Courage, Citizenship, and the Limits of Autonomy

Dhananjay Jagannathan
Dhananjay Jagannathan teaches philosophy and classical studies at Columbia University. His academic interests include Ancient Greek and Roman philosophy, ethics, political philosophy, and the philosophy of literature. He has written for Plough Quarterly and Earth & Altar.

Over the past few weeks I have been volunteering at one of the largest vaccination sites in Manhattan, run by New York Presbyterian Hospital and located at the Washington Heights Armory, which in more ordinary times is a track-and-field complex. The site’s administrators knew they could not staff the effort alone, so in January they recruited volunteers from Columbia University, whose medical center operates in tandem with the hospital. I signed up right away.

Most of my fellow volunteers seem to have a background in medicine or at least medical research, but others, like me, do not. I decided to plunge into the abyss of electronic medical records and volunteer as a patient-intake registrar. My task is to help patients complete a medical questionnaire and ensure their demographic and insurance information is recorded in the hospital’s systems. My favorite part of the job is handing each person their vaccination card at the end of the process, a fragile piece of card stock that represents, perhaps, a ticket to relative freedom or at least tangible proof of the whirlwind, lifesaving experience of receiving the vaccine.

The Armory is one of the few indoors spaces I have been during the pandemic where I feel safe, with the cavernous roof rising high above the track and strict protocols everywhere in effect. Still, before my first shift, I was nervous to be interacting with so many people: we’ve had a year to be trained to be afraid of each other, physically.

What I discovered was a deep well of solidarity, springing up here in my own community to nourish me. I did not know I had been in the desert. The eagerness of our mostly elderly patients, the compassion of the medical and support staff, and the dedication of my fellow volunteers—all these blend into an atmosphere of hope and the renewal of life.

The truth that we need one another, practically and existentially, has become steadily more vivid during this pandemic. First, we needed one another to stay home, except for those of us who keep our community alive. Then and even now, we have needed one another to be prudent—to follow public health guidelines, to be watchful of our breath lest it endanger others.

Now especially, we need one another to be brave.

* * *

Courage is a dazzlingly complicated quality of character. A tempting thought, explored in many of Plato’s dialogues, is that courage might be a sort of endurance. The reason that courage resembles endurance is that, in order to be courageous, you must be willing to resist the ongoing temptation to flee danger. But, as Socrates points out, some who are capable of enduring danger are not necessarily courageous, most notably professionals with special training in managing predictable risks. The somewhat mysterious Platonic example is well-divers; we might think instead of electricians, who dare to do what we would not because they know how to do the job safely.

Now especially, we need one another to be brave.

In our present circumstances, endurance and courage look very far apart indeed. All of us have endured an ever-present and invisible danger for a year or more. Yet, especially for the most privileged among us, the virus has become a manageable risk, one we are “living with,” as the saying goes, not avoiding altogether.

What, then, is courage?

The conversation in Plato’s Laches suggests that for someone to have genuine courage they need not only endurance but also a wise appreciation of “what is worth fearing and what is worth daring.” The dialogue leaves it unsettled whether courage is endurance transformed by the presence of wisdom or simply is this wisdom alone. But in either case, it will turn out that the courageous person has a discerning eye for what is precious in human life and the times when even this must be given up.

In the context of a largely stable liberal political order where conflict is minimal and warfare is outsourced, our imaginative conception of courage tends to be rather narrow. Courage is reserved as a term of praise for extraordinary people in extraordinary moments, especially professionals like firefighters or nurses who have defined social duties and, for that reason, have the chance to exceed these duties, at least on occasion.

It is less well appreciated that we all have social duties, that courage is demanded of us as human beings living together, who must face risks not only for our own sake but also for the sake of the common good. This fact tends to be occluded because wisdom is not generally demanded of the liberal political subject, except the occasional wisdom to elect leaders wiser than we are. Accordingly, the kind of courage infused with wisdom is also not generally demanded of us. But the current state of the pandemic offers an especially important context for its exercise.

* * *

The vaccines that are our best and perhaps only hope for a return to more-normal social life, an end to death and disease but also an end to an isolation that has taken a grievous toll we have scarcely begun to measure, are a wholly novel medical treatment for this novel virus. The Pfizer and Moderna vaccines, in particular, are based on an mRNA delivery system that is itself new. The clinical studies that proved their safety and efficacy were undertaken with almost miraculous speed. There is no question, to my mind, that these vaccines are safe despite the emergency authorization of their use, but neither has there been long-term study of their effects.

At the same time, our medical culture prizes patient autonomy. To some extent, the turn to autonomy has been salubrious, preventing doctors from dictating treatment to patients without adequate consultation. This shift has been especially important given the biases that mar modern medicine, which is characterized by scientific expertise and specialization and so also by the arrogance that accompanies these features everywhere in life.

The distribution of the vaccine has been seen, in part, as an aggregate of decisions by individuals to opt in as an exercise of such autonomy. This framing of the solution to our public health crisis introduces a perplexity: it is quite possible that vaccination will fail to achieve its core aims unless enough of the population opts in. Even those already vaccinated are waiting for so-called herd immunity, perhaps more aptly described as communal protection, the phenomenon whereby any given interaction is vastly safer because virtually all chains of transmission are interrupted.

It would be better, therefore, to think of vaccination for this virus as a social duty, rather than as a merely personal choice. There are some who cannot receive the vaccine or will not be able to for some time yet, not least younger children for whom approval awaits further clinical trials.

