You and your friend are walking down a desert road in the heat of summer. In your hand you hold a container of water: slightly dusty but potable nonetheless. You know that if you drink it, you will be able to reach the next town, but if you split the water with your friend, both of you will die. Just as you catch your friend eyeing the water, you notice how weak you have become, and how the sun has just reached its apex and become oppressively hot. What do you do? The ancient Rabbi Ben Petura says in the Talmud that it is better that both you and your friend drink the water so that neither of you has to witness the death of the other. However, Rabbi Akiva said that you should drink the water, as your life comes before the life of your friend.
Jewish texts are fraught with these kinds of moral dilemmas. Whose life is prioritized? When and how? Although religious Jews may consult these sorts of texts regularly, the average person has little reason to break their head over hypotheticals that seem so lofty and illogical. Little reason, until last year. 2020 has provided America with many difficult situations: a pandemic, a tumultuous political cycle, and social unrest. Along with those comes moral and ethical dilemmas. The latest moral dilemma is arising with the development of the Covid-19 vaccine, which is now being distributed to select individuals across the world.
Of all the vaccines being developed, 64 of which are in clinical trials on humans, 19 have reached the final stages of testing, and three have been approved for full use. The vaccines are tested on animals, to test immune response, and then on a small number of people, then hundreds of people, then thousands of people, and finally, if they have proved to be both effective and safe, are given approval and distributed.
Although the vaccine seems to have lifted, at least in part, the dark cloud brought by the pandemic, it has brought problems of its own. After the creation of the vaccine, the next logical step was to determine who would be given it, and in what order; preferably as quickly as possible. Should the immunization program prioritize those over 65, who are dying at faster rates than any other group, or essential workers who have the greatest risk of infection? Scott Gottleib, the former Food and Drug Administration coordinator, said, “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans. If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”
The Advisory Committee on Immunization Practices laid out a list of guidelines in early December, determining that healthcare workers and nursing home residents would be inoculated first, followed by essential workers and those 65 and older. However, on December 11, 2020, the panel recommended that essential workers be vaccinated before those with underlying health risks or those 65 and older. This received backlash not only from many political commentators but also from the healthcare community itself, as their recommended order was projected to result in more deaths than if they first gave the vaccine to the elderly. However, this debate about vaccinations runs much deeper than the vaccine itself. As Kelsey Piper of Vox said, “When should we trust experts and institutions, and when should non-experts and the public speak up and question decisions they disagree with?” In other words, a modern-day moral dilemma.
Another issue facing the distribution of vaccines is equity. Black and Latino Americans WITH COVID? are hospitalized at four times the rate of white Americans nationally, and the death rate of Native Americans and native Alaskans is twice as high as white Americans. Some medical experts, weighing the socio-economic difficulties and discrimination faced by these ethnic minorities,say that some of these groups need priority access to immunization. As Melissa Healy of The LA Times said, “Legally, health officials are in uncharted territory. Courts have never been asked to adjudicate the use of race or ethnicity in allocating scarce healthcare resources…they certainly have not been asked to judge whether states may use a scarce resource such as a vaccine to right historical or present-day social wrongs.” The need for the vaccine among minority communities is clear, but healthcare officials and medical ethicists are not sure whether the race of these individuals is enough to predicate priority distribution of the vaccine.
It seems as though this past year has been filled with more moral dilemmas than perhaps ever before in modern history. Hospital administrators struggled with the distribution of ventilators, where the issue was even more life-threatening. Priority was given to otherwise healthy people who were more likely to survive, yet doctors still had to take economic and social inequalities into account, complicating the already-complex issue. Another oft talked-about dilemma was that of the economy, as the health of the economy and the health of American citizens seemed mutually exclusive. Although people, and politicians, often took strident and seemingly inflexible points of view on this debate, it’s truly a lose-lose situation with no real answer. Do we let the economy plummet, condemning future generations to unemployment and untold difficulties, or do we endanger public health, perhaps killing thousands in the process? When you’re in the desert, do you save yourself, or do you save your friend?
Jewish hypotheticals were created for a reason. They were not meant to be static or apply only to the unlikely situation that they seemed to predict. These situations can apply to other, vastly distant scenarios, providing us with guidance during our times of doubt and uncertainty. However, more than that, they provide us with a sense of our guiding morals and values. They show us what to do when neither option is ideal and help us justify the decisions we make when there is no good solution.
This past year, there has never been a good solution. Doctors, politicians, essential workers, and all American citizens have been forced to make decisions that they never thought they would need to face. Although 2020 has come to a close, we, as a nation, will never forget the ethical dilemmas that we have been forced to confront: choosing between work and health, the safety of one versus the safety of many. Although the consequences of our decisions have often been tremendous in scale and widespread in effect, perhaps we, just like the ancient rabbis, will leave 2020 behind with a better understanding of who we are as a nation, what we value, and a greater sense of responsibility towards one another.