In recent days, we have seen the rise of many articles in American media (and particularly in Catholic publications), questioning the public health regulations implemented around the world to prevent the spread of COVID-19. One of those articles stood out, both because of the negative feedback it received and because it encapsulates the arguments of the prominent mindset of those who oppose the COVID-19 policies. I’m referring to the article by First Things editor R.R. Reno, “Say No to Death’s Dominion.”
Reno is concerned about the societal effects of the COVID-19 safety measures. With good reason. It is undeniable that shutting down all non-essential business and prohibiting most everyday activity will have an enormous socio-economic impact. This will certainly cause all kinds of problems in society at large. However, the alternatives he presents and the reasoning he employs transcend these practical considerations. In this article, Reno attempts to make a case against these measures by drawing from–among other things–Catholic bioethical principles. In doing so, he makes several doctrinal and ethical blunders that I think should be addressed. As a Catholic doctor, who deals with life and death decisions demanding serious bioethical formation every day, I believe I have a duty to step in.
Society is a moral, not a living organism
In another recent article on the same topic, Reno uses the metaphor of a living organism to describe society, and how, as a living organism, society cannot stop. He says:
“Society is a living organism, not a machine that can be stopped and started at our convenience. A person who is hospitalized and must lie in bed loses function rapidly, which is why nurses push patients to get up and walk as soon as possible after sicknesses and operations. The same holds true for societies. If the shutdown continues for too long, we will lose social function.
Undoubtedly ‘shelter in place’ will slow the spread of disease, but at what cost to the body politic?”
What Reno apparently doesn’t realize is that this exact metaphor has been addressed by a pope who had a great deal of expertise in bioethics. This pope warns us to be wary of reading too much into this metaphor (emphasis from now on is always mine):
“It must be noted that, in his personal being, man is not finally ordered to usefulness to society. On the contrary, the community exists for man.
The community is the great means intended by nature and God to regulate the exchange of mutual needs and to aid each man to develop his personality fully according to his individual and social abilities. Considered as a whole, the community is not a physical unity subsisting in itself and its individual members are not integral parts of it. Considered as a whole, the physical organism of living beings, of plants, animals or man, has a unity subsisting in itself. Each of the members, for example, the hand, the foot, the heart, the eye, is an integral part destined by all its being to be inserted in the whole organism. Outside the organism it has not, by its very nature, any sense, any finality. It is wholly absorbed by the totality of the organism to which it is attached.
In the moral community and in every organism of a purely moral character, it is an entirely different story. Here the whole has no unity subsisting in itself, but a simple unity of finality and action. In the community individuals are merely collaborators and instruments for the realization of the common end.
What results as far as the physical organism is concerned? The master and user of this organism, which possesses a subsisting unity, can dispose directly and immediately of integral parts, members and organs within the scope of their natural finality. He can also intervene, as often as and to the extent that the good of the whole demands, to paralyze, destroy, mutilate and separate the members. But, on the contrary, when the whole has only a unity of finality and action, its head—in the present case, the public authority—doubtlessly holds direct authority and the right to make demands upon the activities of the parts, but in no case can it dispose of its physical being. Indeed, every direct attempt upon its essence constitutes an abuse of the power of authority.”
— Venerable Pope Pius XII
An Address to the First International Congress
on the Histopathology of the Nervous System
Crusades against human finitude
While the above example is a clear theological error, Reno makes many statements throughout the essay that are mostly true but contain subtle errors. Many of his arguments warp the truth, mixing morally correct statements with bioethical blunders. Or, as Pope Leo XIII said: “There can be nothing more dangerous than those heretics who admit nearly the whole cycle of doctrine, and yet by one word, as with a drop of poison, infect the real and simple faith taught by our Lord and handed down by Apostolic tradition.” An example of this is when Reno postulates:
“A number of my friends disagree with me. They support the current measures, insisting that Christians must defend life. But the pro-life cause concerns the battle against killing, not an ill-conceived crusade against human finitude and the dolorous reality of death”
This is mostly true. As an oncologist, I have experienced it first-hand: people with strong pro-life convictions who mistakenly think that opposing euthanasia means we must prolong a sick person’s life at all costs. But while directly killing someone (i.e. euthanasia) is morally reprehensible, letting a person die whose time has finally come is not immoral. In fact, doing otherwise is also a bioethical error, called dysthanasia.
