Public Health

Overview

This section will discuss public health ethics, which explores the tension between individual rights and the public good. During a public health crisis, there is typically a shift between care of individuals and care of the entire population. The new moral calculus introduces many issues, including: how do we weigh the interests of the few against those of the many? What do we owe each other, and what can our government ask of us?

To learn more about legal authority during a pandemic to enforce isolation and quarantine, please read the supplemental materials here.

Is the Cure Worse Than the Disease?

Some have suggested that we must be careful that the "cure" for COVID-19 is not worse than the disease itself. By this, they suggest that public health measures, including social distancing, are taking a dramatic toll on our economy, increasing unemployment, and bringing sectors of the economy to a halt. Many people fear that we are at the beginning of a serious recession that will cause untold hardship for millions of Americans over the course of months to years.

Considering the alternative, if we stop social distancing and allow viral spread, a large number of Americans are projected to die, primarily people older than 60 with pre-existing medical conditions, but also many younger people. In the process, hospitals around the country will be forced to make tragic choices regarding who should receive a ventilator, whether patients with COVID-19 should automatically be made DNR, and many other rationing issues raised earlier. Most likely, we will all know someone who has died of the virus if it continues to spread. However, Americans may develop herd immunity soon and be able to return to work and socialize as before. At the same time, it is important to remember that we do not know how long immunity lasts and if people can get re-infected.

It is hard to carefully consider such catastrophic consequences. Most individuals have never experienced a pandemic this severe, but perhaps the subsequent recession will be greater than any recession in American history. With a large portion of the population unemployed, suicide rates could increase, crime could rise, and many people could develop food insecurity. It is improbable that millions of Americans would die of suicide or starvation, but almost everyone’s lives will be affected for the worse, and those of us who are already the most vulnerable may find ourselves in dire straits.

We have to ask ourselves, are the lives of a smaller group of people, in this case, those who may die from COVID-19, worth immense hardship for a larger group of people? Do we value life above all other goods, or is it possible for quality of life considerations to outweigh life? A utilitarian, who values utility or happiness and aims to achieve the greatest utility for the greatest number of people, may prefer to end social distancing and open the economy. A deontologist, who supports the morally correct option over the option with the best results, may prefer to avoid allowing millions of Americans to die. Now approach the problem the other way: how could a utilitarian prefer social distancing and a deontologist prefer allowing viral spread?

References:

What Do We Owe Each Other?

While much of the debate surrounding the COVID-19 public health response centers on the use of government power, we can consider what we owe each other in a time of crisis. In particular, what do the healthiest among us owe to the most vulnerable?

The U.S. has broken into two camps: those that are observant of social distancing and hopeful of flattening the curve and those that have pushed back against public officials’ pleas to stay home. In China, social distancing policies were harder to evade, as officials closed off apartment complexes and screened millions for elevated temperatures. Yet, in the U.S., there is a strong sense of letting individual liberties prevail in some parts of the country and “carrying on” despite the ongoing crisis. For example, the Washington Metro issued statements asking that people not take the Metro to see the cherry blossoms this year, however, the cherry blossoms continued to draw crowds of people. There are countless examples in the news and media of people, including business owners and government officials, defying social distancing policies. These opposing views bring up a common debate in American politics: When do we sacrifice personal liberties to protect the safety of communities?

How we react to this crisis depends on our understanding of when individual rights must be limited in favor of supporting more vulnerable populations. We are social creatures that thrive in groups, meaning we must make certain sacrifices to be a part of that group. Thomas Hobbes, for example, argues that we intentionally surrender some of our rights to the government for security and other benefits. T.M. Scanlon, a moral philosopher, states, “The idea is that actions are wrong if a principle that permitted the action couldn’t be justified to the affected people in the right way.” In other words, people that defy social distancing rules would have to justify their decisions to the community, particularly older and sicker individuals. Communitarianism is a emphasizes the connection between individuals and the community. The principle of “solidarity” asks that we act in a way that supports the most vulnerable members of our community and that we not abandon those in need in a time of crisis. A more personal perspective: we all have a friend or loved one who is vulnerable to COVID-19 - what would we want others to do to protect them?

Thought questions:

  • What arguments do you see in favor of social distancing? What arguments do you see against those measures? What do we owe each other as members of a community during a crisis?