated or helped later on. Other serious long-term effects of COVID-19, including strokes and organ damage, can also be difficult to compensate in the future because the impact on individuals’ well-being cannot be undone. Consequently, ethicists have argued that preventing death and serious illness expected in the short-term should be prioritized over strategies that prioritize the prevention of short-term financial losses.

In part, these should be our priorities because there are ways to limit or mitigate the potential economic and social harms that may result from restrictive public health measures used to prevent deaths and serious illness (such as closures or lockdowns). For example, financial supports such as income or wage subsidies could mitigate or compensate for unemployment and increases in poverty, both of which may be a consequence of closures and lockdowns.

Where the social or economic harms of necessary public health measures are longer-term, this can of course negatively impact public health as well. However, unlike death there is an opportunity to compensate for these harms in the future, and it will be ethically important to do so to reciprocate for the sacrifices made by individuals and businesses in the name of the public’s health.

Where current ways of doing business or education during the pandemic do not align with public health goals, we should be creative in supporting these businesses or schools in modifying their operations to better align with public health efforts. Some examples are investments that allow schools to reduce transmission by hiring more teachers (i.e., to reduce class sizes) and installing necessary ventilation systems. These supports should be sensitive and responsive to the unique needs of our diverse businesses, including smaller businesses as well as bigger ones, which can be accomplished by working collaboratively to create strategies capable of balancing multiple values and objectives.

To be clear, implementing public health measures that could have serious adverse financial or social consequences for individuals and businesses are ethically problematic when (1) there lacks a good justification for these measures, (2) these measures are disproportionate to the harms they are attempting to prevent or mitigate, and (3) nothing is done to compensate for these harms. But there is strong justification for implementing public health measures to avert the severe illness and deaths we are currently experiencing. We must do whatever is possible to minimize the unintended social and economic harms that result from fulfilling this obligation of preventing serious illness and death.

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Maxwell J. Smith is Assistant Professor and Co-Director, Health Ethics, Law, & Policy (HELP) Lab, Western University. @maxwellsmith