Dysthanasia is a type of medical obstinacy, the extension of the dying process, not life per se, at the expense of the patient’s quality of life. Reno explains the concept of dysthanasia very well when he describes “an ill-conceived crusade against human finitude and the dolorous reality of death.”
The Catechism teaches on this: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted” (2278).
The problem is that, while there are certainly “ill-conceived crusades” to stave off death at all costs, he is not urging the application of the principle in the correct context. No one is suggesting that we should be overzealous in the medical procedures we use for patients with COVID-19. Reno is applying it in the context of his “society as a living organism” metaphor. He is taking bioethical principles that apply to sick individuals, and applying them to the society that takes care of that individual, as if a quarantine was a “burdensome” and “disproportionate” procedure.
This is not a legitimate extrapolation. As St. John Paul II teaches on this very same topic:
“Euthanasia must be distinguished from the decision to forego so-called “aggressive medical treatment”, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family (…) It needs to be determined whether the means of treatment available are objectively proportionate to the prospects for improvement. To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death.”
— Pope St. John Paul II
Evangelium Vitae, 65
The words, “acceptance of the human condition in the face of death,” seem to validate Reno’s rhetoric about “ill-conceived crusades against human finitude and the dolorous reality of death.” But there is a very important distinction. When John Paul describes the acceptance of human finitude, he is speaking about the prospects for improvement of the patient himself. The disproportionate treatments described in Evangelium Vitae are those that place an excessive burden “on the patient and his family.”
Reno is advocating against placing an excessive burden on society, and not on the patient. The corollary of this thinking is obvious. By lifting this burden from society, we are transferring the burden to the patient himself; someone who will contract the infection when otherwise he would not. By imposing an excessive burden on the patient, Reno’s logic is, in practice, doing the same thing as dysthanasia does.
The problems with Reno’s approach far exceed what is immediately visible. Reno’s readers have, for the most part–and rightfully–rejected his logic as inhumane and immoral. However, there is also the risk of going too far in the opposite direction. Some people might protest members of the medical community when they begin to encounter actual “ill-conceived crusades against human finitude and the dolorous reality of death.” By stirring up emotions in this way, Reno is potentially making it more difficult for doctors to address the bioethical error of dysthanasia in the future, because people will associate these legitimate medical decisions with Reno’s misguided rhetoric.
The moral failure of avoidable triage
Another erroneous extrapolation of bioethical principles employed by Reno is his discussion of triage:
“Others speak as if triage signals moral failure. This is false. We are always doing triage. Only the great wealth of our society allows us to pretend otherwise. We do not spend 100 percent of GDP on healthcare. Even in normal times, we ration healthcare by price, waiting times, and physician discretion. We do not offer organ transplants willy-nilly. Our finitude always requires the hard moral labor of triage. That demand is now more visible, because the potent virus puts great pressure on our immune systems and healthcare systems. But it is always there.”
The above paragraph is true, but once again Reno misapplies the principles. Medical professionals regularly manage the problem of finite resources by taking recourse to triage. And it is also true that the COVID-19 pandemic has brought this reality to the forefront. In the past few days, news have emerged of Italian and Spanish healthcare officials asking their doctors to prioritize healthier and younger patients in the allocation of resources. I have seen many people on social media predictably using this to rail against what they refer to as “socialized medicine.”
The reality is that we live in a finite universe with finite resources. Whether a healthcare system is “socialized” or not, it cannot provide infinite doctors, infinite hospitals, or an infinite number of ventilators. Healthcare systems must prioritize. This is done in situations of calamity, in war, and every emergency room in the world, every day.
If two patients need a ventilator and there is only one ventilator available, we cannot stick our heads in the sand and imagine how good it would be to have two ventilators available. While this is true, reality knocks at the door. A decision must be made. It is sensible to allocate the ventilator to the person with the highest likelihood of survival. Unfortunately, this usually means giving it to the young, healthy person.
But, of course, this is not what Reno is talking about. He is not making an argument about the most efficient way to fight the epidemic. He is not giving his opinion about which patients receive which care. He is suggesting that we abandon the COVID-19 isolation measures. He is railing against the temporary closing of businesses and civic institutions. What does this have to do with the triage of healthcare resources?
Apparently in Reno’s mind, it has everything to do with it. Reno’s reasoning on this issue exemplifies the libertarian notion that if we keep businesses running, they will generate more wealth, which will eventually trickle down, which will result in the production of more resources to fight the pandemic.
