Author Archives: Logan D'Amore

Public-Shaming: Privacy and Paternalistic Issues

The COVID-19 pandemic has opened the doors to a diverse amount of issues the entire world was not prepared to address. D. T. Max’s article “The Public-Shaming Pandemic” in The New Yorker highlights one of these many mysterious aspects of the virus. Public-shaming has heightened and intensified due to the combination of social media and the unknowingly, rapid spread of the coronavirus. Max highlights countless different situations around the globe where the first cases of the virus were recorded and spread. Furthermore, he focuses on social media “hate” the people who were first infected received. Throughout his examples, the public has finagled their way into finding the identity of the first infected through social media platforms. This puts a great emphasis on the issue of privacy and is the practice of shaming not respecting one’s autonomy. 

The issue of privacy, in regards to the pandemic, puts into question if an individual’s medical history should be kept private when it puts the health of many at risk. Some may say that the several instances in which high-level officials, such as New York’s mayor Bill de Blasio tweet, or an average person exposing patient information to the public is a utilitarian approach to fighting off the virus. The means of releasing patient information, where they work and/or where they have been in the past week or so, is to protect the general public in the hopes that those possibly exposed to the virus get tested and choose to quarantine. The public is putting the good health and safety of society first. However, the means of releasing such information fail to meet the ends when the consequences of the public using such information to bully those initially infected have huge detriments to that individual’s health. In Max’s article, he clearly illustrates that public-shaming is tremendously detrimental to an individual’s health when they are singled out to society. This may lead to the practice of shaming being paternalistic in society. 

Shaming constructs people’s behavior to fit societal norms; in the case of the pandemic fit public health policy and attempts to encourage certain behavior to avoid. With this definition, shaming makes out to be a paternalistic practice overriding choice by nearly forcing certain behaviors on society. This is then further enhanced with social media. Overall, this puts into question if the public-shaming of these individuals is justified. The ends of making their private information public do not meet the means and it fits the requirements for a paternalistic practice. With more control and not publicly-shaming an individual, the practice could turn less paternal while also being more effective; rather than leading to ruining a person’s life. However, can public-shaming actually be regulated to that point?

Paternalism by the American Government and a Utilitarian Societal Approach

In Peter Hessler’s article, “How China Controlled the Coronavirus” in The New Yorker, Hessler addresses the main role the Chinese government played in the successful lockdown to prevent the spread of the coronavirus. Hessler emphasizes the societal duty that every individual in China understood. They saw the COVID-19 virus threat as a communal threat that was extremely serious to all aspects of life. The Chinese government took the dangers of the virus so seriously to the point of having a year-old baby that tested positive being held in medical observation for more than a month. However, Hessler quickly amends such dramatic examples as distracting from the immensely useful techniques of the Chinese approach to end lockdown and return to normal life. The article raises a vital bioethical question regarding paternalism by the government and societal duty in the United States. The American government must institute a paternalistic mindset regarding lockdown procedures, while also preserving state officials’ autonomy and having a utilitarian societal approach. 

A key difference Hessler indicates between China and The United States is the education and the effort of their peoples. In China, society respects science highly and are grown up in an uber-competitive educational system. Even though it may be criticized, such qualities, with government structure, were essential to fight the pandemic successfully. On the other hand, the Americans’ response to the pandemic has been significantly more passive. To alter this passive emotional response, the American government should take a paternalistic approach. In fact, under Dworkin’s theory of justified paternalism, paternalism is warranted to preserve a wider range of freedom for the individual in question (in this case the individuals). By the American government establishing certain lockdown procedures, such as mandating mask-wearing, we are attempting to preserve not only a wider range of freedom post-coronavirus yet preserving this freedom at a quicker rate. Furthermore, state government officials may also have a say in “intensifying” such requirements depending on the threat the virus holds on the state itself. Thus, having an effective combination of state official autonomy and national government paternalism.  

In such a scenario of paternalism, societal duty must be touched upon. Realistically, it would be super difficult in America for state populations to rely on both state and national government for rules (China strictness seems impossible due to violation of human rights). However, by changes in societal thought incorporating the bioethical practice of utilitarianism, it may be possible. Our people must see that morally right actions during the pandemic, such as following guidelines and going above and beyond to keep our country safe, will benefit every American in the long-run. Also, in such political unrest, establishing trust in our government with their paternalistic view on regulations would be tremendously beneficial to the overall good of society.

