If Only...

 One of the more baffling displays of culture wars run amok happening in my home town in Florida right now is the campaign that far-right officials have waged against the local hospital for its handling of the COVID-19 crisis. Their objection? That the hospital did not dose patients with experimental pseudo-treatments with no support from the FDA but an ardent following on the political right: things like the horse de-worming medication ivermectin and the anti-malarial drug once touted by Trump, hydroxychloroquine. No matter that a hospital needs to follow scientific advice on how to treat its patients or else risk liability. The facility and its staff were nevertheless put through the wringer merely for complying with FDA guidelines. 

In trying to understand how such an absurd controversy could even begin, my mother made a helpful observation: a lot of the local people leading the charge had lost loved ones to the pandemic. And, in a state of personal grief, it is easy to become obsessed with the haunting question of whether things could have gone differently: whether there was not some one thing that one could have done that would have prevented the catastrophe. Would my family member still be alive, people would ask themselves, if only the doctor had been willing to think outside the box--if only they had been willing to try one of these other less popular or mainstream treatments? 

It's not surprising or reprehensible in the slightest that people would think this way in a state of grief--it's only human. What's disgraceful is that right-wing politicians are willing to exploit these feelings and doubts to their own advantage. Yet doing so has become a standard MO for Republicans nationwide--and not only on the subject of public health. They apply the same tactics to each new controversy that becomes freighted with culture war significance. 

On the issue of undocumented immigration, Republicans find people who lost loved ones to drunk drivers who happened to not have papers, for instance. "If only," the politicians encourage them to think, "If only that person hadn't been in the country at the time... my loved one might still be alive." Anti-vax advocates likewise find parents of children suffering rare medical conditions and implant or at least nurture the suspicion: "If only I hadn't taken my child to get that shot.... would all of this be different? Would none of this have happened?" It's the exact same playbook as with the ivermectin controversy: "If only the doctors had let them try this... would they still be alive?"

Such doubts operate on the fact that every event that occurs is the result of an infinite series of prior causes. It is always true with any tragedy, therefore, that if some handful of minor circumstances had been slightly altered, things would have turned out differently. It is true for instance that if a drunk driver hadn't been in the country at the time they accidently hit someone, the loss would never have occurred. But this is true whether or not the person was undocumented; and the same could be said of every other circumstance that contributed to the disaster: the fact that they were drinking; the fact they were on the road that night, etc. 

So too, if someone develops an extremely rare negative reaction to a vaccine, then it is true to say: "if only they hadn't had that shot, they would still be okay." But the point is that a negative reaction to a vaccine is far less likely than a negative consequence of not getting the vaccine. For every individual whom anti-vax advocates are able to find who has a horror story to tell about a side-effect (or an imagined or purported side-effect) of getting the shot, therefore, there will be thousands more with an even ghastlier tale of the loss that resulted from choosing not to get the vaccine. It is a point Benjamin Franklin made all the way back in the eighteenth century, in a passage from his Autobiography: 

In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.

This is exactly the truth. It is impossible through any course of action to perfectly eliminate the danger of unforeseen consequences and side-effects of our choices. Either way may lead indirectly to loss, because the future is contingent and unknowable. And if either path indeed does result in loss, we will be left with the same haunting doubt: "if only I had taken the other course, then this disaster would not have occurred." But since either path may lead to the same outcome, as Franklin points out, the only choice we have is to decide based on which path seems least likely, which is to say, least foreseeably, to lead to danger. 

When it comes to vaccines, then, it is impossible ever to rule out entirely the risk of a harmful side-effect, at least not with absolute 100% certainty--because nothing in empirical science is ever as certain as that. But the evidence is overwhelming that the danger of not taking the vaccine is much higher. And, as Franklin says, since "the regret may be the same either way [...] the safer should be chosen."

So it is with everything in the right-wing culture war playbook described above. Could it be true that a timely dose of ivermectin, by some inexplicable twist of physiology not currently explicable in the present state of our knowledge, might save an individual life? Of course it's possible-- our knowledge is always imperfect, and no one can foresee every conceivable indirect outcome of a given course of action, because the indirect effects of everything are infinitely ramifying. So too, it is true that if a given undocumented driver had not been in the country at the time of a specific accident, that tragedy would not have occurred. But the driver might just as well have been a U.S. citizen. 

It is for these reasons that we must confine ourselves, in forming moral and prudential judgments, to the domain of the foreseeable. This is why, in the law, we distinguish between a "but-for" cause and a "proximate" cause. Every event, after all, has innumerable "but-for" causes." "But for that man not being in the country, my child might still be alive!" The question, though, is whether the outcome was reasonably foreseeable. And to establish this, it would be necessary to show not only that a given drunk driver was undocumented, but that there was some statistically-predictable causal relation between being undocumented and driving under the influence--and there is manifestly not. For every undocumented drunk driver, there are no doubt so many more U.S. citizen drunk drivers, in proportion to their greater share of the population--the two variables (drunk driving and immigration status) are simply independent of one another. 

An illustration that probably will not be making its way into any law review articles anytime soon occurs in the thirtieth anniversary Power Rangers special that recently aired on Netflix--which a friend coaxed me into viewing as an exercise in thirty-something millennial nostalgia. In this feature, the erstwhile Blue Ranger Billy attempts to restore his beloved former mentor Zordan to life--but ends up resurrecting the villain Rita Repulsa instead. This leads to the death of the Yellow Ranger, Trini (portrayed in the original series by Thuy Trang, who tragically passed away in real life in a car accident in 2001). Trini's daughter, Minh, therefore grows up resenting Billy for the death of her mother, and, in an emotionally-charged scene, she hurls at him the charge that it was his choice that caused her death. 

What her accusation really amounts to, of course, is pointing out that Billy's actions were a "but-for" cause of her mother's death. This is true, according to the show's plot. It is not fair to suggest, however, that his actions were a proximate cause. And Minh, in eventually reconciling with Billy, comes to appreciate this fact, by the end of the hour-long special. She acknowledges that he couldn't have known what would happen, and that it therefore wasn't his fault. 

The central characters of William Maxwell's novel They Came Like Swallows--about the 1918 flu pandemic-- come to the same conclusion as Minh, after wrestling with the same doubts. After losing his wife to the disease, the husband and father of the novel's central family obsessively replays every minor "but-for" cause that might have led to her death: their choice to take a particular train ride on which his wife might have caught the contagion, for instance. In ruminating ceaselessly on what might have gone differently, and how he might--by the smallest change in his action--have prevented the tragedy that ultimately occurred, he is essentially going through the same mental operation that is haunting the family members of patients who died of COVID-19, and who are now beset by the doubt (fostered by right-wing politicians) that "if only the doctor had tried ivermectin..." It is the same obsessive line of questioning that drives people to think: "if only that undocumented driver had not been in the country..."

But the point, the husband in Maxwell's novel eventually realizes, is that the "but-for" causes of tragedy are not ultimately what matter. "Neither Robert nor anyone else was responsible for Elizabeth's death," he realizes. "And anyway, it was what people intended to do that counted--not what came about because of anything they did. James saw that, clearly." In other words, James is realizing that, whatever actions one may have performed that indirectly served as a but-for cause of what ultimately came about, one cannot be held morally responsible for them so long as these results were neither intended nor reasonably foreseeable. This is what Minh comes to realize too, and what prompts her to forgive Billy at last. "It was what people intended to do that counted--not what came about because of anything they did."

If only our right-wing politicians would learn the same moral lesson...