Photo by the CDC
Is It Ethical to Jump Ahead in Line for the Vaccine? Jim Squire 3/24
Dr. Sanjay Gupta put this question to Dr. Art Caplan, one time bioethicist from Penn who is now a bioethicist at the New York University Goodman School of Medicine. Art has been my mentor so I was surprised by some of his responses but not by all. There were parts that I would do differently.
First, Dr. Caplan acknowledges what a difficult and complex problem that Dr. Gupta raises. The full interview is below, but I want to summarize some of his key points and then get to how I think we should go about making sure things are ethical by proposing a different approach.
Here is some background that will help you know what informed my “better way”. My wife and I got both shots from our health provider. They called us as we fit the categories that were now OK to receive the vaccines. All worked out well as it did for our family members who live in different parts of the country. Vicki and I live in the suburbs of Philadelphia in one of the counties that did not get their fair share of the vaccine. Senators and members of the House of Representatives were very much involved in our plight. The state kept saying that we were getting what was fair, but everyone knew that wasn’t the case as the numbers were being made public by the press.
But that is not what became tempting for us to cheat. Before we got our vaccines, we started to hear from people we knew such as Vicki’s sorority sisters in North Carolina. Most had already gotten their second shot before we got our first. We also heard about the extraordinary way that some people “cut in line” to get their vaccine. Of course, Philadelphia put the distribution of the vaccine in the hands of a 22 years old college graduate who became the leader of the distribution in the city. He took some home for his friends and really didn’t know what he was doing. Everybody was wondering how he got the job in the first place. We were living in a situation where everyone around us had adopted the principle of “everyone for themselves.” It was classic Machiavelli where the ends (getting the vaccine) justify the means (anything goes). There was a touch of Social Darwinism as well where “only the strong or connected survive”.
Dr. Caplan cited stories to address the question indirectly. He said sometimes jumping ahead is OK, but at other times it isn’t. This is an Ethic of Relativity that usually begins with those magical three words, “It all depends”. He cites other issues such as it is not only about getting in line. It is also where the vaccine is. He thought that the problem was that there was still not a universal approach. His feeling was that the first thing that needed to be done in the future is for all the governors to meet in the beginning and come up with a strategy. We know they met on a zoom call, but can you imagine all the governors agreeing on an approach. Think Texas!
Dr. Caplan felt that part of the problem was that there were no consequences to those who did jump in line. He thought that might help. There needs to be a punishment. It is at that point that I disagree with him.
It is time for our superhero to enter the scene and his name is Nudge Theory. I didn’t think that I would ever agree with Rand Paul who is always taking on Dr. Fauci in an impolite know it all sort of a way, but he did say something that could move us forward. When Dr. Fauci said that we need to continue to mask because of the variants, Paul shot back that people need a reward! In the words of the Sopranos TV Show, “Bada, Bada, Bing!” I think he is on to something although not what he means by reward.
Nudge Theory was invented by two behavioral economists, one of whom, won a Noble Prize for coming up with Nudge Theory. Their names are Thaler who won the Nobel Prize and Sunstein. These are two high powered academics, one at the University of Chicago and the other at Harvard Law. Nudge Theory persuades people to act in their own and others’ best interests. I have included their ideas in a new form of counseling that I have developed found at my website, revsquirecounseling.com.
Nudge theory takes seriously what is going on around you. Some examples will help. When I was traveling from my home to another town, I was speeding and got a ticket. The next time I was speeding along that road I encountered one of those blinking signs that tells you how fast you are going. Without thinking I immediately slowed down. I was nudged to change speed and slow down.
There was a town in England that was having a difficult time collecting taxes. They sent out scary penalty letters to the residents threatening punishments. It didn’t change a thing. Then they sent out a letter which told how many people were paying their taxes in a timely matter so others could compare what they were doing with those who were being responsible. They made it more local and therefore more immediate. Taxes started rolling in at a super speed.
If everybody around you (which was the case for Vicki and me) is sharing stories of others getting the vaccine earlier or in a suspect fashion, your tendency is going to be to enter the arena of “anything goes”. Those numbers on the evening news are too global and don’t touch us literally where we live. They don’t make us aware of who is following the guidelines, and they don’t tell us the percentage of people who are doing things the “right” way and are not jumping ahead in line. Social behavior is a powerful force. It is not necessarily a reward, but it is rewarding those who are doing the right thing. Interview people for the evening news who are doing things right. Subtract the deceased from the total population in a county. Give the numbers of those who are living. One problem! That doesn’t sell news. Fear doesn’t change people. Showing who is doing it right and the results of that behavior will change them.
I know people who could have gotten the shot illegally and those who didn’t. Jumping ahead in line occurs when we are desperate and when we feel that we are the only one following the rules. Nobody likes the role of “outlier”. Let them know that they have some good neighbors to model appropriate behavior. I assure you that will reduce the line jumping. You don’t get a Nobel Prize for something that doesn’t work in many different situations.
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