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When we think of emergencies, we imagine cases of imminent threat. These are cases in which, unless you act now, something bad will happen very soon — as when a patient will be dead in a few minutes if you do not perform cardiopulmonary resuscitation (CPR) now or a house will burn down if you do not put out the fire right away.
There are, however, cases in which a bad, even disastrous outcome is not imminent, but it can be avoided only if you act now. I propose to call these cases hidden emergencies.
There are hidden emergencies in all areas of life, but I will focus on medical cases here. Consider patients with cancer whose tumor has not yet spread. Most can be cured if surgery is performed promptly, but if the surgery is delayed, the tumor will metastasize, and the patient will die. Such cases, I wish to suggest, involve an emergency, but they are not treated accordingly. Why?
It is not, I think, because we believe the outcomes in the regular emergency and what I just labeled "hidden emergency" are expected to be different, for example, that it is significantly better for a person to die five months as opposed to five minutes or hours from now. Rather, our intuitions get tricked. Since the disaster is not in the very near future, it seems to us that we have time, that there is no need to hurry. The patient, after all, isn't dying now. So we take our time. But in so doing, we take time we don't have. According to one meta-analysis, “even a four-week delay of cancer treatment is associated with increased mortality.”
What makes a given case an emergency is not, primarily, the proximity of the bad outcome; it is the length of time you have at your disposal before the outcome becomes unavoidable. If you have very little time before the window of opportunity closes and it becomes impossible to avert a calamity, you are faced with an emergency even if it is true that the calamity will take place not today or tomorrow but several months from now. This is because there may be nothing — absolutely nothing — that you can do later.
Now there may be cases in which the potentially catastrophic outcome is so far into the future, that the case truly is not an emergency. For instance, suppose a giant asteroid is headed toward the Earth. It would hit the Earth in 500 years unless we do something now. It may be that in this case, it is permissible not to act — particularly if doing so would be extremely costly — for the following reason: We do not know what technology will be available a few centuries from now. Future people may find ways to prevent the catastrophe. So we don't have to act immediately.
But we can set such scenarios aside. The cases I have been discussing here involve much less uncertainty about the future. They are cases in which we basically know that if we don't act now, the window of opportunity will close. While it is, in principle, possible that delaying a life-saving surgery will not, in the end, lead to a tragic outcome, because a new groundbreaking treatment will become available in the next two months, the chances of that are exceedingly small. Major breakthroughs in medicine are infrequent. The possibility of a fortuitous event of this sort is extremely low.
To be sure, people who are directly affected by the prospect of a bad outcome may not have their intuitions tricked in the way I described. Patients with tumors, for instance, generally want those tumors out as soon as possible. They are often keenly aware of the fact that disaster is coming. Perhaps, hidden emergencies have a way of revealing themselves when our own lives or well-being are at stake.
It may also be that no one’s intuitions are fooled if there is a true commitment to ensuring a favorable outcome. For instance, I suspect that if a president, prime minister, or queen has a medical problem that would likely result in death several months later unless something is done now, something will be done now. Surgery will be scheduled for this week, not for some date three months into the future. This suggests a less charitable interpretation of our reactions in the sorts of cases I focused on here: Hidden emergencies may not, after all, be so hidden. Perhaps, we really know they are emergencies, but we fail to act accordingly, because we don't care sufficiently.
There is probably something to this suggestion, but it doesn’t explain the difference in responses to regular and what I dubbed hidden emergencies. Any patient who is suffocating now — and not just a prime minister, president, or royalty — would get prompt medical assistance. Not so with patients who have a problem that would, unless dealt with promptly, kill them several months later. The fact of the matter is, however, that death today isn’t significantly worse than death before your next birthday, and it may be that unless you act today, the later death will, short of a miraculous breakthrough, become just as inevitable as the earlier one.
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