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If I'm Old During the Next Pandemic
A snippet from my living will
The Great Barrington Declaration famously advocated replacing conventional anti-Covid policies with “focused protection”:
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
A standard objection zeroes in on these “multi-generational households.” If a sick grandpa lives with his children and grandchildren, how can the family live normal lives and protect him at the same time? The obvious answer is: “They can’t do both. Instead, they’ll have to strike a compromise.”
The obvious objection to the obvious answer, however, is: “Many elderly people are too confused to prudently tailor their behavior to risk, much less thoughtfully bargain with younger family members.”
Yet here, too, there is an obvious answer to the obvious objection to the obvious answer. Namely: Hammer out a contingency plan now while you’re still sharp enough to do so. Prudent people already write living wills to pre-answer tragic dilemmas before they arise. Why not write a Pandemic Provision right here, right now, so your family knows your wishes?
To get the ball rolling, here is my personal Pandemic Provision:
I, Bryan Caplan, being of sound mind, have thought long and hard about what how I would like to be treated during any future pandemic. Above all else, I absolutely do not want to be isolated from my children and grandchildren for a year, a month, a week, or even a day. I strongly prefer to assume the risk of death by infection in order to continue living a meaningful life, even if the risk is dramatically higher than Covid ever was.
I also strongly encourage my younger relatives to continue to see all of the friends that are willing to see them. Indoors or outdoors, masked or unmasked. Don’t worry too much about me. Live your life as fully as you can. If you want to avoid big indoor parties, I mildly appreciate your sacrifice, but I definitely don’t insist on it.
If there are low-cost ways to substantially reduce my risk, strongly encourage me to adopt them. Obviously try to vaccinate me ASAP, but don’t stop there. If, for example, my weight is a serious risk factor (as with Covid), then immediately put me on a low-calorie diet. Don’t starve me; just give me the minimum amount of calories I need to avoid feeling hungry.
If, due to diminished mental capacity, I request higher levels of caution, just smile and ignore me. I know now what will be best for me then.
In the unlikely event that effective vaccines can be expected to arrive at historically unprecedented speeds, please maximize my quality-adjusted lifespan, assigning the following values:
(a) Every day of full isolation is worth negative 1 days to me.
(b) Every day where I am isolated with my family is worth .5 days to me.
Suppose, for example, that the future pandemic has a 10% Infection Fatality Rate for my age, and I am otherwise expected to live for 10 additional years. Full isolation reduces my annual probability of infection from 50% to 0%. Family isolation reduces by annual probability of infection from 50% to 40%. You know for sure that I can be vaccinated in half a year, so my six-month infection probability either goes from 29%—>0% or 29%—>23%.* Then we have two scenarios:
Scenario #1: Full isolation for six months. This reduces my quality-adjusted lifespan by a full year (since I actually assign negative value to this experience) in order to save the subsequent 9.5 years with a 10%*29% probability, an expected value of 101 days. Don’t do it.
Scenario #2: Family isolation for six months. This reduces my quality-adjusted lifespan by .25 years (since I value the six months at 50%) in order to save the subsequent 9.5 years with a 10%*6% probability, an expected value of 21 days. Don’t do this either.
Despite the deliberately extreme pandemic scenario, then, I prefer normalcy.
If the future pandemic kills me, please remember me as someone who loved life, family, and friends too much to endure for a second time the dehumanizing dystopia of Covid. I love you all, and as they say in the fictional universe of The 100 (look it up!), “May we meet again.”
* The math: An annual infection probability of 50% implies a 6-month infection probability of 1-(.5)^.5=29%. An annual infection probability of 40% implies a 6-month infection probability of 1-(.6)^.5=23%