The doctrine of patient autonomy holds that every person has the right to refuse medical treatment. But we must be able to say also that people who are, for one reason or another, afraid to be vaccinated and thereby refuse when their turn comes are doing a harm to the rest of us. That is why we need courage to survive this pandemic, not just the sort of courage that has been shown by nurses and grocery-store workers, but the courage demanded of each one of us.

* * *

My claim about vaccination fears may seem acceptable in abstract form, but it poses serious problems when introduced to our cultural and political context. In the United States, there are two groups of people in particular whose vaccine hesitancy has been well-documented.

The first group is black people, many of whom are skeptical of vaccination because of the long history of both malign treatment and harmful neglect by the medical profession, the horror of the Tuskegee experiments serving as an example of the former and the appallingly high rate of maternal mortality indicating the latter. The fears of black people to go first in the queue to be vaccinated—as nursing-home workers, for instance, have been asked to do—are not outrageous. The profound and uncorrected failures of the medical professions are primarily to blame for this lack of trust.

Still, once evidence emerges that the vaccines are safe, not just in clinical trials, but in widescale distribution, vaccine hesitancy grounded in such a generic fear will become increasingly unreasonable. It is incumbent on both the medical and political establishments and community leaders to make this evidence manifest.

As vaccination rates for black Americans continue to lag, it is also incumbent on politicians not to treat vaccine hesitancy as the sole reason, given the inequities that have marred the early phase of distribution. At the Armory, I have witnessed firsthand the excitement of black residents of Washington Heights and Harlem to receive the vaccine, one of whom recently showed me a video he was posting on social media to encourage others to follow in his footsteps when they could.

The second group of those with high rates of vaccine hesitancy are white Republicans, especially Trump supporters. This is to be expected when nearly every aspect of the public health response, from mask guidance to lockdowns to the very reporting of hospitalizations and deaths, has become subject to extreme partisan polarization in the United States. Moreover, this group is generally skeptical of institutions, even more so than other Americans. It is no surprise, then, that the Trump movement has absorbed anti-vaccine sentiment into the miasma of conspiracy theories that maintain it.

An underappreciated aspect of partisan polarization is the way that the qualities of character prized by different groups have come apart. For years, it was conservatives on the right who insisted that people did not have the untrammeled right to do whatever they wanted because of negative social consequences. The Trump movement is not conservative in this way, and many of its most extreme members, to the extent they have any ideology at all, are right-libertarians.

Right-libertarians do, of course, have a conception of courage, which in the American context is particularly associated with the need to resist the incipient tyranny of government. Resisting tyranny is certainly an occasion for courage, but the misapprehension of tyranny in the bureaucratic state or the vicissitudes of democratic politics has instead become an occasion for delusive heroism, as the political violence at the Capitol on January 6 so vividly illustrated.

More broadly, the common good shrinks, in the libertarian worldview, to the private sphere, to one’s family and friends. The possibility that courage, rightly ordered, serves others thereby vanishes. Even leaving aside the fantasy that we can opt out of our interdependence, we should reject the libertarian vision of courage, not only for its theoretical shortcomings but also for the damage it does to our hope for an escape from this pandemic.

As I noted earlier, however, liberals—whether on the center-right or the center-left—tend not to emphasize the need for courage in our common life. While liberals, unlike libertarians, generally recognize that autonomy and freedom have their limits, the articulation of these limits requires a positive and robust conception of the common good (and, to a degree, of human nature) that liberalism eschews. Worse yet, the prevailing liberal political order asks only some to make sacrifice for others, as it has with essential workers during this pandemic, a position that amounts to “virtues for thee and not for me.”

What’s more, the urban professional avatars of this order, especially of a left-liberal stripe, have sometimes tended to revel in a sanctimony that sees their own privileged position as a universal experience. This sanctimony minimizes the depth of the loss that we all have experienced in staying apart this year, treating as a mere annoyance our grief over the absence of the ordinary goods of physical communion: seeing our families, sharing our meals, hugging our friends.

To live without this awareness is to deaden oneself to the sense of what is worth fearing and what is worth daring.

Neither the libertarian position, that courage is preservative of the self, nor the liberal position, that only some people in our society need courage, can make sense of the qualities of character the present crisis demands.

As the ancient philosophers continually emphasize, the virtues only get their meaning from their social use. Nevertheless, these qualities, including courage, do not demand self-abnegation. As Aristotle argues, it is the courageous person who is most keenly aware of the value of their own life.

I am not saying, then, that we simply need people to behave more altruistically in the face of the pandemic, to give up their autonomy and get vaccinated for the sake of others. Rather, what we need is collective and individual wisdom, or in other words, the imagination to see ourselves as creatures who are vulnerable and called on to act in the face of this shared vulnerability.

* * *

An important consequence of the pandemic is that moral and political reflection have been forced to become concrete, not least because the differences in the worldviews held by our political leaders can be measured in death and devastation. But especially for those of us who have been largely stuck at home for a year, a space has opened up to think about what we want our individual and collective lives to be like when this is all over.

Talk of our path out of the pandemic has focused on the revival of economic life, not unreasonably given how many are out of work or otherwise suffering in material terms. Also important is the question of how we will learn again to be with one another, to occupy the same space, the same air, without unreasonable fear. Everyday life will require us to navigate a path between reckless risk-taking and timorous retreat. Ordinary acts of intimacy and sociality will demand a proper appreciation of their value.

For my own part, in spending time with the elderly and others of those most at risk in my community at the vaccination site, I have come to see better the preciousness of life in its essential vulnerability. To live without this awareness is to deaden oneself to the sense of what is worth fearing and what is worth daring. If endurance transformed by wisdom is something like courage, then fear transformed by wisdom is, perhaps, reverence.