At Unmarried Equality, we discuss many different forms of discrimination against people who are not married. During the COVID-19 pandemic, the possibilities are as serious as they can get.
“You don’t know her…Yes, her cancer is advanced. But before this pneumonia she was taking conference calls from her hospital room. She’s smart as a whip. Funny too. We have plans together, he told me. Places we want to see.”
In an op-ed in the New York Times, critical care doctor Daniela J. Lamas recounted this conversation she had with the husband of a patient on a ventilator, who was trying to make the case that his wife deserved to be saved. In this time of COVID-19 resource scarcity, he was worried that the ventilator might be taken away from his wife and given to another patient deemed worthier.
That conversation stayed with the doctor. She never did have to decide whether to give the ventilator to someone else, because at the time, there were enough to go around.
I wonder, though, what would happen if the patient had no spouse. And no children. Would the same plea from a friend or cousin be as memorable or as moving? And if ventilators were in short supply, would the life of an unmarried patient be sacrificed for a married one?
Professor Joan DelFattore has already written compellingly about why that is a legitimate concern, drawing from research on the systematic undertreatment of single people with cancer, and the inaccurate and gratuitous reasons sometimes offered for that bias, including, for example, the assumption that single people don’t have anything to live for and just don’t have that fighting spirit. She also included a set of suggestions for what single people can do to improve their chances of receiving fair treatment.
I will not reiterate her arguments but instead broaden the range of concerns. It has become apparent that single people are not just worried about the care they may or may not get as patients; they may also be getting deliberately put at greater risk for becoming infected.
On March 31, “Dr. H” @SnarkyMD posted this tweet:
“I need to make a confession. It has bothered me that after I volunteered to take care of infectious patients, I was placed in a riskier position than other providers because I “don’t have a family.” I don’t have children. But I do have a family. I am someone’s child.”
Her message did not quite qualify as blowing up Twitter, but it did resonate. It has only been a few days and already it has been retweeted nearly 1,000 times, often with added commentary, and liked more than 9,200 times. Plenty of people are similarly worried that without a spouse or children, their lives are considered less valuable, less worthy of being saved.
Sometimes that sort of policy is explicit. For example, the op-ed by the critical care doctor includes this:
“A woman in her 60s fiddles nervously with her oxygen tubing as she acknowledges to me that she is entirely alone. I must tell her that no social support means no transplant.”
Condemning certain single people to death is official transplant policy.
One issue is what counts as “alone.” I have long been making the case that we should all stop using the word “alone” to mean “single,” with approximately zero success. “Poor Bob, he’s alone.” “Jane is unattached.” “Chris doesn’t have anyone.” All of those expressions are shorthand for single.
They shouldn’t be.
As DelFattore has argued, people without a spouse (or children) often have people who care about them deeply. They could include, for example, friends or cousins or other relatives. Those single people are not alone, they are not unattached, and they do “have someone” – maybe a whole circle of someones.
In response to Dr. H’s tweet (and my retweet saying that her experience was appalling), she tweeted:
“I agree that it’s appalling. As I just commented, though, invoking other family relationships like daughter or sister still suggests that the standard of value for a life is one’s place in a family — it just broadens the range of what those places might be.”
But what about the patient who really is “entirely alone,” not just by conventional standards of who counts as a person in your life who matters, but by your own standards? Do you have to have a person who, in your own estimation, cares about you in order for your life to be worth saving?
The U.S. has faced fundamental questions before about the value of different persons’ lives. Here’s what I wrote in the section, “What is the Life of a Single Person Worth?”, in Singled Out:
“After the terrorist attacks of September 11, 2001, the United States government created a fund to compensate the families of the victims. Compensation was calculated separately for each victim, based in part on projected lifetime earnings and other sources of money. In addition, each family was paid a standard $250,000 for pain and suffering. The final component was an extra $50,000 for spouses and for each child.According to these calculations, the lives of single victims were automatically worth less than those of married victims. The $50,000 that would go to a married victim’s spouse would not go to any living person who cared about the victim who was single.
“The Victims’ Compensation Fund declared in cold, hard numbers that in contemporary American society, the life of a single person is worth less than the life of someone who is married. That’s only one of the reasons I find it interesting. The Fund also made another set of values unusually clear: A relationship with a spouse is considered worthier than any other adult relationship, including even ties to parents or siblings. Said the mother of one of the 9/11 victims, “When they did this formula, why didn’t they consider the parents? My daughter-in-law was married for five years. We had Jonathan for 33 years.”
“The person in charge of the excruciating task of assigning a dollar value to victims’ lives, attorney Kenneth Feinberg, had second thoughts about the matter after the job was completed. In the book he wrote about his experiences, he concluded that if Congress ever decides to create such a fund again, all victims should be valued equally.”
I think the equal-value rule could be applied to care providers such as Dr. H. Every medical professional could be assigned equal amounts of time at the riskiest assignments. It could be challenging, but it should be possible to at least aim for such a goal.
It is more complicated when there are not enough life-saving resources, such as ventilators or human organs for transplants, to go around. A 2019 study showed that people really do think that organs should be given to married people over divorced people or patients who show up for an evaluation appointment without a spouse or an ex-spouse. In that study, biographical sketches were created in which the patients needing the transplant were identical except for their marital status.
In response, The American Journal of Bioethics published a special issue on whether social support should be a consideration in decisions about adding patients to transplant lists. A target article, an editorial, and 11 commentaries were included. A wide range of opinions was represented. The contribution by Maura Priest, Professor of Philosophy at Arizona State University, was titled, “Social support is not the only problematic criterion, but if used at all, “lack of social support” should count in favor of listing, not against.”
What was important about the special issue was not any particular recommendation that resulted; there was no consensus. Instead, I am heartened that the matter was taken so seriously. Whether, and in what way, factors such as marital status, family status, and social support should be weighed in matters of life and death – well, that deserves the deepest thinking from scholars, practitioners, advocates and every other invested party. The American Journal of Bioethics showed us how it’s done.
[Notes: (1) The opinions expressed here do not represent the official positions of Unmarried Equality. (2) I’ll post all these blog posts at the UE Facebook page; please join our discussions there. (3) For links to previous columns, click here.]
About Bella DePaulo
