Author Archives: Clio Hancock

Fights on Facebook: Effective Moral Communication Online

D.T. Max’s piece about the harsh social side effects of COVID brings up questions about how moral duties and beliefs change when societies expand past the physical constraints of borders, and into the seemingly lawless realm of social media. Max details the stories of early COVID-19 patients around the world. Some of these individuals were frequent flyers, moving rapidly around the world, while others were seemingly low-risk for COVID, having never left the country. While they all battled COVID to varying degrees, each individual faced equally malicious attacks online, attacked by people for their “contribution” to the spread of COVID. These angry responses proved worse than the coronavirus for some people, in one instance it led a prominent Polish doctor to commit suicide. This phenomena of pandemic shaming relates to personal responsibility and morality over the Internet. The decontextualization that comes with social media can be a powerful tool for social change, but it can also be a veil that allows people to interact excessively and irresponsibly.

Strong personal ties play a vital role in moderating our use of shame and punishment with others. As shown with the virtue ethics approach, shaming others is meant to be an educational experience intended to help regulate moral behavior. This type of instruction requires an investment in the person being admonished, so the Aristotelian goals of shaming vanish when the personal connections do. 

The ethics of care argues that caring is essential to mortality, as it underlines the feelings and relationships that we deem to be important. Caring about others is part of what guides us in our moral actions. As our social interactions become increasingly decontextualized and distant, people turn to the broader reaches of social media as their sole source of contact with others. With this separation, COVID shaming has emerged as a way for strangers to vent and express their disappointment in another’s actions. This type of shaming becomes more of an attack of individual character, rather than a neutral experience meant to improve future behaviors.

As a society, our hope in controlling the pandemic lies in our ability to moderate our own moral actions, as well as to help guide those of others in the right direction. As our social network becomes increasingly remote, with both close friends and strangers, how can moral lessons be properly moderated online? How can public health officials spread important information and advise against bad behavior without unleashing a firestorm on a defenseless COVID patient? How will our shaming patterns developed during this pandemic persist in the future?

The United States or the Individual Will of America?

In his essay “How China Controlled the Virus”, Peter Hessler offers a unique cross-cultural perspective on the public health response to COVID, as an American professor living and teaching in Sichuan when the pandemic struck. In his essay, he articulates the day-to-day living, highlighted by constant surveillance and isolation during the worst of the pandemic. As Hessler explains, the lockdown was much stricter than what happened in the United States, driven by a combination of restrictive orders from government officials and by strong values of hard work and cooperation shown in Chinese culture. These measures appeared extreme, but it soon appeared that they were necessary to stamp out community spread of COVID in China. As Hessler’s life returned to normal in China, he watched as American cases continued to rise, with no apparent response from the federal government. This complete reversal of trajectories in response to the same virus may have been predicted based on the different approaches to government, the idea of state, and the moral implications of these power structures.

Aristotelian philosophy, on the surface, appears to be another individualistic approach to morality. He writes about the importance of achieving “eudaimonia”, or the most excellent state of being, through continuous good actions. His philosophy focuses on gaining experience, cultivating good habits and making the “right” choices. In a modern Western context, these seem like individual characteristics. People, not societies, should build their own good habits and make the decisions that seem correct to them. This interpretation, while taken out of its original context, fits seamlessly into an American perspective of morality. As shown by the pandemic response, the onus was put mostly on individuals. Without stringent lockdowns or mask mandates like those in other countries, Americans were expected to police themselves, to change their own habits and make their own choices about their health. This led to a complete breakdown of communalistic thinking as some Americans retreated into their homes, while others continued to party in crowded bars.

In striking contrast, the Chinese government took a path that more closely resembles Aristotle’s views on politics and ethics. Although Aristotle does mention that each person should be able to reach excellence, he includes an important clause. In order for people to gain the “right” experience and have the “right” moral reasoning, they must come from a society that rules by these correct standards. As seen in both government and cultural response to COVID, China took drastic actions to gain a foothold against the virus. In doing this, the nation left few moral dilemmas for citizens, and certainly no room for protest. This power and trust put into the state is something not seen in the United States. It raises questions about what kind of power structure Americans really want. A state that solely lets individuals make their own decisions is hardly stable, as it will bend constantly to the will and whims of the people. It is clear that Americans do not want a state with as much control as the Communist Party in China, but it’s less clear if Americans are willing to make any sacrifices to maintain the integrity of the nation that they love.

The COVID-19 Veil of (Partial) Ignorance

Sarah Zhang’s piece, “A COVID-19 Vaccine Reality Check” examines the intricacies of vaccine research, development and distribution that are often overlooked by the general public. Zhang notes that this vaccine, currently being developed at record speed, will still take many more months of trials and necessary regulatory hurdles before it is cleared for universal use on the general population. Once the vaccine is deemed safe, public health officials will have to determine who gets the vaccine as limited doses become available. This will certainly lead to a shortage of supplies as the population rushes to get vaccinated. The ethical challenges that accompany dissemination of the vaccine can be examined through a lens of Rawls’ theories of distributive justice.

