Within days of being declared the presumptive winner of the presidential race, President-elect Joseph R. Biden Jr. had assembled a coronavirus task force that will, in his words, “help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.” This is not a surprising development; it makes good on one of his central campaign promises, which was to construct a national Covid-19 strategy based on public health expertise that would finally bring this deadly pandemic under control.
The population most at risk of death from Covid-19 infections is the elderly. It is alarming, then, that President-elect Biden has chosen Dr. Ezekiel Emanuel to be a key player in guiding national policy as a member of his transition team’s Covid-19 task force. Although Dr. Emanuel is certainly a well-credentialed expert—a Harvard-trained physician and political philosopher, a prolific researcher in medical ethics, and the current chair of the department of Medical Ethics and Health Policy at the University of Pennsylvania—his attitudes toward the elderly and disabled ought to be disqualifying. As a moral philosopher who often teaches Dr. Emanuel in my medical ethics courses at the University of South Carolina, I am dismayed by Mr. Biden’s choice.
Although Dr. Emanuel is certainly a well-credentialed expert, his dismissive attitudes toward the elderly and disabled ought to be disqualifying.
Dr. Emanuel is widely known for his dismissive attitudes toward the elderly and disabled. In a 2014 article in The Atlantic, provocatively titled, “Why I Hope to Die at 75,” he describes elderly people as “no longer remembered as vibrant and engaged but as feeble, ineffectual, and even pathetic”; he therefore does not wish to be in their ranks for very long. His basic argument goes like this: Because of advances in medicine and technology, many Americans are living much longer than before. Dr. Emanuel questions whether this newfound longevity is positive because our elderly years are likely to involve disability and loss of function. Dr. Emanuel expresses a special horror at the prospect of cognitive disability, which he describes “as the most dreadful of all possibilities.”
When we become old, frail and dependent, Dr. Emanuel questions whether “our consumption is worth our contribution.” For Dr. Emanuel, it seems, a human life is valuable and meaningful to the extent that it is productive and creative; whereas children are potentially useful workers, old people are simply past their prime.
Even after facing widespread criticism, Dr. Emanuel did not temper his position. In a follow-up interview in 2019, he was asked about healthy elderly people who still enjoy activities like hiking, spending time with family or engaged in enjoyable hobbies. In response, Dr. Emanuel laments that “when I look at what those people ‘do,’ almost all of it is what I classify as play. It’s not meaningful work.” He goes on to conclude that if a person’s life is devoted to such activities it is “probably not a meaningful life.”
For Dr. Emanuel, it seems, a human life is valuable and meaningful to the extent that it is productive and creative.
Such attitudes toward the elderly are inhuman because, at bottom, they rest upon a profound self-deception. As the philosopher Alasdair MacIntyre has forcefully argued in his book Dependent Rational Animals, we humans are not essentially independent or autonomous. To the contrary, we can only reach our potential within communities where we can depend on the care and help of others throughout our lives. This dependence is especially manifest at the beginning and end of our lives, when we are most vulnerable and weak. But even in the prime of our lives we must recognize the networks of dependence that make our flourishing possible. As accomplished as he is, Ezekiel Emanuel did not spring fully formed from the head of Zeus like Athena, nor are his current accomplishments entirely his own.
When we acknowledge our human vulnerability and interdependence—then we should be able to recognize that the disabled or infirm are not “other” from us at all, since their immediate vulnerability and need was once and, if we are lucky, at some point will again be our own. Because we are dependent rational animals who can only flourish within communities of reciprocal care, we need to develop what Professor MacIntyre calls “the virtues of acknowledged dependence.” These virtues are dispositions to recognize and appreciate our vulnerabilities and dependencies and to respond to them appropriately.
In Professor MacIntyre’s view, vulnerability and weakness are essential to human life; therefore, we should not fear but embrace our dependence, since it affords all of us the opportunity to cultivate and exercise virtues that center around the essential work of caring for others, without which none of us could develop properly or flourish.
Because we are dependent rational animals who can only flourish within communities of reciprocal care, we need to develop what Alasdair MacIntyre calls “the virtues of acknowledged dependence.”
Dr. Emanuel’s horror at the prospect of becoming dependent, frail and, God forbid, unproductive, reflects an alienated and self-deceived condition. Dr. Emanuel wants to insist that not only he is not like them, those burdensome elderly people living largely meaningless lives, but he will do what is prudent to avoid staying among them for too long. Beginning at 75, he will refuse treatments or interventions to preserve his health. He wants to be remembered by his children as “independent” rather than as a “burden.”
Defenders of Dr. Emanuel will argue that he is only articulating his own personal preferences and that what he says has no obvious policy implications for this pandemic. I fear this view is deeply naïve. Dr. Emanuel is not saying that he happens to personally want to die at 75, the way someone might happen to prefer chocolate ice cream rather than vanilla. Rather, he is making an argument about how any rational person should feel about growing old and dependent, and he wants to convince his reader that his position is the correct one to take.
Moreover, Dr. Emanuel’s inhuman attitudes about the elderly and disabled are evident in his work on health care rationing in a pandemic. In scholarly articles and an op-ed in The New York Times, he outlines a case for rationing health care in favor of those who have the best chance of survival. This, of course, is to advocate for discrimination against those who are most vulnerable in this pandemic, and it is clearly rooted in his perceptions of their quality of life (or lack thereof).
We should consider how the choice of Dr. Emanuel exacerbates the shame that our most vulnerable already feel about their own frailty.
We should also consider how the choice of Dr. Emanuel exacerbates the shame that our most vulnerable already feel about their own frailty. In a wrenching and beautiful essay, Ian Marcus Corbin, a postdoctoral fellow at Harvard Medical School, describes his interactions with patients struggling to recover from stroke. Mr. Corbin speaks movingly of the shame they feel over their incapacities and how this shame forces them into forms of isolation that can be detrimental to their recovery and overall health.
Mr. Corbin warns us that stroke victims have internalized the pervasive assumption that “mastery is our natural, proper condition, and if you aren’t capable of it, you’re defective.” But while mastery is an accomplishment, he says, it is “achieved only temporarily and with tremendous help from other people.” Mr. Corbin argues that we must not lose sight of the fact that what makes humans unique, both from an evolutionary and anthropological perspective, is the extent to which we have always placed caring for our vulnerable at the center of our lives. Our weakness is nothing to be ashamed of—to the contrary, it is our strength.
Finally, we should question Dr. Emanuel’s assumptions about what makes for a meaningful human life and the pre-eminent value he places on work as a measure for this. While work provides most people with the resources they need to sustain themselves, few of us consider work to be what we live for or what gives our life its highest meaning or purpose. People work so that they have the freedom to enjoy what they truly love: spending time with loved ones (perhaps, yes, in festive modes of play), contemplating what is beautiful or worshiping what they consider divine. At the end of their lives, people do not wish to be surrounded by trophies or other tokens of accomplishment but by the people they have loved and cared for, and who have loved and cared for them in return.
President-elect Biden has elevated Ezekiel Emanuel into a position of power and authority, during a time when the anxieties of our most vulnerable are understandably heightened. But when it comes to knowledge of humanity, Dr. Emanuel has proven that he is no expert at all. His ideas about the value of human life are not only shallow and profoundly wrong but potentially deadly for many vulnerable Americans.
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– Who goes first? The ethics of distributing a Covid-19 vaccine.
