Photo: Disability from anjan58 flickr photo stream

A response to the recent social commentary on the perceived value of individuals with ‘underlying health conditions’

The COVID-19 pandemic has changed the fabric of society and has left many wondering about the social, political and economic structures that will emerge. The pandemic has also revealed the fragility and inhumanity of the neoliberal system that has come to characterise British society. In this piece, we discuss the rise of a discourse of disposability that is applied to certain ‘bodies’ during the COVID-19 pandemic. We highlight the ways in which a neoliberal desire to accumulate capital and to monetise human life, has manifested itself in a discourse that, in the context of the pandemic, foregrounds economic value and, through a process of discursive ‘othering’, implies that bodies marked by ‘underlying health conditions’ are inherently valueless and, even, burdensome.

The discourse of ‘underlying health conditions’ raises key questions about the ‘value’ applied to certain bodies that are branded by disability, age or any other marker of a ‘spoiled identity’, and moreover, it raises a major question about the philosophy of ‘value’ and ‘worth’ in a neoliberal society that sees economic activity as the foundation for ‘human value’ and an attendant right to life.

Discourse of disposability

On 31st March 2020, Toby Young published an opinion piece in The Critic, a socially conservative publication, funded by Jeremy Hosking, who donated £1.7 million to the Vote Leave campaign. In this piece, Young overtly launches an attack on the UK Government’s lockdown strategy that has been based on the model put forth by Professor Neil Ferguson and a team of experts at Imperial College. What creeps into Young’s argument, however, is a sustained attack on the ‘valueless’ members of society who, through an elaborate series of calculations, he deems not worthy of being protected.  He draws on the quality-adjusted life year (Qaly) established by the National Institute for Clinical Excellence (NICE) and his own calculations, to conclude that ‘the lockdown is extending the lives of 370,000 people by an average of less than one-and-a-half years’ and that with the Government’s current price-per-life, each individual would have to live 11 years to make financial sense; even in this scenario, he argues, ‘we’re still over-valuing those lives since NICE would price those 11 years at £330,000, not £500,000”.

Young’s understandings of ‘health’ and the right to life are built on dubious foundations.  He singles out two groups that are deemed valueless or even burdensome, in his analysis: the elderly and those with underlying health conditions.  Indeed, he equates old age with ill-health and references the idea of a need for ‘perfect health’ in determining the right to life.  His conclusion that the ‘majority of people whose lives could have been saved only have one or two years left and those will not be good years’ underscores his assessment that in order to be ‘saved’ one must be able to live a ‘good life’.  What precisely does this mean?  First, there is his assumption that a ‘good life’ cannot be experienced by those also experiencing disability.  Second, there is the assumption that short-term survival cannot be equated with ‘goodness’.  Third, there is a need to consider what this ‘goodness’ means for Young.  It is apparent that, from his perspective, ‘goodness’ and life are connected to the ability to be economically active, which comes back to the first assumption that disability precludes a ‘good life’ defined by a high level of economic activity and productivity. For Young, ‘extending the lives of 370,000 people by an average of less than one-and-a-half years’ does not represent a good economic return for the investment.

Young has not been alone in his call for an end to the lockdown and an attendant sacrifice of the elderly and those with ‘underlying health conditions’.  Recent media discourse has overtly emphasised the divide between the trade-off between lives being lost vs total collapse of our economy, alongside a growing emphasis on other vulnerable groups in society such as victims of domestic violence who are being significantly impacted by current restrictions on liberty.  Professor Graham Medley, quoted in the Times (and then elsewhere in front of a paywall), asked whether we were ‘going to continue to harm children to protect vulnerable people’. Here, he pits young people against the vulnerable, suggesting that children being unable to attend school will cause more harm than the potential infection of ‘the vulnerable’.  This argument, too, is based on protecting future economic vitality, based on the assumption that ‘the vulnerable’ cannot provide such vitality, thereby rendering their protection economically disposable and expendable.

We see, then, a discourse emerging where the value of lives defined by ‘disability’, ‘underlying health conditions’ or ‘vulnerability’ are pitted against those who can provide more economic return.