Though Rawls’ theory is rooted mostly in the abstract, his Veil of Ignorance has a somewhat tangible application in the case of the current pandemic, and his principles of justice can serve as a model for the type of national collaboration needed to rebuild our health and economy. The COVID-19 virus itself acts as a Partial Veil of Ignorance. Individuals are often acutely aware of their privilege or lack thereof, and this privilege can act as a shield from COVID-19. However, as has been evident with a recent COVID outbreak in the White House, the virus does not function strictly along the same socioeconomic or racial hierarchies. Individuals must then consider themselves at equal risk to get the virus and make decisions about the virus with that possibility in mind. This acts much like the Original Position, forcing individuals to choose a path under the assumption that they do not know where they will fall in society.

Rawls’ Difference principle provides a framework that could help with vaccine distribution and the greater challenge of ending the pandemic completely. The Difference principle, states that inequalities are acceptable as long as actions are taken to remedy these inequalities. As mentioned earlier, this virus may act indiscriminately, but people are put in positions based on inequalities that may change their chances of infection. In terms of vaccine distribution, an honest effort to remedy these inequalities would include getting the vaccine to groups who have been hit the hardest by the virus so that they have a better chance of fighting off the virus and limiting spread. “The committee, which is composed of outside experts, last met in late June, when they discussed prioritizing vaccines for health-care workers, the elderly, and those with underlying conditions. They also considered prioritizing vaccination by race, given the racial disparities in COVID-19 cases” (Zhang). This comparison to Rawls’ theory brings up questions of how these disadvantaged communities were put into this position in the first place, and brings up the other component to the Differences Principle, equal opportunity to office. In giving all individuals equal opportunity to office, would these social determinants of COVID have been alleviated or better identified? Can some of these structural inequalities be resolved so this country can battle future pandemics more equitably?

Maximizing Utility or Maximizing Profit

The second part of The Immortal Life of Henrietta Lacks by Rebecca Skloot, traces the different paths taken by HeLa and Henrietta Lacks. The immortal cells, called “HeLa”, become an essential tool for scientific research in countless fields. Initially, the cells are distributed freely by Dr. Gey, the scientist who harvested the sample. But demand grows quickly and the cells are soon the center of an entirely new area of scientific study, cell culture. The cells and the industry quickly become profitable. HeLa cells eventually become “general scientific property” (Skloot 104). While HeLa and scientific research are booming, Henrietta’s family struggles in difficult living situations, lacking money, education or most importantly, healthcare. This shows the completed division between Henrietta Lacks, the African American woman from Turner’s Station, into HeLa, cells only known for their furious division and accompanying range of discoveries.

Pomerat’s declaration that HeLa cells belong to the entire scientific community represents a very utilitarian view of research. From the utilitarian perspective, the free distribution of these cells results in huge benefits at relatively low cost. At this point, these cells are largely viewed as an object–a cargo that should be shipped carefully, a substrate that can be endlessly poked and prodded. Because of the biomedical success of HeLa cells, they contributed to the overall good of society. This was likely the thought process followed by Gey and other researchers who were instrumental in HeLa’s spread. This utilitarian approach follows the methods of collaboration and sharing of new discoveries common in the sciences.

However, the utilitarian theory quickly breaks down upon inspection of Henrietta’s children and family following her death. The argument for universal healthcare can also be made using the ideas of maximizing utility. If the entire population has access to the same service meant to maintain a basic quality of life, then the quality of life of the population should improve, a positive outcome from a utilitarian perspective. The contradiction comes when looking at the Lacks’ family decades after HeLa flourished. Much of the family is plagued by serious health conditions, yet none of them have reliable access to healthcare. This begs the question of the universality of a theory. Would utilitarians allow for this type of double standard? On one hand, the distribution of Henrietta Lacks’ cells without her consent can be brushed off as being overwhelmingly beneficial for society. But these utilitarian principles not apply when trying to maximize the good of the very people involved (indirectly) in remarkable scientific breakthroughs. Are there ulterior motives in following some a moral theory in some realms but not others, potentially for financial or professional gain? This represents the issue that arises when trying to apply abstract moral theories directly to concrete applications–clear stances and principles appear to soften or even contradict.

