Author Archives: Jake Meyer

COVID-19 Lockdowns: Necessary Evils?

The United States, more than any other country, might as well have been built to foster moral and ethical conflict between the private citizen and the government.  Whenever you have a country with its moral principles firmly cemented in personal freedom and autonomy such as the US, questions of paternalism and sociopolitical regulations are bound to arise, especially during times such as the COVID-19 pandemic. The United States’ firmly planted principles of personal autonomy and the potential need for a form of government paternalism have been placed face-to-face by the pandemic; and the shortcomings of these beliefs become only more apparent as we compare them to other countries such as China. Personal autonomy in one’s life is so fundamentally laced into the moral patchwork of our country that it may as well be the Autonomous States of America. This is great for a multitude of reasons and has provided innumerable personal freedoms and luxuries that positively differentiate us from other government-dominated societies. However, this is also a recipe for paternalistic policy conflict. With the covid-inspired lockdowns across the country, violent protests resisting these government orders have surfaced. In response to Peter Hessler’s article How China Controlled the Coronavirus, we must evaluate when regulatory government paternalism, especially in crisis times, is necessary and should be tolerated, as well as how this paternalism can relate to moral Utilitarianist theory.

In China, the government has taken a firm paternalistic approach to the COVID lockdowns, as Hessler says “the Chinese lockdown was more intense than almost anywhere in the world”.  Doors were sealed, infected children were taken for ‘medical observation’, and extreme neighborhood lockdowns. If these procedures were enacted in the US, there would be nothing less than a revolt. However, although these procedures may be extreme, they did an extremely good job of containing the spread of the virus. In contrast, US virus cases spiraled out of control. This case study is a strong argument for the benefits of paternalism for the mass good of the people: aka, paternalism for utilitarianism. The intense isolation and lockdown of the society for a short time and isolation of select sick individuals caused the most benefit overall for the society as a whole. On the other hand, groups in the US heavily resisted paternalist action on the basis of autonomous freedoms. People in the US believe that they have individual rights to take care of their own health and decide what is best. Morally and logically, the argument can be made that this did not provide benefit to our society.

 If the Utilitarian theory was used in this pandemic, the US would have enacted the necessary paternalistic lockdown theory and we would not have ridiculous spikes of COVID deaths and cases while virtually every other country that sacrificed a bit of their autonomy for the general good has gotten their cases under control.

COVID-19 Vaccine Distribution: An Ethical Approach

America is and has been ethically and structurally unprepared for the Coronavirus pandemic. Practical shortcomings became clearly evident in the early days of the pandemic, on issues such as mask production. But as we move into the ‘late’ stages of the pandemic and everything is allocated to the possibility of a vaccine, even more infrastructural concerns are arising. Some of these are identified clearly in Sarah Zang’s article A Covid-19 Vaccine Reality Check: the complications relating to the vaccine are even more threatening. The complicated nature of the disease and the potential two-step nature of the vaccine threaten to throw the US healthcare distribution process into complete disarray. I believe that to organize this incredibly important ethical healthcare issue, we can apply ideals we have studied in this class- mainly, a combination of general Utilitarianism and Norman Daniel’s Normal Function models.

The utilitarian distributive approach– Sarah Zhang identifies in her article the method of ‘prioritization’ of distribution, where healthcare officials meet to decide which groups are a priority and therefore should receive the vaccine first. Zhang says this has been used before- in the 2009 H1N1 pandemic, a prioritization system was put in place with considerable success. However, I believe that this system needs to be modified to fit with the Covid crisis, and Utilitarianism theory can help. Utilitarianism, as we know, advocates maximum well-being for the maximum amount of people. Under this theory, I would strongly advocate priority immunization of groups who are actively fighting the pandemic, such as healthcare workers and researchers. This would result in them being able to devote maximum effort and time to caring for the sick and researching a vaccine without the fear of the disease itself. Therefore, by increasing their productivity, they in turn would produce the most good for society as a whole. They may not be the most numerous group, but their professions and actions will undoubtedly have the largest possible positive repercussions for our society in this pandemic. After these high-priority, society-affecting groups have been immunized, the distributive approach undoubtedly needs to focus on providing vaccination to those at risk. Yet as Zhang argues, there is endless discourse and speculation about ‘at-risk’ populations and who truly deserves the vaccine. It is because of this situation that I propose the use of the Normal Function model.