This thinking is severely flawed. There is absolutely no evidence that keeping businesses running as usual would eventually lead to more money being allocated to COVID-19 patients. The money generated with these measures might end up anywhere, even in the off-shore account of a billionaire somewhere. As Pope Francis authoritatively teaches:
“In this context, some people continue to defend trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world. This opinion, which has never been confirmed by the facts, expresses a crude and naïve trust in the goodness of those wielding economic power and in the sacralized workings of the prevailing economic system. Meanwhile, the excluded are still waiting. To sustain a lifestyle which excludes others, or to sustain enthusiasm for that selfish ideal, a globalization of indifference has developed”
— Evangelii Gaudium, 54
The truth is that Reno’s proposals will not have the intended effect. There is a reason why medical professionals often nag their patients about taking preventive measures. Even if only a minority of people are able to stop smoking, doctors keep pressing smokers to do so. Why? Because doctors know that preventing a problem is usually cheaper and less cumbersome than correcting that same problem.
Reno seems to envision a society that will go on with business as usual, while only a small minority of people will die. This does not correspond to the truth. There is no way a society could function normally with this type of pandemic raging through it. The spread of COVID-19 is exponential. If we do nothing to stop it, the number of sick people would be so high that it would severely hinder productivity.
Each new case of the virus has costs. There are costs in productivity, of course (whether for the sick person himself, or for a caretaker that needs to take time off work to tend to a sick person), but also costs relative to healthcare resource consumption. What we have seen in countries where the epidemic went out of control was that the healthcare systems were not able to cope with the increased demand that a new and unexpected disease imposed on the systems. Those systems were designed (and sometimes were already straining) to accommodate all the other preexisting diseases which–I must remind you—will not magically disappear just because COVID is at its peak. We must also factor in a reduction in available medical personnel because of the increased number of healthcare workers exposed to the disease.
The collapse of healthcare systems will inevitably result in suboptimal care, even for those who Reno’s ideological compatriots deem more productive. In the end, swamping the healthcare system will result in an even greater need to ration resources. The more patients that overwhelm the hospitals, the more need we will have of triage. Ironically, Reno’s false “triage” will result in a vicious cycle. While Reno is correct that triage is not a moral failure, it is also true that triages that could have been avoided had society acted more responsibly are indeed moral failures. Every death that is due to a lack of medical resources, which could have been avoided with proper safety measures, is indeed a moral failure.
The greater good
Finally, I would like to address Reno’s mistake when he says, “only a small percent of the population of New York is at risk.” This is not true, even if–ironically–Reno affirms that authorities are sacrificing truth by not validating this claim. It is not true that a small percent of the population is at risk, since the entire population is at risk. I assume, however, that Reno means that only a small percent of the population is at risk of dying or of developing serious morbidity from the disease. Statistically this is true. But is it legitimate, from a Catholic perspective, to sacrifice this “small percent of the population” so that Reno may continue to enjoy the social functions that the COVID-19 restrictions are making him miss?
Here, Reno falls into the classical confusion between “common good” and “greater good.” The former is a Catholic value, whereas the latter is not. Advocates for the greater good argue that the wellbeing of the minority must be sacrificed for the good of the majority. This is a utilitarian concept, and certainly not Catholic.
Catholicism is much more radical. It concerns itself with the common good. In Solicitudo Rei Socialis, Pope John Paul II defines the common good as “the good of all and of each individual.” No exceptions.
The pontiff then contrasts the common good with “structures of sin,” amongst which is counted the “all-consuming desire for profit.” On the contrary, the common good demands “a diametrically opposed attitude: a commitment to the good of one’s neighbor with the readiness, in the gospel sense, to ‘lose oneself’ for the sake of the other instead of exploiting him, and to ‘serve him’ instead of oppressing him for one’s own advantage.” According to the principle of the common good, “we are all really responsible for all.”
