Ponesse: A pandemic of coercion and compliance

Today, a Google search for “pandemic” yields over 6 million results. For over two years, COVID-19 has been the top story on every major news outlet. It has monopolized daily government reports, public health press conferences, social media fodder, and discussions between family and friends. Our society has been gipped, and some say paralyzed, by the idea that we are in, and may never emerge from, a viral pandemic.

By now, you will probably have the sense that I am concerned about how we view science and experts, how medical care has become politicized, and who ultimately gets to make the decisions that affect our health and well-being. These issues strike at the heart of medical ethics and they will be explored in various ways in the weeks to come. But today I want to speak plainly, and no doubt controversially, about what I think is plaguing us more than anything else right now. It’s controversial so hold onto your seats!

My view is this. Alongside COVID-19, I think we are suffering from a pandemic of coercion and compliance, one in which we are bullied into outsourcing our thinking to others and following public health orders in the absence of evidence, and one in which blame, shame, manipulation and cancelling have become the moral norms. 

I don’t use these words lightly. “To coerce” is to persuade someone to do something using force or threats. “To comply” means to act in accordance with another’s will or desire. And this is just what our health officials, with the help of the media, are asking from us; they are asking us to act in accordance with their will or desire using mandates, threats, and often abusive language rather than reason and open debate. 

And their attempts are not terribly covert or apologetic. In fact, governments in many Western countries, including the United States, have formed Behavioral Insights Teams — “nudge” units — to monitor public sentiment and attempt to shape it in order to address, for example, “vaccine hesitancy.” The approach, based on the advice of the book Nudge (2008) by Richard Thaler and Cass Sunstein, uses behavioral science to understand how people think and then influence us to make ostensibly better choices about health, wealth, and happiness, for ourselves and for society as a whole.

So what? Why does it matter if we are nudged, coerced, or even forced, as long as we get the ‘right’ answer in the end? If others make better choices for us than we make for ourselves, then what’s the harm in being ‘nudged’ a little?

Let’s leave aside for now the question about whether others do in fact make better choices for us than we make for ourselves (see Experts, officials, grifters, and imposters). (There is good reason to think this isn’t true. Your doctor might know better than you which mayonnaise on the market has the healthiest list of ingredients but only you will know how that mayonnaise will make you feel.) But the fundamental, ethical question is whether or not sacrificing our autonomy to get the ‘right’ answer is a justifiable trade-off. 

Autonomy, the state of being self-governing, is the precondition for informed consent and the cornerstone of contemporary medical ethics. It is not about making the right choice by some objective standard, but making a choice for ourselves according to how we view, weigh and deliberate about the evidence. To act autonomously is to do what you would do in the absence of being coerced, manipulated, or nudged. As Tom Beauchamp and James Childress (Principles of Biomedical Ethics, 5th ed.) explain, autonomy “is undermined by coercion, persuasion, and manipulation.”

So what do we lose when we are nudged or coerced? We don’t just lose a luxury, a convenience, a nice-to-have. To lose our autonomy is to lose what makes us who we are. To lose our autonomy is to fail to be free. And if we lose that, we lose what is most fundamental to our humanity. In the words of Atul Gawande (Being Mortal: Medicine and What Matters in the End):

“All we ask is to be allowed to remain the writers of our own story. That story is ever changing. Over the course of our lives, we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties.” 

What can you do?

• Ask yourself, “Why am I being asked to make this medical decision?” Who is asking and on what grounds?
• When it comes to decisions about your health, demand evidence, ask questions, and trust only those who support autonomous medical decision-making
• Ask yourself “Why does autonomy matter?” What would you lose, what would your life look like, if you were no longer able to be the author of your own story?

Until next week,

Julie

Julie Ponesse, PhD

Ethics Scholar

The Democracy Fund