Norman Daniels and the Problem of Autonomy

In his writing, Daniels breaks down different justice theories and finds their merits and shortcomings as a way to expose the true complexity of the issue of universal healthcare. One of the challenges he notes is that none of the moral philosophies directly mention the dilemma of healthcare–leaving uncertainty surrounding definitions and interpretations. His most engaging review was of the ideas of equal opportunity and moral contractarianism. In this, he looks at John Rawls’ theories and applies them to medicine. Rawls’ theories are based in a society structured by individuals from behind a “Veil of Ignorance”. From this Original Position, society’s governing principles will always resemble the Equal Liberty Principle and the Difference Principle. The Equal Liberty Principle states that everyone should have equal access to the largest set of liberties possible. Daniels argues that if this moral philosophy is followed, then every individual would not only have the right to equal healthcare but also to an equal baseline standard of physical and mental well-being. “For example, if through medical intervention we can ‘enhance’ the otherwise normal capabilities of those who are at a competitive disadvantage, then our commitment to equality of opportunity requires us to do so” (Daniels 766). In his view, if individuals were not all at the same starting point, then the Equal Liberty Principle would be violated since individuals would not truly be able to have access to the same opportunities.

Though Daniels’ argument lays a strong foundation for the merits of universal healthcare, his interpretations of contractarianism and the Equal Liberty Principle bring up important questions about the autonomy of individuals. Respect for autonomy is a cornerstone of an equal and just healthcare system and should be thoroughly evaluated before implementing further plans. Deciding on concrete expressions of normalcy brings up questions about the motives and justification behind deciding what traits are valued, and if that diminishes autonomy. For instance, in Deaf culture, there is backlash against defining deafness as a “disability”, and even resistance to using medical interventions to restore hearing (Byrd, Serena et al. 2011). The Deaf community, as well as many other individuals with disabilities, embrace their “differences” and use them adaptively to enrich their lives. It would be a detriment to the autonomy of individuals if these differences were eliminated solely for the purpose of strict adherence to the Equal Liberty Principle. 

A definition of normalcy that draws a hard line regardless of individual circumstances would be in direct contradiction with Aristotelian views of human flourishing and opportunity. An individual can only directly experience their life, and Aristotle would argue that through this experience, a person becomes moral and experiences personal worth or happiness. Deciding to make decisions about individual worth and happiness on a population-level is a serious drawback of Daniels’ framework. Understandably, some concessions have to be made when modeling a system for a large group of people, however, the violation of autonomy is something that needs to be considered very closely.

Byrd, Serena et al. “The right not to hear: the ethics of parental refusal of hearing rehabilitation.” The Laryngoscope vol. 121,8 (2011): 1800-4. doi:10.1002/lary.21886

What about Doctor’s Autonomy–an opinion on “The Refutation of Medical Paternalism”

When looking at the bioethical divide between paternalism and autonomy, much of the focus is placed on the position and opinion of the patients, but it is important to include the individuals tasked with the knowledge and the experience in the situation–the doctors. This post will focus on “The Refutation of Medical Paternalism” by Alan Goldman. In this article, Goldman lays out his principles for the importance of following the patient’s wishes and respecting their autonomy. 

Goldman mentions the unique circumstances that doctors must operate under throughout his essay. He notes one of the major assertions of paternalism, that telling the patient the truth may lead to the detriment of the patient’s health. He argues that these distinctions should not be the responsibility of the doctor and that the doctor should not even weigh these consequences, because the rights of the patients should always take precedence over any other factors. 

He goes on to discuss the conditions where paternalism is allowed but makes a clear distinction that medical doctors should not be allowed any paternalistic freedoms. He argues that while some professionals can adopt paternalism and it will not have a strong effect on one’s life, allowing doctors to determine what is best for patients will fundamentally change the way that medicine is practiced and treated in our culture. He believes that giving doctors such freedom would allow them to lean on the principles of beneficence in order to have power over others. 

I agree that the clearest way to solve any uncertainty about a patient’s wishes is simply to follow the patient’s wishes and respect their rights. This principle reminds me of Kantian ethics, putting a heavy emphasis on the respect of every rational being. The clearest way for doctors to do the morally correct thing is to respect the freedoms and choices of their patients. I think it is especially important that Goldman removes the exceptions that come along with evaluating any unintended consequences. This also follows the Kantian philosophy that making a single excuse will ultimately lead to more excuses, and in the case of patient autonomy, the deterioration of any respect, as physicians make increasingly invasive decisions. 

Goldman’s argument about relative levels of paternalism gives me pause, however. He is willing to give lawmakers the freedom to practice paternalism because he believes it is fundamentally part of the philosophy that lawmakers follow and that there will be minimal impact on individuals. I think that both lawmakers and doctors work with the best interest of their constituents in mind and they both carry knowledge that will make their approach different from a layperson. I do not see how there can be a distinction between lawmakers enforcing what they believe is best for people–especially when they are sworn to act for the people–with doctors carrying out their duty to help patients. Since the principles of beneficence are written explicitly in the Hippocratic Oath, doctors cannot simply neglect or place less emphasis on this principle while practicing medicine.