Viral Responsibility

Speaker A: 00:00:00

Hello and welcome to the Cognitive Engineering Podcast produced by me Fraser McGruer for Aleph Insights. In this series of podcasts we take a look at interesting topics and discuss what we think they tell us about analysis and decision making. I'm here with Peter Coghill and Nick Hare of Aleph Insights and this week we're talking about diseases. Yeah you look like a good person to go to for this one Nick. Tell us about diseases. I'm the only person who doesn't

Speaker B: 00:00:31

seem to have a disease or a broken limb or something. Peter seems okay. He's all right for now until I break his arm again. Anyway so it's the time of year is it not that people start talking about colds. Now doctors will tell you that there's no connection between the temperature and getting colds. According to doctors and I'm not sure I believe this but according to doctors you're more likely to get cold in winter because you're more likely to be indoors and have the windows closed and it means that you're more likely to catch diseases from people but be that as it may it is now the season to start talking about colds and flus. But more strategically than that of course there's been a lot of discussion about vaccinations. There's a big anti-vaccination movement here and in the US and you know that's having there have been now we're seeing the first sort of outbreaks of measles diseases that have been long forgotten. You know now are now popping up again because of you know people not getting vaccinated and there's a lot of discussion online about you know whether this makes you immoral if you don't vaccinate your children. There are certain people who can't get vaccinated of course they're at higher risk as a result and immunocompromised people yeah they can't they sometimes cannot get vaccines for medical reasons and so we rely on herd immunity. And so anyway is it the case is there a moral responsibility to get vaccinated you know and at the other end of the scale do you have a moral responsibility to try and not spread your cold for example and is it fair as we often do usually ingest to complain that you've got someone's cold you've given me a cold as though you're kind of a bit responsible for that. You know should we stay at home when we have a cold for example to stop spreading it and to what extent can we be held you know morally responsible for our own diseases.

Speaker A: 00:02:35

Well let's start off at the lower end of the scale. Peter what are your thoughts on this?

Speaker C: 00:02:42

One of the reasons why you feel so crap when you have a cold it is thought by some evolutionary scientists that your body's part of the reaction is your body saying just stay inside so you don't spread it around you'll stay away from the rest of your family and friends and everything so you don't spread it around so it's sort of you've got a built-in mechanism that tries to prevent you from spreading it around. But yeah how much do people to blame for giving you a cold or how much do you blame for getting the cold given that being a bit hard-line about this given that your immune system that getting a cold or not is linked to the strength and general health of your immune system which is by and large driven a lot by your own personal fitness and health. And who would argue against you being responsible for that so you know the fitter and healthy you you are the better your diet etc the stronger your immune system more or less most of the time so the less likely you are to get colds. So you can't blame somebody for entirely for giving you a cold if you're an unhealthy fat smoker who just who doesn't do any exercise ever.

Speaker A: 00:04:00

Okay but what about so as was the case with me earlier this week you know this is quite timely because as you say it's that time of year and most days of the week I'm on train into London and I noticed this particular morning I was just surrounded by these people coughing and spluttering there were two people right next to me having a coughing contest and and and I just oh god just stay at home but is is that and actually these days I don't get I don't get ill very much I don't get colds I used to get them all the time and now I never do really.

Speaker B: 00:04:35

You may have developed gradually developed immunity to more and more of them.

Speaker A: 00:04:39

I don't know I have a theory about this which is just that when I was really unhappy and not very you know and quite stressed in my work I got ill all the time yeah could be and and actually now I'm really happy in my work I've heard I think that might be a thing I didn't look into that yeah yeah but anyway so you know these two people are just I don't know but then people feel this need to go into work you know you've got to be there but actually actually maybe these are the worst kind of people who I saw on the train because I can't bear the people

Speaker B: 00:05:12

who are coming to work it sounds like you might be the worst kind of person getting crossed because somebody else happens to be ill like as though as though their as though their life should be driven by the need to stop you being maximally comfortable all the time that sounds all right you get annoyed because you get annoyed in case someone's sitting down because that's a seat

Speaker A: 00:05:29

you could be using sometimes yeah um no but I what I don't like are the martyrs the cold martyrs you know and I've been on on video calls with them and they're just there coughing and and everyone's saying oh you should just go back to bed and they're just like no no I'm fine and yeah

Speaker C: 00:05:45

but they'll just shut up and there's a bit of a myth there's a lot of a bit of a myth the common cold and the sort of mild flu-y type illnesses you get often by the time you exhibit symptoms like the coughing and spluttering you're already you're no longer um you're symptomatic but you're not uh it's the previous bit that's worse yeah you're you're not going to spread it at that

