Sandro Galea, the dean of BU’s School of Public Health, recently wrote a wonderful (free) Substack post reflecting on the nature of health in the pandemic and post-pandemic era. I’m writing about Galea’s post here because the questions it raises are absolutely philosophical ones.
He closes with the important comment: “we do not live to be healthy—we aspire to be healthy so we can live.” In other circumstances this might seem a truism. But the past fourteen months have made it all too clear how much this needs to be said. For we have all become all too aware of just how much can be given up for the sake of health. Government restrictions already placed major limits on our activity. Most people I know, myself included, limited their activity considerably further than what was required by the government. And most of us also know others whose restrictions went even further than our own. A number of people effectively became voluntary shut-ins, losing all physical contact with the outside world out of fear of a dread disease.
One doesn’t need to be a utilitarian to plan one’s reactions to a pandemic on the basis of risks and benefits. With a long disease like COVID, those reactions are not a matter of individual actions but of habits – which is what virtues (and vices) are. And one can reasonably ask: how does this particular habit (avoiding the grocery store, seeing my family) contribute to a flourishing life? Here health must be weighed against other ends of life. Sometimes this weighing is easy: even if it turned out that antifreeze is delicious, the pleasure of drinking it would not be worth dying for. Conversely, the risk of catching a minor cold clearly does not outweigh the importance of visiting one’s dying mother.
COVID, however, has involved many weighings that fall in the more difficult middle between these extremes. Inhabiting a middle is not easy; it has often been easy to err entirely on the side of caution in all cases. In particular, in the United States of 2020, everything had to be viewed through a politically polarized lens: Trump supporters were reckless about ignoring health warnings, so therefore one needed to be as restrictive as possible. (An article about left-wingers who “can’t quit lockdown” took as its case study Somerville, Massachusetts, where I live and am writing this right now.) Since ignoring health was a Trump priority, ignoring everything that competed with health had to be a priority for those of us who oppose him – even, for some, after they are vaccinated.
But Galea reminds us that we cannot and should not ignore other priorities. Health must often be the top priority – but not always. Health is a means, not an end. In this, I think, health is analogous to wealth. If our only goal is the alleviation of our suffering, as it is for many classical Buddhist authors, then perhaps we could ignore health just as we ignore wealth. But both of them are important for the achievement of other puruṣārthas, other goals of human existence that are not reducible to the alleviation of suffering. To health and wealth I would then add a third such external good: time. In responding to Martin Hägglund I noted how free time, too, is a means and not an end – though Hägglund is right to highlight its importance, because it is as essential to a good life as health is.
Health, wealth, time: these three, I submit, are instrumental goods. What they serve is more intrinsic goods, genuine puruṣārthas, human ends. It is difficult, perhaps impossible, to come up with a definitive list of these intrinsic good. The goods we seek can and do vary by culture; a qualitative individualist can make a good case that they vary by individual. Nevertheless, some things do seem to be held in common by humans across cultures: among them the idea that health, free time, and access to material goods make a difference to living well. (One might note that the act of becoming a monk, which effectively rejects material wealth, nevertheless typically provides one with more time for access to important spiritual and intellectual pursuits than does the life of a farmer, homemaker or merchant which is typically being rejected.)
I have been trying to think about what one can say about human ends at that larger scale, in a generalizable human case. I spoke a little bit about this in an earlier discussion of the book I am writing, though the nature of the book has changed considerably since I wrote that post, and I expect to say more later this year about how. I would still broadly stand by that previous post’s assertion that, in addition to seeing correctly and removing suffering, our ends “at least include love, justice and self-respect, defined in particular ways, and likely some form of achievement or self-actualization.” And while I think utilitarians are quite wrong to take pleasure as the only thing valuable for human beings, I think they are right to take it as a thing valuable for human beings (for reasons noted by MacIntyre).
Health, wealth and time can each help us achieve these various deeper ends – and that is why they all matter. As Galea says:
Health matters because love matters, because connection matters, because working with valued colleagues matters, because tasting food matters, because going for a swim matters, because traveling abroad matters, because watching your daughter graduate from college matters, because writing a book matters, because living a rich, full life matters—which we cannot do unless we are healthy.
Nor, we might add, can we live that full life if we have no spare time. And it is difficult to live fully without some material goods beyond those necessary for health; a monk lives a life that is full in its own way, but is so by limiting the pursuit of aims beyond seeking truth and removing suffering. We should not exaggerate the importance of external goods here either: I think Aristotle is right to say that while a good person who meets with a bad fate does not fully flourish, her virtue can still shine through enough that she will never be wretched (athlios). Still, we likely do live better if we have access to a sufficient quantity of health, wealth and time – not for their own sakes, but because they serve our higher goals.
[EDIT, 29 Oct 2021: I had originally goofed up and said “free time is an end and not a means”. I meant the opposite, “free time is a means and not an end.” Fixed.]