Othering, stigma and the case of spoiled identity

This emerging discourse has enabled an insidious distinction to be made within our society that violates the very notion of personhood. Moreover, with increasing levels of attention paid in the media to the potential for healthcare to be rationed in favour of those ‘more likely to survive’, the very qualities that make us human—our vulnerabilities and our genetic idiosyncrasies—are ultimately potential justifications for our disposability. Is the first responsibility of government not to protect and safeguard the lives of its citizens–all of its citizens?

The pandemic has confused and challenged our sense of being, and thus contributed to widespread ontological insecurity.  It has also facilitated the discursive ‘othering’ of individuals with ‘underlying health conditions’ that is deliberately perpetuating the social construction of both the real and anticipated stigma surrounding chronic illness in our society. Through othering, it is possible to conceptualise those with ‘underlying health conditions’ as different or indeed deviant–a class separate from the rest of humanity. This construction of the ‘other’ is akin to our conceptualisation of the human/non-human dichotomy and the legitimisation of behaviour that accompanies this distinction–that we ultimately see animals as disposable for economic gain. Disposability is an assault on personhood.

In conceptualising those capable of living a ‘good life’ as holding higher socio-economic value, Toby Young has legitimised the understanding that those who have an ‘underlying health condition’ are different and inferior and therefore disposable due to their inherently ‘spoiled’ identity. In constructing these ‘spoiled’ identities, the media and its social commentary are merely the latest actors in a long history of the devaluation of status related to illness in modern Western society.  The media discourse and commentary put forward a case for the disposability of human life based on flawless bodies and the perceived worth of perfection.

It is implicit in the above commentaries that Young and Medley wilfully neglect an individual’s social worth in favour of their perceived capacity to provide a positive economic impact. Furthermore, this position perpetuates the myth that those with ‘underlying health conditions’ cannot participate in gainful employment and lead full lives. In effect, these bodies with ‘underlying health conditions’ are being discursively constructed as having suffered a ‘functional death’ whereby an individual is no longer deemed capable of positively contributing to society and providing appropriate economic recompense for what they consume.

Individuals with ‘underlying health conditions’ now find themselves on the cusp of being overtly discriminated against for being vulnerable. Through socially constructed stigma, given a powerful voice through mainstream media, those with ‘underlying health conditions’ are at risk from an exercise in state-sponsored eugenics by neglect. We risk society’s entrenched neoliberal desires of accumulation and monetisation being accepted as justification for prioritising bodies with perceived economic ‘worth’ over bodies for whom it is argued that due to their very vulnerability, we now owe a presumptive duty of care.

While Toby Young and Graham Medley have been key vocalisers of this discourse of disposability, we must remember that they alone are not responsible for this semantic and symbolic sacrifice of vulnerable bodies.  Their discourse lies within a broader context of actually-enacted sacrifice.

A care agency that supports adults with learning disabilities reported that GP surgeries had applied ‘do not resuscitate’ orders (DNRs) to autistic working-age adults with capacity, without consultation with families.  NICE’s proposed used of the Clinical Frailty Score (CFS) to determine whether a patient presenting with COVID-19 receives treatment and how much, has angered parents of children with special needs, and early reports in February as the threat of the pandemic was growing, the public was told that if critical care capacity were to be stretched to the limit, the most vulnerable would be denied care.

These are strange times in which we find ourselves.  To get through them, we need to work together as a society, protect and champion each other.  We must not fall further into the trap of ‘othering’ one section of our society and offering the most vulnerable members as a sacrifice.  People with ‘underlying health conditions’ are people.  We have needs and dreams, and we make both economic and social contributions to our society.  As a society, we must counter this pernicious discourse: it serves as a yardstick against which we can measure our humanity.  Presently, we are falling short.

About the authors: Alice Butler-Warke is a Lecturer in Sociology at Robert Gordon University. Her research interests are in discourse and power, urban experience and marginality, and the process of stigmatisation. Alice can be found on Twitter @alice_butler31. Caroline Hood is a Lecturer in Sociology at Robert Gordon University. Her research interests are in cycling, mobilities, and the stigma experienced by vulnerable groups throughout society. Caroline can be found on Twitter @the_cat_said