Speaker B: 00:06:03

point but also the problem is malingerers of which there are many yeah people who immediately claim to have the flu as soon as they get a slight sniffle and you need to put you have do you have an obligation don't you to prove that you're that you're ill yeah that's why you know being sent to hospital for some reason is great because it you know you then that becomes much harder to fake I agree um so yeah I mean so there's a sort of signal should we sit back and up from this sort

Speaker C: 00:06:30

of money old man conversation just for a moment yeah but I think when the the computer the report apportioning of blame uh is a um it within society and within societal groups is is is a way of regulating behaviors that's that's why we you know we sort of in order to comply with social norms or particular ethical frameworks so we we blame people for a car accident because we want to uh we want to we want to prevent other members from the of the group from from doing the same thing so we've apportioned blame in order to try to control behaviors um but we but I think we we we as a species are sort of um guilty of trying to oversimplify things trying to make everything as legible as possible and often blame is apportioned uh neatly over fairly so we're trying to find the one person whose fault that accident was or that cold cold spreading was well actually it's a much more complex combination of factors that that caused that thing to that event to occur

Speaker B: 00:07:40

yeah you could think of I mean it's like if someone pushes me in a crowd and I push someone else whose fault is that it's the first guy so what you know if if I'm just passing a cold on how is that my fault any more than it was the fault of the person who gave me the cold you know I think fault if you go out and start I think we're touching on a few things yeah so so actually that brings me on to this question before we talk about the wider case yeah in any detail about about praise and blame which are kind of social uh socially enforced the legal side of things so to what extent are you legally liable for diseases um now it in uh here and the US which the only places I've looked at it's only applied to sexually transmitted diseases okay so you can't you can only you you can give other people diseases apparently to your heart's content as far as I can tell you cannot be convicted even if you've got ebola uh you I don't think I can't go

Speaker A: 00:08:36

around injecting people but I get what you're saying well that would be assault wouldn't it

Speaker B: 00:08:39

and and the car any consequences uh or of of doing that would would be part of the consequences of your punishment okay but as far as I can tell merely being there and having a disease is not is not doesn't make you legally liable for things but having sex with people does and and so in in um in the US it's got to be intentional and reckless so you've got to know that you have the disease you have to actually intend as far as I can tell to to pass it on or at least do it in a reckless way so so and um it's what is not clear actually is whether or not it's consent can help you out there so if you say I've got you know herpes and you then have sex with someone whether or not um they can consent to that it's a tricky one apparently it's not totally legally settled and it's similar um uh I think in the in the US sorry in the UK um the criminality is about the is about the mens rea so it lies in your intentions and that's and and what you knew um so it's a tricky thing to prove but and I think going back to what Peter said you know the the to do with sort of being able to uh actually say yes it's that person is the ability to enforce to identify an offender and enforce it um you know relies on some sort of qualitative act which I think is why they why sexually transmitted diseases specifically are an attractive thing for the law because you can prove whether that's happened much more easily than just you know the fact that I stood next to you on the tube proves that I that that you know I'm the person who gave you that cold can't necessarily be proved terribly easy easily um so yeah I mean it has happened that people have been so in the it's not very common I don't think it's very rare that this law is applied but say in Oregon uh someone who someone who uh had unprotected sex with um uh women when he was HIV positive uh was was convicted of attempted murder for example um and there's also I mean you know I now I don't know to what extent this is sort of legal particularly but uh you I don't know if you've heard of typhoid Mary Mary Mallon was a she was a servant or a cook actually uh in the early part early 20th century who um was an asymptomatic carrier of of uh of um typhoid so she she and she affected about 50 people and three of them died what sexually or no through just through cooking so she just she was just breathing out typhoid oh she just she just she just had typhoid and out it came wherever she went there was a trail of typhoid they named her correctly then didn't they they did yeah and she she uh but eventually she was put in unforceable isolation um and died and spent 30 years there and eventually died yeah but she did no she did it is pretty uh it um it's pretty uh unforgivable what she did because she was she was they identified it was her she knew they identified it was her they said you're not allowed to be a cook anymore and so she then uh spent five years doing something else didn't like it and went back to being a cook so yeah so so anyway which I guess brings us on to that wider question of sort of moral responsibility exactly that's what

Speaker A: 00:11:46

I want to come on to um so uh well yeah let's widen it out um are we sort of edging towards this question of vaccines and so on um and this kind of moral responsibility uh peter do you want

Speaker C: 00:11:59

to come in uh well just just to just to lay the ground foundation for that so vaccinations and other sort of mass public health interventions like that only work if a suitable number threshold of the population take it up um and it doesn't require everybody necessarily depends on the how transmissible and how um the properties of the disease basically as to how much what proportion of the population you need to vaccinate could be as little as 10% of some things other things which are more um virile could be you need to vaccinate up to 90 100 of people but you don't need to get everybody but you need to get enough so uh but it's one of those things that if if enough people do it everyone will benefit maybe indirectly maybe you maybe directly maybe you won't get a disease that you would otherwise have got or indirectly society is just generally more healthy and therefore more productive and everyone has a happier more uh rich life than they would have done okay but it's something that everyone benefits from but it requires people to voluntarily choose to to be involved in so it's very very vulnerable to a tragedy of the commons where people will go i don't like that i don't like being stuck with a needle so i won't i won't do that and you have therefore sort of taking yourself out the pool of possible vaccines um and everyone