The Compendium of the Social Doctrine of the Church further explain on this concept of the common good:
“The common good does not consist in the simple sum of the particular goods of each subject of a social entity. Belonging to everyone and to each person, it is and remains “common”, because it is indivisible and because only together is it possible to attain it, increase it and safeguard its effectiveness (…) Moreover, it must not be forgotten that in the democratic State, where decisions are usually made by the majority of representatives elected by the people, those responsible for government are required to interpret the common good of their country not only according to the guidelines of the majority but also according to the effective good of all the members of the community, including the minority”
— Compendium of the Social Doctrine of the Church, 164, 169
The same Compendium goes on to say that the “responsibility for attaining the common good belongs also to the State, since the common good is the reason that the political authority exists.” This runs counter to the fears Reno expresses in another article, where he (quoting a friend) suggests that the government mandated restrictions will result in an “indirect socialism.” Here we can perceive what Reno’s real problem is: as a conservative and economic libertarian, he is suspicious of any kind of state interference, even when (as is the case now) such regulations are perfectly justifiable and understandable to anyone whose common sense is not clouded by ideology.
What Reno is saying is not what Catholicism teaches at all. By trying to hammer Catholic and medical principles into his ideology, in an attempt to masquerade his politically-driven conclusions as consistent with Catholicism, he ends up muddling a series of concepts that cannot be wielded in the way he intends to.
According to Catholicism, society is a moral organism, not a living one (as Pius XII teaches). And society acts as a moral organism precisely when it works to bring about the common good:
“Just as the moral actions of an individual are accomplished in doing what is good, so too the actions of a society attain their full stature when they bring about the common good”
— Compendium of the Social Doctrine of the Church, #164
Saving all lives at all costs
Since the common good is defined as the good of all and of each individual, does this mean that we need to save all lives at all costs, as Reno accuses? My years of medical practice have shown me that I need to be realistic: not all lives can be saved. Yet, even if we cannot save all lives, this does not mean that we should not strive for the common good as our aim.
And this is where Reno’s argument fails spectacularly. He could certainly emphasize the economic and social costs of the COVID-19 measures, but the way he does this backfires. As Brian Killian said in an excellent Twitter thread:
“You could argue that the cure is worse than the disease, but it has to be based on the same impulse behind the cure – the protection of human life and the common good. You can’t subordinate human being to the stock market (…) If there’s an economic argument to be made it’s because the economy affects human life, not because the economy is more important than human beings”
But Reno doesn’t do this. He is not providing an argument, he is simply mocking the idea of “saving lives.” The question of the economic and societal impact of the quarantines is a serious concern and, therefore, mandates a serious debate. However, Reno has not contributed to that debate, since his line of reasoning is, ironically, filled with the same sentimentalism he accuses others of having.
It is sentimentalism to argue that measures taken to avoid the spread of a deadly virus are somehow counterbalanced by Reno being able to host a small dinner party, or by young people being able to play basketball in a New York City park, as he argues. It is sentimentalism to play the victim card for being glared at as a “moral criminal” for — I kid you not — spitting into the street. And it is sentimentalism to sabotage a life-saving contingency plan designed by leaders, public health officials, media personalities, and clergy, by creating this false dichotomy: “What about justice, beauty, honor, and truth?”
What about justice, beauty, honor, and truth indeed? Those values are not a list of disembodied and abstract ideals: they must exist in connection with something tangible, otherwise we veer into sentimentalism. As Pope Francis teaches in Evangelii Gaudium, one of the principles that guides the development of society and orients it toward the common good, is that “realities are more important than ideas.”
There is no justice, nor beauty, nor honor, in artificially maintain societal functioning at the expense of the death or suffering of thousands of people. Also, his proposal is clearly not based on truth, because it grossly misrepresents Catholic, medical, and bioethical principles. And his ideas are disproven by sound medical expertise and authoritative magisterial teaching. So no truth in his reasoning.
However, opposing his ill-informed arguments is indeed based, not on sentimentalism, but on justice, honor and truth. And no one can say that there is no beauty in the solidarity that so many people have shown by abiding by these life-saving safety measures.
It is not sentimentalism that drove me to write this article, but Christian charity and my duty as a professional in the field of medicine. The World Health Organization has brought attention to the dangers, not only of the epidemic itself, but of an “infodemic” of false information regarding COVID-19. Similarly, an “infodemic” of sorts has been spreading throughout formerly Catholic media since the election of Pope Francis (and arguably even before). I hope that Reno’s scandalously irresponsible articles will serve as a wake-up call to many who, affected by the disease or not, will see the fallibility of these pundits and publications, and will return instead to full communion with the Vicar of Christ and the Successors of the Apostles, as well as to a healthy trust in their healthcare professionals and health policy makers. Human lives, justice, beauty, honor and truth are all at stake, now more than ever.