Leonard Lades asks the question:
Should we trade off physical health outcomes (including potential deaths) with mental health outcomes (including subjective well-being and mental health issues) when deciding about the strength of isolation policies? For example, the policy to not allow people to sit in parks likely reduces the spread of the virus but also takes away the joy of being outdoors or in nature with its potential detrimental mental health benefits. Are there ethical concerns when making such trade-offs?
Another reader asks a similar question:
Is it more important to stop the harmful effects of the pandemic at all costs even without considering the psychological damage of many people susceptible to prolonged confinement?
Marinus Ferreira responds, saying why we shouldn't think of the decision to lock people down as a trade-off, because making a trade-off requires knowing how much physical well-being you would get from giving up some amount of mental well-being, but we don't know enough about COVID-19 for that to be the case. He goes on to describe what we're doing instead: deciding which risks we are willing to take on in our response to the pandemic.
The question is about how we could decide whether and how to trade off increases in physical well-being (from more severe restrictions to tamp down on the spread of COVID-19) with decreases in mental well-being (from the psychological strain of living with the restrictions). This is a very good and very difficult question. What I'm going to say here is mainly that at the moment we don't know enough to be able to make such trade-offs. The idea is that not every choice between two different bundles of goods is a trade-off, because a trade-off requires a measured exchange of bits of one bundle of goods for another, in this case trading mental for physical well-being. But we don’t know what the results of our actions regarding COVID-19 are, so we don’t know what we will get in exchange for giving up some things, so we are not making trade-offs. As such, the issue to consider isn't 'what trade-offs are worth making?', which we can't answer, but 'what risks are we willing to take while responding to this crisis?'.
Firstly, in Ireland at least, we are luckily not in the situation where we are entirely cut off from our access to the outdoors. Ireland does allow and indeed encourages people to go enjoy the outdoors as much as they are able, as long as they don’t travel more than 2km to do so. The restrictions in Ireland are still less than in places like Italy and some parts of the US, where people are not encouraged to do even this. So, there are some ways authorities like the Irish government can choose options which don't do as much as it could to preserve physical well-being, partly because other options do better for mental well-being. But this shouldn't be understood as a trade-off in any real sense. For one thing, physical and mental well-being aren't disconnected from each other. One reason for this that is easy to see is that physical illness often leads to mental illness, and vice versa as well. In particular, that very often illness (your own or those of people around you) is traumatic. This is part of what happened with the Spanish Flu of a century ago; in some places, like much of the US, there was a first wave in 1918 which was met with restrictions we’d find familiar: schools were closed, large public gatherings were banned, and so on. But these restrictions were lifted too soon in some places, and there was a second wave of infection in 1919, which in many places was worse than the first wave. The resulting epidemic lead to a generational trauma from the enormous amount of death and disruption this two-year pandemic caused. In that case, governments made a choice that provided neither physical nor mental well-being.
So, the choice between more and less restrictive options isn't really a trade-off, because we don't know enough to be able to make a trade-off. To sensibly do so I need to know how I can get the most physical well-being, and know how much of that I give up when I do things like loosen the restrictions, and I also need to know what would give me the most mental-well-being, and how much of that I give up when I do things like insist on more stringent restrictions. But nobody at the moment knows what the outcomes of the various approaches to handling COVID-19 are; that is something we will only be able to know after the fact, only after the decisions and their consequences have all come to pass. So, even if I put the two different bundles of goods in play next to each other, I can’t make a trade-off between them, because I can’t make a measured exchange of some amount of physical well-being for some amount of mental well-being. As the Spanish Flu example shows, I can’t even know that loosening the restrictions will actually provide better mental well-being; it may counterproductively do the opposite.
If we aren't able to sensibly make trade-offs, what are we doing? We are instead deciding between options based on what risks we are willing to take on, where the risks are understood not just as higher or lower but each one having a distinct character. Consider the decision to allow the Cheltenham horse racing festival and not trying to quarantine or contact trace the people who went to go ahead. At that stage, it was not yet known how many people in the UK and Ireland were likely to be infected, nor how much an event like that would contribute to the spread of COVID-19. People who asked for the event to be called off didn't want to take the risk with people's health; the officials at Cheltenham and the authorities didn't want to risk the disruption and disaffection from interfering with people’s business and entertainment. Nobody doubts, not now or then, that the possible harm to public health was far more serious than the disruption of cancelling Cheltenham (that is why all such events are now banned for the foreseeable future), but by the same token it wasn't known how much of a contribution Cheltenham would make to a public health crisis. The risks from interfering and not-interfering were different: one with serious harms but uncertainty about how likely it is to arise, and the other with noteworthy but clearly less serious harms which would be certain to arise. To make a clearly correct choice between them would require knowing the likelihoods of the actions of the two, like people are taught in decision theory and economics and similar fields, but even now we don't know those likelihoods. This isn't a trade-off: it's a choice between two distinctly different kinds of option. Just so with the decision between the relatively certain and relatively lower harms that comes from the stress and uncertainty from imposing restrictions to slow the spread of COVID-19 and the relatively uncertain but much greater harms of opening society back up while the virus could still explosively spread. Given what we have seen the effects of COVID-19 has been in places with fewer restrictions, the explosive growth in COVID-19 infections we saw earlier this year is no longer something the Irish and UK governments are willing to risk happening are willing to take.