Speaker B: 00:13:23

will suffer as a result yep okay yeah i mean i don't think it's uh now look i mean i'm obviously about as far from being an anti-vaxxer as you can get and the science is uh pretty irrefutable and i think uh purely from an individual selfish point of view the cost benefit of getting a you know getting a vaccination is huge and everyone should do it there's no no reason there's no there is you know there is a there are side effects from vaccines but they're lower than the probability of dying of that disease you know so that's that there's a selfish argument for for getting vaccinated and and that should that should be enough to compel anyone there's no evidence of things like a connection between vaccines and autism having said all that so vaccination isn't it's not a legal obligation in the uk and i i'm not sure it uh should be i i think i don't think it's settled as far as i'm concerned that it is morally acceptable to force someone to have a medical procedure because of either benefits to them or benefits to um you know to others i mean you know we there are lots of activities that are sort of risky uh you know to ourselves and others that we don't seek to ban legally um and and so yeah i don't think it's i don't think it's straightforward that we should make it uh legal a legal obligation but like peter was saying i actually think the the praise and blame the kind of argument of a marketplace of sort of moral ideas is a perfectly acceptable place to do it i think it's okay to shame people who choose not to get not to have their kids vaccinated um i think i don't think it's probably i probably don't think it's okay to compel them legally to do it but i do think it's okay to shame them maybe but maybe

Speaker C: 00:15:06

we could compel them to wear black armbands so everyone can avoid them yeah i think paint their

Speaker B: 00:15:11

front doors green i think a lurid green with a biohazard symbol on it yeah yeah yeah but it

Speaker C: 00:15:17

is some yeah it's it's kind of demonstrated it's worth doing we've eliminated i mean actually

Speaker B: 00:15:23

i actually think that's a good idea i think that's because you know the immunocompromised people are the people who need to know who might not be vaccinated so actually having some sort of if you you know if you're proud to be an anti-vaxxer then where where the where the green armband with the biohazard symbol on it just for the benefit of other people why not yeah why not oh well we can herd them into ghettos and yeah i mean so i so i i think i think you know peace is talking about the idea of praise and blame there being a kind of social technology for for enforcing um you know or getting trying not to uh have a tragedy of the commons and i think that's that to me is a really good way of thinking about what what function those ethical judgments um uh you know have and and and so then going on from that it becomes plausible to think that actually our sense of how responsible you need to be or what precautions you need to take kind of depend on the various costs and benefits involved so um you know if the cost of taking precautions is quite low um or if the cost uh you know or the cost for prevention is quite low then we might expect the sufferer to take those precautions you know if it's relatively easy if you look at you know sort of um in uh you know east you see those east asian surgical masks very common aren't they you see people wearing and that's that's so that people don't transmit diseases not them being paranoid of catching diseases it's people who have colds by and large oh is it yeah reverse yeah so so now that's and now that i think there is a cultural cost to doing that in the uk which is that people think you're a weirdo which is not the case in east asia obviously um so you know that's a low cost way of preventing your disease from spreading and and i think i suspect it's the case that um uh in east asia they would probably look down on you far more if you if you got on the tube with a cold uh with a visible cold because you know it's not costly to just wear a surgical mask um but of course also the cost of the disease itself of how bad it is you know so you would might expect that the worse the disease is the more we would expect people to take precautions and so the more blame we would heap on them the more fatal the disease that they spread so i think we'd rightly have a bit of a downer on someone who knows they have a bowler and decides to go out you know to the pub um and uh spit in people's drinks for example uh so i think i had a look if you look at i'm never gonna forgive chris wragg for that exactly if you look at uh you know if you look so so the kind of prediction i suppose that comes from this is that you know diseases which are more virulent we would expect to be or which are easier to to prevent um and easier to know that you've got we would expect to to heap more blame on people and if you look at uh so you know looking at the diseases the things where which are sort of right down on on the uh how deadly they are how contagious they are and relatively easy to prevent things like the common cold uh up to the things like tuberculosis uh the the upper end tuberculosis and whooping cough and measles um where you know they're the diseases that we would we would you would expect on this model people to be uh you know most censorious about yeah if you've got measles and you decide to go to a you know children's birthday party yeah well don't do fibrosis conference or something yeah yeah if you decide to go to a conference of immunocompromised people yeah yeah so anyway there we are yeah so i think that's i think you know that what we're saying i what i guess i'm saying is that the law is a narrow very narrow uh sort of application of this idea but that broadly yes i think it is right to to treat disease as a kind of moral thing and um and i think probably our intuitions are not bad at capturing you know the sort of

