Reelin’ In The Years: Age and Selective Restriction of Liberty in the COVID-19 Pandemic

The pandemic experience has raised the question of whether and to what extent freedom restrictions can be applied unequally during future public health emergencies.

Despite lockdown stemming the tide of initial COVID-19 deaths, lockdown measures imposed a considerable cost on society. The COVID-19 virus inflicted a significant cost in terms of lives lost. Lockdown measures resulted in substantial job losses, a global recession, and deteriorated physical and mental health, causing substantial death and disability (Rogers and Cruickshank 2021; Banks, Karjalainen, and Propper 2020). For the purposes of this article, “lockdown” refers to mandatory stay-at-home orders and subsequent closure of businesses. Legal mandates were introduced given anticipated challenges in ensuring continued effectiveness and widespread compliance in an ultimately enduring emergency (Murphy, et al. 2020).

In 2020, Savulescu and Cameron argued for selective lockdown of the elderly, avoiding the need for a population-wide lockdown by isolating only those most at risk of COVID-19 hospitalisation and subsequent use of healthcare resources. This solution would allow social and economic activities to continue while offering a significant degree of protection to the most vulnerable groups (Williams, et al. 2021). Lockdown measures and their hitherto unquantified societal, psychological, and economic costs would be largely avoided.

Other authors have argued that this age-based lockdown may set a precedent for discrimination in future public health emergencies (Blunkett 2020). Taking selective lockdown of the elderly to its natural endpoint provokes discussion about selective lockdown of those with other morally relevant characteristics. In particular, individuals of certain ethnicities, sex, disability, immune-status, or Body Mass Index (BMI) also have an increased risk of hospitalization from COVID-19 and presumably hitherto unknown infectious diseases (Humberstone 2020).

If COVID-related risk profile is considered the relevant criterion for targeting population groups in selective restrictions, the liberty of which groups should be restricted? That is, assuming restriction of liberty is justified in the COVID-19 context (an assumption we will not discuss here), who—if anyone—should be coerced?

Savulescu and Cameron (2020) rejected criticisms of ageism, understood as unfair discrimination on the basis of age. That is because, they argued, discrimination is only unfair when it is based on arbitrary, morally irrelevant traits and contributes to making someone worse off than others. But increased risk of disease and pressure on limited health resources are morally relevant characteristics that can, in certain circumstances, make age-based discrimination not unfair. The possible implication that we should also restrict people’s freedom on the basis of their ethnicity, sex, or other problematic characteristics has not been properly addressed. One worry is that this policy might result in racist, sexist, or otherwise ethically problematic forms of discrimination. In this paper, we argue that age has meaningful differences as a morally relevant characteristic in restricting liberty.

In light of the ensuing discussion about whose freedom to limit, and the risk of unfair discrimination that comes with treating different groups unequally, there is a question to be asked as to whether and when targeted public health restrictions might open the door to unfair discrimination and more specifically to ageism.

Addressing all the nuances that define ageism and make it ethically and socially problematic (Levy and Macdonald 2016) would require a separate discussion that is beyond the scope of this paper. For example, there is a discussion as to what counts as old age (Giles and Reid 2005). However, we will discuss features of differential treatment that would make a policy ageist, and we will argue that they do not apply to age-based restrictions in the case of a pandemic like COVID-19.

We offer four moral domains that separate age from other proxies and which we will call, respectively, empiricism, operationality, discrimination, and disparity. Lockdown measures, although increasingly irrelevant for the now endemic COVID-19 pandemic, may be brought back to the table by policymakers to tackle potential future pandemics if healthcare systems are placed at risk. It can be debated whether protecting healthcare systems should be a priority of government response to pandemics or other public health crises; however, as a matter of fact, this often was presented as the rationale behind tight restrictions, which suggests that it will likely be considered a priority in future public health emergencies. As we move beyond COVID-19, restrictions for public health purposes will remain—rightly or wrongly—an option on the table of policymakers. And with it, the ethical issue of fairly applying freedom restrictions across a population will arise.

Previous authors rightfully draw attention to increased elder abuse, nursing neglect, and suicide rates among the elderly during lockdown, which may contrast the perceived benefits for the elderly of age-based restrictions in terms of protection from the virus (Giri, Chenn, and Romero-Ortuno 2021; Yunus, Abdullah, and Firdaus 2021; Sarangi, Fares, and Eskander 2021). These challenges are valid, but they are reasons against lockdowns in general, not against selecting upon age itself. These problems are not necessarily worsened by age-based lockdown. In this article we will not provide arguments for or against freedom restrictions in general. Instead, we will argue that if freedom restrictions in the form of lockdowns are (rightly or wrongly) adopted, age-based lockdowns are not unfairly discriminatory when tackling a virus like COVID-19 that threatens the elderly far more than it threatens the young.

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