COVID-19 Vaccine: Distributional and Paternalistic Methods

In Sarah Zhang’s article, “A COVID-19 Vaccine Reality Check” in The Atlantic, she addresses the false hopes that the coronavirus vaccine is providing for America. She argues her case by stating America’s H1N1 vaccine procedures and how the coronavirus differs immensely. For example, the dosage is a two-step process and the uncertainty revolving around the coronavirus has yet to slow down. However, there are key similarities that, with ethical modification, America should implement. It is crystal clear that distribution will be an extremely complicated, particular process. America, as a whole, failed to address resource scarcity in the early stages of the pandemic, running out of masks and ventilators within weeks. While our focus must now shift towards a vaccine, keeping Zhang’s article and resource scarcity in mind, questions of what ethical practices that are justifiable must be put into place. I believe that America should take a modified, general utilitarian approach to distribution and heavily consider mandating the vaccine to a certain extent.

By taking the utilitarian approach to distribution, the allocation of resources will be properly addressed while respecting ethical practice. Zhang mentions the prioritization of certain groups of people as a successful procedure used during the 2009 H1N1 virus. This could be swiftly and effectively replicated for the coronavirus vaccine. The first group of people to be vaccinated and have priority should be healthcare workers, researchers, and officials on the frontlines of this pandemic. By vaccinating this group of people, we are adhering to the utilitarian perspective: a maximization of benefit and “good” produced in our society. These healthcare warriors could then devote their time and effort to save patients with great health, which is proven to increase productivity by economist Robert Fogel, and not have the preconditioned danger of receiving the virus. Furthermore, this group is fairly small with humongous value. With this method, we are still keeping in mind the scarcity of the vaccine. 

To streamline the process of distribution along, the people most vulnerable to the virus should receive vaccinations after healthcare workers. This would mainly include those with underlying health conditions and older adults in America: those who can truly not function “normally” due to the virus in their lives. Once again, we are adhering to the utilitarian perspective by decreasing the danger and effectiveness of the virus by protecting those most vulnerable. Thus, producing the most good and benefit by decreasing the threat that the COVID-19 virus possesses in America. This is also fairly similar to the normal function philosopher Norman Daniels stated while addressing the right to healthcare. However, this method becomes problematic after the first two prioritized groups: as it is extremely difficult to determine whose lives have been affected the most by this virus. 

Alongside questioning distribution methods, paternalism through the law (mandating the vaccine) could be justifiable to a certain extent and must be discussed. For example, if a healthcare worker or person with underlying health issues were, to hypothetically, deny the vaccine, should they still be able to work? Should we respect their autonomous decision? A golden rule when referring to paternalism in medicine is that overriding and/or restricting one’s autonomy is just if it is necessary to protect others in society. Refusing the vaccine is not only putting yourself in danger but putting others at risk that may be tremendously vulnerable to the coronavirus. To protect some autonomy, vaccines should be mandated to return to education at schools, the workplace, and other essential places. What is deemed to be an “essential place” is yet another complication to the hundreds of other logistical practices that must be addressed to successfully deliver the vaccine to the people.

Part II of Lacks: Is the Separation of HeLa and Henrietta Lacks Justifiable?

In Part II: Death of The Immortal Life of Henrietta Lacks, Rebecca Skloot illustrates the years succeeding Henrietta’s death. The immediate impact of HeLa, Henrietta’s immortal cells, on the cell-culture industry, and additional misleading truths of the care displayed by Johns Hopkins and Dr. Gey in Henrietta’s medical case are put on full display. At first glance, it is very clear that HeLa and Henrietta Lacks are two completely different living beings. Not only from the point of view in physical health and welfare, as HeLa is booming and Henrietta’s family is struggling in poverty, yet from multiple philosophical points of view it can be concluded that the separation of HeLa and Henrietta may not be justifiable. 