The Normal Function approach– To provide a quick summary of the normal function approach: Health philosopher Norman Daniels advocates that healthcare should be provided first to those who are not able to function ‘normally’ and achieve their goals (operating in a ‘red’ rather than normal ‘green’ zone). This could be almost flawlessly applied to this Covid vaccine distribution crisis. After the healthcare workers/other groups I identified above was immunized, the distributive professionals should use this model to identify groups that are operating out of their normal function range because of Covid. An example would be someone with a compromised immune system who cannot attend work and achieve goals because of fear of catching and dying from Covid. This person is operating out of their ‘green’ zone, and therefore that group needs to be designated as a priority. Do not prioritize groups that are not being directly pushed out of their green zone by Covid-19. Rinse and repeat. We have extensive knowledge of how Covid and similar viral diseases affect patients with pre-existing conditions that we didn’t have in the past. We need to use that knowledge to designate priority groups with the normal function model; streamlining the distributive process.

Although I believe this process would work, I do leave some questions after writing it. I wonder how officials would agree on the defining value zones that are critical to the normal-function theory? I also (sadly) wonder how we could balance utilitarianism with the ever-present diaspora of financial and lobbyist influence in the US, especially in the healthcare industry. 

In conclusion, the Covid vaccine distribution process is undeniably technically and ethically complicated. The US administration was not adequately prepared for the structural difficulty of this complicated Covid crisis. However, in the lens of ethical distribution, I believe that by applying utilitarianism and the Normal function model to society, the distributive process would be immediately streamlined, allowing society to focus more on refining the technical aspects of the pandemic.

Henrietta Lacks and the Question of General Ownership

In section two of The Immortal Life of Henrietta Lacks by Rebecca Skloot, Skloot investigates and scrutinizes the intersection of personal and scientific ‘ownership’ and the somewhat ironic repercussions that the HeLa situation has had on the scientific community vs. Henrietta’s family.  To explore the ethical question of scientific ownership, I will focus mainly on Dr. Charles Pomerat’s classification of HeLa cells as “general scientific property”, and how this designation has impacted-and could continue to impact- both the scientific world and patients/their families.

In Part Two, Skloot quotes Dr. Charles Pomerat on page 104 as saying that Gey should have finished his own HeLa research before “Releasing HeLa to the general public since once released, it becomes general scientific property” (p.104). Unsurprisingly, this immediately raises questions about this concept. A quick search defines this term as “[a community’s] absolute ownership, usually of personal property, with the right of complete dominion over it”. In HeLa’s case, this right of complete dominion was used to allow doctors to buy, sell, and perform millions of tests on reproduced HeLa cells. This leads us to the unavoidable question of ownership. In Henrietta’s case, the cells were not considered to be “hers” once they were removed- they instead became a general experimentation asset to the medical community. In other words, the tissue that used to be intertwined with Henrietta was removed and became, instead, a separate ‘thing’ that was considered completely separate from the person from whom it was taken. This new object is now the property of the medical community and any benefit or profit made from it does not benefit the patient or in this case, the family of Henrietta (as she passed away.” This is a dangerous precedent to set, in my opinion, because it sacrifices the informed consent and personal ownership of one person for the “general good” of a community. However, once this vague precedent is set, the community which benefits would often do so at the expense of others.

This complete separation of the HeLa cells from the Lacks family immediately presents itself as an ethical issue, especially when you compare the massive, profitable impact HeLa had on the biomedical field and the world as a whole. The book repeatedly mentions the massive industries born from Henrietta’s cells, notably cell culturing centers, which now reap millions in sales and exert large influences over scientific fields. However, at the same time that HeLa was starting this, Lacks family relatives were dying of TB and other preventable illnesses because of inadequate healthcare. Examining this through Utilitarianism, it, at first glance, seems justifiable: it produces the most happiness for the most people. However, the lack of respect and ownership given to Henrietta and her family complies with a dangerous double standard: the benefit of one community (science) is more valuable than the utility of another (Lacks and other African-American patients at the time). One must realize that by only looking at the utility gained by the medical community and the potential people their HeLa research could help, they are overlooking and ignoring the underlying issue of inadequate moral respect, communication, and access to proper care for the Lacks and other families.

Norman Daniels and the Normal Function Model

In discussing the candid distribution of healthcare in modern-day society, Norman Daniels focuses mainly on his philosophical theoretical concept of “normal functioning” to justify healthcare as a right. Daniels also argues that healthcare is a positive right (a right that requires someone, in this case, the state, to engage in certain policies). Therefore, the state must enact comprehensive healthcare laws to protect its citizens. Within this argument, Daniels also actively refutes the ideals of utilitarianism and argues that they have no logical place within the sphere of healthcare. The normal functioning model that Daniels argues is, in my opinion, a comprehensive, accurate, and well thought out healthcare policy. If the medical establishment is solely committed to keeping patients within their normal functioning range, it would allow for complete care for very sick patients whilst also preventing the dangerous over-extension of healthcare programs, therefore also accounting for resource-oriented concerns.

