Public health as a profession does its job in the background, without demanding attention or praise. But COVID-19 has thrust public health onto the front page, and created an opportunity for the public to understand what public health is, and how it works.
Public health has a code of 12 ethical principles which have guided behavior during the COVID-19 pandemic, number 2 which says, “Public health should achieve community health in a way that respects the rights of individuals in the community.” Despite the rapidly changing and tumultuous circumstances of the COVID-19 pandemic, local and national leaders have striven to strike the right balance between protecting the community while respecting the rights of individuals.
What has been lost on many people during COVID-19 is that consideration of the rights of individuals is not synonymous with giving people the freedom to do whatever they want. This ethical principle of protecting the community is built upon the concept of interdependence, which teaches that all the individual members of a community are dependent on one another for the common good, and that no single individual is an autonomous agent with unlimited freedom.
Part of the problem lies with people confusing medical ethics with public health ethics. Medical ethics places the autonomy of the individual patient first, and focuses on their needs. But under a pandemic, elected officials are required to make difficult decisions to protect the public’s safety, and ensure the common good, but to do so cannot also confer unlimited autonomy upon individuals. Of course individuals still have a say in the decisions, and are able to give input through public hearings. But at the end of the day, the public needs to accept that public health officials are trying to do what’s best for the majority. While it may not appear so in the short run, these measures are also what is best for the individuals in the long run, for the suppression of the pandemic and the minimization of morbidity and mortality resulting from it are the only pathways to a return to normalcy and a recovered economy.
In implementing mitigation measures, public officials are striving for measures that are proportional to the magnitude of the harm to be prevented. So the magnitude of the harm that might come from having to grind through 18 months of uncertainty, justifies the same magnitude of lockdown necessary in the short term. This is in order to shrink the height of the epidemic peak (“flattening the curve”) to reduce the burden of disease, and to shorten the length of time that the pandemic rages so as to reduce the duration to less than say 18 months. If this can be accomplished, then the stringent mitigation measures implemented early are justified.
From the U.S. experience, it might easily be argued that an insufficient balance has been struck during COVID-19. It appears that excessive concern for individual freedoms, with lax mitigation measures, and premature lifting of these measures, has contributed to the prolongation and intensification of the pandemic, including many lost lives.
For the public to accept decisions made for the common good is to share in the community struggle by making individual sacrifices. Wearing a mask in public and maintaining social distancing are some of the least obtrusive measures to be taken, and allow a society to avoid the most obtrusive measures, such as shutting down businesses.
That some people consider the requirement to wear a mask to be a substantial sacrifice, and a violation of their individual liberty, when wearing a mask is done largely in service of protecting those who are vulnerable to the worst COVID outcomes – the elderly and those with underlying medical conditions – is unimaginable. Sacrificing individual liberty for benefit of others, even though it isn’t one’s personal preference, is a reflection of true virtue – whether from humanistic or Christian motivations.
In summary, public health officials are not trammeling individual rights when they implement public-focused mitigation measures. These have been imposed only to the level that has been absolutely necessary. In so doing public health officials are using principles of reciprocity to minimize the burdens imposed on individuals and maximize the public benefit to be achieved. In so doing, they are simply obeying their professional public health code of ethics.
Strand lives in Fargo.
This column does not necessarily reflect the opinion of The Forum's editorial board nor Forum ownership.