Change the Moral Calculus

October 14, 2014

I guess I’m trying my hand as a public commentator, because I now have a second piece in Slate. Check it out here. Also, here’s an excerpt:

After the Dallas Ebola patient Thomas Eric Duncan died last week, public comments ranged from expressions of sadness and condolences to his family to vitriolic condemnations of his behavior for lying to airport screeners. It may be helpful to revisit the rationale that likely brought him here, especially in light of the Centers for Disease Control and Prevention’s new airport screening procedures, as well as Liberia’s and Texas’ earlier proposals to prosecute Duncan for evading airport checkpoints. Thinking carefully about his mindset can help us understand how better to address this outbreak and keep it from spreading further.


One method of encouraging honesty is to change the self-interest calculus: to penalize those who lie, as was proposed by Liberia and Texas. But if that calculation is off—if, for instance, the stakes are so high that the penalty is not a real penalty in comparison—then there is little risk to the self-interested party. “If I lie, I may survive. If I don’t lie, I stand a much greater chance of staying behind and dying.” Even if you do not believe that you have contracted the disease, there are plenty of excellent reasons, including the collapsing infrastructure of Liberia and ongoing risk of contracting the disease, to leave the country immediately.

A different, but no less important, method of encouraging honesty, however, is to change the moral calculus so that there is no reason to lie. This, remember, is not about shifting one’s calculations of self-interest, but rather about demonstrating that the best, most careful way to keep other people safe is to seek help from competent medical professionals immediately.

This is yet another reason why it is critical to address the Ebola epidemic swiftly and immediately in West Africa. We need to set up non-threatening isolation units and care facilities so that the clearest path for keeping other people healthy—families, loved ones, neighbors—is to enter isolation voluntarily and not to make the trip to other better facilities. What this means, frankly, is that to keep the infection in West Africa we must bring the full expertise of our medical system to West Africa. Any lesser option will permit and encourage more accidental transmissions across borders.


  1. I just read your article on Slate.

    Perhaps you have sources of information on the extent of Duncan’s involvement, or his motives, not generally available to Internet news source readers.

    This seems likely to be so since so many other major news sources are and have been reporting that Duncan traveled in a taxi with the Williamses as they first sought treatment in an unnamed clinic, and when transfusing treatment there did no good and she deteriorated markedly (L.A. Times), were directed to go off in search of of an ebola treatment unit.

    Duncan, reports say, (including one of your own AP links if you even read through it) did more than compassionately touch an arm, as you so winsomely put it, but is widely reported as carrying Marthalene and accompanying the Williamses on their taxi ride to the clinic where she was transfused; on to JFK hospital and its ebola unit (NYTimes), which had no beds; andeither prior or subsequently, to other ebola units as well.

    Yet you write:

    “He briefly assisted his neighbor, a 19-year-old Ebola-infected pregnant woman, as she climbed into a taxi.

    It is hard to blame someone for such a brief and noble encounter. Here is a sick young woman who needs help getting to a hospital, but who is too weak to climb into a cab on her own. There he is, standing nearby. Who would not help? Who would recoil and refuse to assist an ailing friend?

    And besides, it was just a brief encounter. The opening of a door. The holding of an arm. The making comfortable.”

    Since you seemed quite diligent in providing links ostensibly supporting other of your fact contentions, perhaps you would do so now regarding the “fact” that Duncan merely touched her arm after he happened to be standing nearby.

    Because many of the news reports I have read made it plain that the Williams family was his landlord, and that Duncan was asked to go with them, that he helped to bodily carry her, and that he may well have done so reluctantly, because could hardly refuse being he was their tenant.

    These reports alone do not make him noble nor ignoble; but they rebut your predicate, or insinuation, that he was a noble and disinterested party to it all.

    Looking forward to your cites. After all you are a professional.

  2. Even accepting relatively involved engagement on Duncan’s part doesn’t change the argument in the article.

    Though actually, I don’t think that this claim is supported by the article you cite. Here’s what the article says:

    Thomas Eric Duncan rushed to help his 19-year-old neighbor when she began convulsing days after first complaining of stomach pain. Everyone assumed her health problems were related to her being 7 months pregnant.

    Soon Duncan, Marthalene Williams’ parents and several others tried to hoist her into a taxi cab bound for a hospital downtown…

    …”My pa and four other people took her to the car. Duncan was in the front seat with the driver and the others were in the backseat with her,” recounted her 15-year-old cousin Angela Garway, standing Thursday in the courtyard between the homes where they all lived. “He was a good person.”

  3. Just for the record, that quote I “cited”, was actually from the article you had linked to, but which did as much to undermine your fact outline, as to buttress it.

    I referred to the Los Angeles Times and The New York Times, as two of the numerous sources for information that Duncan had had prolonged physical contact with her, while he and her family sought her admittance to ebola treatment units.

    Now, as for your “moral” argument reasoning, and your ratio decidendi, so to speak, floating unmoored from your summary: with that, I would agree.

    Makes one wonder why you bothered to present an ostensible fact situation in the first place. Sort of like having premisses irrelevant to your conclusion, isn’t it.

    Well, it’s apparent you really haven’t covered the matter in question, and that your argument hasn’t anything to do with the actual facts one way or another.

    I’ll let it drop at that.

  4. Thanks for your contribution.

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