A Failure of Empathy Led to 200,000 Deaths. It Has Deep Roots.

One giant psychology experiment explains why many people seem like they don’t care about the deaths of the elderly.

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Getty / The Atlantic

Sometime this week, alone on a hospital bed, an American died. The coronavirus had invaded her lungs, soaking them in fluid and blocking the exchange of oxygen and carbon dioxide that makes up our every breath. Her immune system’s struggle to fight back might have sparked an overreaction called a cytokine storm, which shreds even healthy tissue. The doctors tried everything, but they couldn’t save her, and she became the 200,000th American taken by COVID-19—at least according to official counts.

In reality, the COVID-19 death toll probably passed 200,000 some time ago. And yet “the photos of body bags have not had the same effect in the pandemic” as after other mass-casualty events such as Hurricane Katrina, says Lori Peek, a sociologist at the University of Colorado Boulder who studies disasters. “Is our national empathy—our care and love and concern for one another—at such a low level that we are not truly feeling, in our bones, in our hearts, and in our souls, the magnitude of the loss?”

It’s hard for anyone to comprehend the sheer horror of mass death. As I wrote in April, “compassion fade” sets in when victims are no longer individuals but statistics, and few Americans have witnessed something of this scale before. But there’s an additional explanation for this empathy deficit: Part of the reason this majority-white, majority-non-elderly country has been so blasé about COVID-19 deaths is that mostly Black people and old people are dying. Eight out of 10 American COVID-19 deaths have been among people older than 65; the rest of the dead are disproportionately Black. White people’s brains psychologically sort minorities as “out-groups” that stir less empathy. Segregated neighborhoods have also helped insulate white Americans from the horror Black Americans face, because the ambulance sirens and the packed hospital wards are typically far from their own zip codes. “We literally don’t see those deaths in the same way we might if we didn’t experience segregation,” says Nour Kteily, a management professor at Northwestern University who studies hierarchies.

Ageism reduces human beings’ capacity for caring too. Globally, people don’t value elderly lives as much as they do young people’s, research shows. When it comes to deciding who lives or dies, there’s a disregard for the elderly, even among the elderly.

Discrimination against the old is perplexing, because age will ultimately catch us all. Though no white person will ever be a Black person, every person, if all goes well, will get old. But several studies that forced people to imagine life-and-death decisions hint at how little society values the elderly.

One major insight into this phenomenon comes from a 2018 study called the “Moral Machine experiment,” which invites participants to determine how to program a self-driving car. People who play the Moral Machine game are shown two images, each of which depicts an out-of-control car driving into a different group of people (or, in some of the images, a cat or a dog.) For example, the game might tell the player that if you let the car plow ahead, the car will kill three little girls and two adult men. But if you swerve to the right, the car will instead kill two elderly men, two elderly women, and another, non-elderly woman. Would you swerve, or stay straight? Who would you kill?

After it launched in 2016, the Moral Machine experiment went viral a few times, which meant that millions of people in 233 countries and territories ultimately played it. Through the game, its authors were able to glean country-specific preferences for sparing or sacrificing different types of lives.

The strongest signals that came out of all those sessions were that people preferred to spare a greater number of lives, to spare human lives, and yes—to spare young lives. The most likely lives to be saved in these simulated car accidents were those of babies, children, pregnant women, and male and female doctors. Male or female homeless people and overweight men, meanwhile, were likely to be sacrificed.

Overall, older men and women were some of the least likely to be spared, ranking just above dogs, human criminals, and cats—disturbingly, in that order. (“People like dogs,” says Azim Shariff, a social psychologist at the University of British Columbia and one of the authors of the study. This could explain why the large number of coronavirus cases in prisons has also provoked a collective yawn from policy makers.)

Interestingly, people of all ages and backgrounds generally agreed on who to kill. Older players were less likely to sacrifice the older pedestrians than younger players were, but they still did it. As Texas Lieutenant Governor Dan Patrick, himself a septuagenarian, has said, “As a senior citizen, are you willing to take a chance on your survival in exchange for keeping the America that America loves for its children and grandchildren? And if that is the exchange, I’m all in.”