Speaker A: 00:19:20

costs and benefits involved yeah yeah yeah i think we've pretty much put that one to bed um with a hot sort of toddy or something um um peter anything to add before we wrap up this i think i want to ask but i don't know if you've got anything to add at this point uh well i don't

Speaker C: 00:19:36

know if we want to explore uh the sort of the philosophy of blame a bit um something i find in if you consider the world through a very sort of moral relativist lens and you just consider that we're just a bunch like we're a bunch of particles kind of flying around and bumping into each other and things and occasionally those bumps cause harm to one or both parties um and yet we we um we feel great sense of guilt for particular kinds of actions and perhaps more so than other sorts of actions so imagine you're driving along the road and suddenly out of nowhere a child bump uh jumps out in front of you you don't you don't hurt them terribly but you bump them and they're they're hurt they're mildly hurt they'll get over in a couple weeks compare a comparable level of damage say to a cold would you feel the same uh level of guilt if you if you kind of knowingly went to a child's birthday and they got a cold probably as a result of you being there well i don't think i don't know to me because it's so difficult to portion like the blame the effect is not so clear yeah but but yes you don't feel you wouldn't feel quite as guilty less direct well uh

Speaker B: 00:20:47

then what you're saying is that we ought to i think that's a good good question um but i'm not sure it's a comparable situation um it feels to me like going to a children's party in a way is worse it's like you're driving you're driving along the road near a near a near a school or something which i guess might be might be what we're thinking about was yeah i'm thinking about

Speaker C: 00:21:10

all the possible variables in both situations if you if you're in the if you're probably roughly about certain in each situation that you cause that child to have a comparable amount of

Speaker A: 00:21:21

suffering yeah i think that's a faulty premise though because you wouldn't be so sure right because when if you're a you know car or bike whatever whatever the example is it's really clear cut and it's really quite definable what happens and to apportion that is really quite

Speaker B: 00:21:36

clear yeah so you're saying it's not a responsibility issue it's a whether or not

Speaker A: 00:21:40

you can tell it was you yeah because if you if you think i've got a cold and i'll go to this kids party anyway i don't think anyone in themselves is as certain that oh i might pass it i won't i will and i just don't think it's nearly yeah but perhaps we should be

Speaker B: 00:21:56

we should see them as similar like you know if just because you know which kid you hit with your car but you don't know which kid you hit with your cold doesn't mean that you're let off

Speaker A: 00:22:06

the hook i don't know no no because you say well we should but no one ever would you would never

Speaker B: 00:22:11

feel that same certainty um what i'm saying is maybe our intuitions about physical damage have not evolved in a way that make them very immediate to us but we haven't evolved intuitions about disease transmission in the same way right because the germ theory of disease is only something that we've understood in the last couple of hundred years so a thousand years from now so i'm agreeing with peter well i'm just saying you know it's worth considering well actually maybe we should see it in that light yeah we should think about passing a cold on as a bit like bumping into

Speaker A: 00:22:43

someone in the street i don't think so it just doesn't it just sounds like a lot of sort of worrying over nothing to be honest but um classic fraser response response but yeah but by the way i just want to sort of hold my hand up my damaged hand because this is exactly what happened to me

Speaker C: 00:22:59

recently which is i had to enough about you um but the but the but the point is that uh you've got a very mind phrase that we're all relatively healthy we don't look at but you know we're lucky we get over a cold quite quickly but there are some people who are simple cold will actually kill uh well i've not been to so many kids parties recently where someone's going to die because

Speaker B: 00:23:19

yeah oh yeah kind of makes me think of um the responsibilities we might have about allergens and stuff you know about whether or not we have a moral responsibility to make sure for example when we're cooking for people that none of the do are we responsible for making sure there are no allergens in that food or is it the responsibility of the sufferer to uh to to avoid them you know and i think i think like all these things this is about you the decision about where to apportion blame is in some ways is like an economic um it's a bit like whose fault is pollution you know who's responsible for that is the person who's suffering you know and actually we're in a gray area where we haven't really decided who's who owns that disease so you know it's a sort of situation if we if we could decide who owns the disease um then then you you know you could be properly compensated and and and then i think that would sort of do away with this slightly messy praise and blame situation but i mean that's obviously not going to happen but okay well i

Speaker A: 00:24:18

think we'll wrap up there then so um thank you as always for listening to the Cognitive Engineering Podcast i'm Fraser McGruer um i've been here with Peter Coghill and Nick Hare of Aleph Insights until next time goodbye