Claar Sbu 333 Assignment 8

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Public Health and Ethics: Finding Balance Amidst a Pandemic

Christina Claar
Seton Hill University
Public health is an area that requires ethical decision making in nearly every aspect.

There are different principles of ethics that come into play where public health is involved,

especially beneficence and autonomy. The goal of public health initiatives is to create a healthy

community and society, so officials responsible for making decisions need to consider how their

actions will affect the whole community over the individual while still recognizing and

respecting an individual’s rights. There are differing perspectives on how much authority public

health policies have to exert so much influence on the lives of the people in the affected

communities; some believe that their individual rights are more deserving of respect than the

protection of the whole, while others argue that the good of the whole does nothing but benefit

the individual as well. Recent mandates that have been implemented as results of the COVID-19

pandemic have shed new light on the importance of balancing public health initiatives with the

rights of the individual and the needs of the community, as well as considering the needs of more

vulnerable populations.

Incorporating virtue ethics into public health comes with benefits across the board for

health officials and members of the populations they serve. There are many reasons ethics are

important to public health, but three most important. First, the focus on collective health runs the

risk of neglecting individual interests, rights and values, and public health requires careful

considerations to balance the good of the one with the good of the whole. Second, public health

care does not typically involve personalized care, so decisions are made from a distanced and

overarching perspective that would benefit from ethical mindfulness to compassionately consider

the needs of the population. Finally, the decisions made by public health professionals have a

significant impact on the lives of those in the community, so officials must be aware of the

responsibility they have to the population and use it wisely (Fahlquist, 2019).
Public health professionals have a responsibility to the public, and therefore their

decisions are not made lightly. There are many factors to be considered, especially during a

pandemic, when introducing new policies that will impact the community. A virus that presents a

threat to public health requires a response that is rooted in beneficence, or the most good for the

most people. This can sometimes cause backlash from the public, but the point remains that

“unless we gave infinite resources, we can’t have and do whatever we want, whenever we want”

(Koons, 2020). In other words, no decision is going to please everyone, but a decision must be

made regardless. During a pandemic, resources are stretched thin, and the goal is use as few as

necessary to avoid hospitals being overrun because of illnesses that could have been prevented

(Gostin, Friedman, & Wetter, 2020).

Protecting the whole does not happen without including the more vulnerable populations

of the community as well, as they may often require extra considerations due to disabilities and

preexisting conditions. Policies to protect these groups were already lacking before the COVID-

19 pandemic, so members of these populations were faced with additional struggles (Sabatello,

Burke, McDonald, & Appelbaum, 2020). Quarantine orders made it more difficult for those with

limited mobility to access necessary resources such as food and medicine, and others struggled to

receive needed medical care from providers who were stretched thin. People in rural areas faced

added challenges as well, as many members of those populations are older on average and

therefore at higher risk of complications from contracting the virus due to age and other common

comorbidities (Chillag & Lee, 2020). Also at risk are those with preexisting mental health

conditions that require ongoing treatment; it has been argued that lockdowns are prone to

damage mental health disproportionately, with vulnerable and disadvantaged people being at an

increased risk (Cheung & Ip, 2020).


One topic that has been the subject of many discussions is the need to use ethical

decision-making practices when public health is a concern so that individual rights are not

violated. First, one must examine the role and nature of public health to understand how some

decisions that may seem unethical are only to benefit the greater good. When discussing the

measures taken to mitigate the fallout of the COVID-19 pandemic, one issue that has been

heavily debated is that of protecting the whole at the consequence of the individual. Mandates

such as mask wearing in public and stay-at-home orders have been accused of violating an

individual’s rights, but the goal has always been to slow the spread of the virus for the good of

all.

Another side of the argument for individual rights is that of protection; those who favor

the public health mandates often do so because they feel there is no price too high to save a life.

However, to public health officials, there is only value in the whole, and unfortunately,

sometimes tradeoffs will happen to keep more people safe. This does not mean that the policies

are morally wrong; due to the fragility of humankind, nearly every activity has an inherent risk

of danger or death, so it is not possible for public health professionals to prevent every loss of

life (Koons, 2020). If stay-at-home orders must be lifted to ensure society continues to function

in the long-term, it is worth the potential resulting loss of life for the benefit of the whole

community. The risk with this approach appears when health officials may “neglect the rights

and values of individuals through their attitudes and behaviors toward the public” (Fahlquist,

2019). For this reason, ethics must be an integral part of developing public health practices and

policies.