“All things being equal, people were willing to place a priority on sparing a younger person to sacrifice an older person,” Shariff says.

This preference for sacrificing the old to save the young was found in every country. The only places where people showed a weaker preference for killing the old—though they still preferred it to sacrificing the young—were in East Asian countries, such as Japan and Taiwan, and in majority-Muslim countries, such as Pakistan and Saudi Arabia.

The two countries where people most preferred to sacrifice the elderly, meanwhile, were France and Italy. At the peak of the pandemic, this question became real for Italians, and doctors in the most affected regions of Italy used 80, or even 65, as their “cutoff age” for access to scarce ventilators.

Shariff and his team didn’t ask people why they preferred to kill the old, but judging by anecdotal reports, such as YouTubers playing the game for their viewers, people seemed to rationalize that the elderly had fewer years left to live.

Indeed, doctors follow a similar logic. In a May paper in the New England Journal of Medicine, a group of doctors from different countries suggested that hospitals consider prioritizing younger patients if they are forced to ration ventilators. “Maximizing benefits requires consideration of prognosis—how long the patient is likely to live if treated—which may mean giving priority to younger patients and those with fewer coexisting conditions,” they wrote. Perhaps, on a global scale, we’ve internalized the idea that the young matter more than the old.

The Moral Machine is not without its criticisms. Some psychologists say that the trolley problem, a similar and more widely known moral dilemma, is too silly and unrealistic to say anything about our true ethics. In a response to the Moral Machine experiment, another group of researchers conducted a comparable study and found that people actually prefer to treat everyone equally, if given the option to do so. In other words, people didn’t want to kill the elderly; they just opted to do so over killing young people, when pressed. (In that experiment, though, people still would kill the criminals.) Shariff says these findings simply show that people don’t like dilemmas. Given the option, anyone would rather say “treat everybody equally,” just so they don’t have to decide.

Bolstering that view, in another recent paper, which has not yet been peer-reviewed, people preferred giving a younger hypothetical COVID-19 patient an in-demand ventilator rather than an older one. They did this even when they were told to imagine themselves as potentially being the older patient who would therefore be sacrificed. The participants were hidden behind a so-called veil of ignorance—told they had a “50 percent chance of being a 65-year-old who gets to live another 15 years, and a 50 percent chance of dying at age 25.” That prompt made the participants favor the young patient even more. When told to look at the situation objectively, saving young lives seemed even better.

To Shariff, his study and others support what many already suspect to be true—that certain deaths bother us more than others do. “If it was attractive, 15-year-old, blond, soccer-playing children who are dying, then we would have more of a concern,” he says.

At 74 years old, President Donald Trump falls smack in the COVID-19-death demographic. Yet he has also minimized the threat of the virus repeatedly. This makes sense: The elderly themselves don’t care much about protecting the elderly because they typically don’t think of themselves as such, says Susan Fiske, a Princeton psychologist who has studied ageism and other prejudices. The “old” are always just a little bit older than ourselves.

For the rest of us, there might be a more sinister impulse behind ageism. Most of us know someone who is elderly, be they an aging parent or grandparent, and those ties make us subconsciously crave control over how the elderly behave, Fiske says. Younger people subconsciously want to be sure that the elderly don’t hog a disproportionate amount of time and resources. “Older people are expected to step aside,” she told me.

The only American cultures that have consistently positive views of the elderly are African Americans and Native Americans, Fiske has found in surveys. She’s not sure why, but speculates that the adversity these communities have faced has made them prize older people’s wisdom and experience.

Likewise, some experts have pushed back against the assumption that young COVID-19 patients are more worth saving than the old. Fifty-year-olds, for example, might be more useful for the economy because they have skills and experience that 20-year-olds don’t have.

Utilitarians would argue that policy makers should simply maximize the total number of years people have left to live; the young certainly have more. But the fact that mostly older people are dying has helped justify something that isn’t justifiable. It’s helped public officials look away when they should be taking action.