To accurately dissect and analyze this argument, we must first understand the core piece of Daniel’s theory: that of the “normal functioning range”. To simplify this analysis, I will use a color-oriented method. Daniels argues that every human properly functions within a range- consider this the “green zone”. Within this zone, a person is medically well enough to pursue and attain opportunities within the social, political, economic, and personal spheres of their lives. Consider a patient in this green zone who then contracts a debilitating condition such as breast cancer. Look at this as the “red zone”. Within this zone, the patient is unable to attain success in any of the previously identified fields because of his medical condition. It is in this case that Daniels believes that the patient should have equal access to healthcare- to nurture him/her back inside their normal functioning range. This system would place a higher priority on patients whose conditions obviously inhibited their ability to attain success in their lives. 

It is important to note the distinction between Daniel’s argument and the theory of utilitarianism (absolute healthcare equality for all conditions). Daniels refutes this theory for the following reasons: it would not likely be economically possible, the difficulties of justifying any unequal access that would arise, and finally concerns about autonomy and paternalism (e.g could you refuse treatment in a universal healthcare society? What about changing or choosing which practitioner you saw?)

When analyzing this healthcare model, it is critical to consider the impacts this would have on medical practices that do not focus on bringing patients from the “red” to the “green” zone. This can be examined through Daniel’s “Treatment/Enhancement Distinction”. Daniels believes that healthcare should only be responsible for treating sicknesses and that a right to healthcare does not include treatment made to improve conditions that don’t’ take a person out of the “green zone” (e.g genome mapping technology, inherited trait modifications on fetuses). This would restrict healthcare to necessary practices, which Daniels believes is necessary to preserve moral integrity of healthcare.

I agree with Daniels in almost every facet of his argument. The only criticism I have is that of varying definitions of the normal function. Just as Goldman argued with his theory of value orderings, could different patients not have different intrinsic definitions of their own “successes” or opportunities in life? In this situation, Daniel’s model falls apart- when there is no one-model-fits-all that can be applied to the normal function.

Goldman’s Refutation of Medical Paternalism- An Analysis

In refuting the practice of Medical Paternalism, Alan Goldman focuses mainly on the ideological theory of “value orderings”; defined as the order of one’s life priorities, and how medical paternalism fundamentally violates this doctrine. Goldman argues that medical practitioners cannot accurately assume that a patient’s top value is prolonging their life, because intrinsic moral values are completely subjective on a personal basis. Goldman continues his confutation by discussing the relationship between subjective and objective harm, and concludes with a rebuttal of paternalistic assumption of moral authority. Therefore, according to Goldman’s argument, Medical Paternalism is almost never justified because doctors cannot accurately assume one’s value orders, and thus should not act paternally because of the subjectivity of individual moral codes. 

To conduct an informed analysis of this argument, we must first understand the main anatomical  piece- Goldman’s idea of value orderings. This can be understood as the order in which an individual “ranks” his life priorities. The reason Goldman takes issue with Paternalism is because it assumes that the prolonging of life is at the top of everybody’s value orders. Goldman disputes this assumption, as everybody’s value orders are completely subjective- a doctor cannot accurately estimate a patient’s priorities without deep interpersonal knowledge of every patient- a task that would be virtually impossible. Goldman argues that the autonomy to decide and uphold one’s values takes precedence over “mere biological existence” (124). I read this to mean that the nature of one’s life may be more important than its’ length- such as a terminally ill patient opting for assisted suicide. 

The other important aspect of Goldman’s argument is his idea of subjective vs objective harm, and how they stack up against each other. For him, objective harm is as such: physical injury, death, depression- something no rational person would wish on themselves. Subjective harm is when someone’s autonomous development (aka their life projects/value orderings) are blocked and externally interfered with. His argument claims that subjective harm is likely to cause more hurt than objective in the long run, as it fundamentally invalidates one’s “integrity as an individual” (121), since something other than his ideal state of affairs will be actualized. Respecting the autonomy of the person may cause objective harm, but that harm cannot be used as an excuse to disrespect one’s free will.
I agree with Goldman in almost every sense of this argument. However, when evaluating his argument, some issues arise. When Goldman identifies the concept of the value order, he does not analyze the case of psychologically impaired patients. For example, a clinically depressed person may make life choices that do not align with his usual life priorities. Secondly, Goldman defends his value order theory by using the example of people putting quality over quantity in relation to their lives, such as people taking risks to enrich their lives. I have to wonder if this is truly representative of the population, and if it is, if this concept of a pleasure-oriented life can be used in a medical sphere, where doctors are bound by the Hippocratic Oath. One must consider if there is a clash between the overarching medical goal to prolong life and the enrichment-oriented life goals argued by Goldman.