To combat the spread of the COVID-19 virus, public health officials implemented social

distancing policies, isolation and quarantine measures, and gathering limitations. Many found
these to be controversial because they “raise tensions between individual freedoms and public

goods, place disproportionate burdens on persons with few resources and other vulnerabilities,

and can be abused because they involve restriction of civil liberties” (Chillag & Lee, 2020).

Others are concerned that the rate at which these measures were imposed sets a dangerous

precedent for public health policies in the future as they “permitted the suspension of a wide

range of human rights” (Cheung & Ip, 2020). For these reasons and others, the popular view is to

reform public health policies to be more mindful of virtue ethics and human rights going

forward.

Suggestions for public health reform come following the United States’ failure to respond

initially to the COVID-19 pandemic and a presidential administration that undermined and

maligned public health (Frieden, Rajkumar, & Mostashari, 2021). This begins by understanding

the primary purpose of public health – protecting the public from health risks. The system can be

improved and made more efficient if the public health officials strengthen the public health

system, reorient healthcare delivery to reward providers for managing the overall health of

populations efficiently, and empower individuals to make healthier decisions by addressing the

preventable root causes of poor health. The COVID-19 pandemic has highlighted the importance

of individual behavior in health outcomes, and the individual supports the good of the whole

(Frieden, Rajkumar, & Mostashari, 2021). Without acknowledging that the public health system

is in need of updates, it will continue to fail the members of the population most in need of its

services and the community altogether.

Public health departments across the world faced unprecedented times with the onset of

the COVID-19 pandemic, and while it is clear that many aspects could have been handled

differently, the results can be used to learn and improve the existing systems. Using ethical
practices and decision-making is of the upmost importance to ensure the best decisions are being

made for the whole population while balancing the consequences with the need to protect

individual’s rights and privacy. Provisions must be in place to support those in disadvantaged

and vulnerable populations, such as those in rural areas, those with mental illnesses, and those

with disabilities, to guarantee access to all necessary care and resources. With ethics in mind,

public health officials have the opportunity now to redesign the systems and provide the best

services to the most people.

References

Cheung, D., & Ip, E. C. (2020). COVID-19 Lockdowns: a Public Mental Health Ethics

Perspective. Asian Bioethics Review, 12(4), 503–510. https://doi-

org.setonhill.idm.oclc.org/10.1007/s41649-020-00144-0

Chillag, K. L., & Lee, L. M. (2020). Synergistic Disparities and Public Health Mitigation of

COVID-19 in the Rural United States. Journal of Bioethical Inquiry, 17(4), 649–656.

https://doi-org.setonhill.idm.oclc.org/10.1007/s11673-020-10049-0

Fahlquist, J. N. (2019). Public Health and the Virtues of Responsibility, Compassion and

Humility. Public Health Ethics, 12(3), 213–224.

https://doi-org.setonhill.idm.oclc.org/10.1093/phe/phz007

Frieden, T. R., Rajkumar, R., & Mostashari, F. (2021). We Must Fix US Health and Public

Health Policy. American Journal of Public Health, 111(4), 623–627. https://doi-

org.setonhill.idm.oclc.org/10.2105/AJPH.2020.306125
Gostin, L. O., Friedman, E. A., & Wetter, S. A. (2020). Responding to Covid‐19: How to

Navigate a Public Health Emergency Legally and Ethically. Hastings Center

Report, 50(2), 8–12. https://doi-org.setonhill.idm.oclc.org/10.1002/hast.1090

Koons, R. C. (2020). Prudence in the Pandemic. First Things: A Monthly Journal of Religion &

Public Life, 306, 39–45.

Sabatello, M., Burke, T. B., McDonald, K. E., & Appelbaum, P. S. (2020). Disability, Ethics,

and Health Care in the COVID-19 Pandemic. American Journal of Public

Health, 110(10), 1523–1527.

https://doi-org.setonhill.idm.oclc.org/10.2105/AJPH.2020.305837

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