From the utilitarian scope, HeLa being distributed, leading to profits in the cell-culture industry and medical breakthroughs, may be reasonable at the very low cost of Henrietta’s family (many suffering from health conditions). HeLa was distributed not only around the nation but eventually around the globe due to Dr. Gey’s initial findings of being able to ship it successfully. At this point in the novel, the researchers and doctors see HeLa as an immortal gold mine of biomedical findings to be “pushed and shoved” to its limit. The cells grew to the point of “general scientific property”, according to Skloot (104). The cell-culture industry is booming due to Henrietta Lacks’s cells. Because of this gold mine characteristic, the overall benefit and good society receives is monumental. However, this utilitarian perspective seen by Dr. Gey and many other doctors disregards the moral beliefs, more specifically autonomy and “justice as fairness”, being violated during Henrietta’s care and the consequences her family must now face.

Dr. Gey’s actions to distribute HeLa already violated Henrietta’s, alongside her family’s, autonomy. Her cells were taken without her true, informed consent. This made the audience already question Dr. Gey’s moral thinking. However, during this second part, Skloot paints a very different picture of him. She makes him the “hero” by not saying and or mentioning Henrietta in interviews. From my point of view, this is immoral justice for Henrietta and her family. The “justice as fairness” policy is being violated; they must suffer from poverty when they have an opportunity to gain profit, yet that opportunity is unattainable (without true mention of Henrietta till twenty years later). Furthermore, after the death of Henrietta, the importance of her family’s autonomy increased when Dr. Gey wanted to perform an autopsy and needed her husband’s consent. Yet, Day, her husband, did not even know of what Johns Hopkins wanted. Due to Dr. Gey’s and Johns Hopkins’s mishaps, their action to not include Henrietta Lacks with HeLa is not morally valid. 

Allen E. Buchanan: Attractions and Specialized Right to the Decent Minimum Policy

In “The Right to a Decent Minimum of Health Care”, Allen E. Buchanan argues the faulty premises of universal right being justifiable for a mandatory decent minimum policy in health care. First, he explains logically and coherently the attraction towards, not the reasoning for, a mandated decent minimum policy for healthcare by our rational thought. Next, he explicitly explains through the combined weight of arguments from special rights to healthcare, harm-prevention, prudential arguments, and enforced beneficence is sufficient enough for a decent minimum of healthcare. In his special rights to healthcare, Buchanan emphasizes that there be no individual right to health care but a societal duty relying on the actions of all. 

Buchanan explains his three main reasons why a decent minimum policy seems to be a great idea at first glance. First, allocating resources from health care to other social policies would be a byproduct of health care having a decent, adequate minimum; as many prioritize health differently. It also stays on track with the societal obligation to help those in need and those of the less fortunate. Lastly, Buchanan exclaims that it is a floor beneath an individual, a safety net of some sort, to allow a person to put some priority on their health care. I agree with the second and third points of Buchanan’s interpretations of attractions towards the decent minimum policy; societal obligation and a safety net. However, his first point runs on the same assumption made by Alan Goldman, in which health and longevity are not priorities to a large majority of society. I would believe that most of our social policy expenditures are on health care and education to better ourselves as humans, so most of society would still spend money on a “higher level” of health care despite the decent minimum. This idea intertwines with the idea of individual autonomy, as the freedom to choose ideal personal health care is enhanced when nutrition is in its best form. Therefore, allocating resources would be a difficult task as this creates equal opportunity in such a case for those who do not prioritize health at such a high value. From an economic, realistic point of view, this may be exceeding the resources health care can provide and making the decent minimum policy less attractive.

In his suggestion to alter the decent minimum of health care, Buchanan argues the idea for special, not universal, rights to fit the definition of the decent minimum more effectively. Buchanan is attempting to enhance the decent minimum policy by disintegrating the vagueness of a universal right. He, once again, uses three primary groups of people that should receive a decent minimum policy. One group for those involved in a rectifying past or present of injustice, such as Native Americans. Another group for those who have suffered unjust harm or been unjustly exposed to harm by others. And a final group for those who have had exceptional sacrifices for the good of society, such as the military. I believe Buchanan does a great job transitioning to these arguments after explaining the counter of why a decent minimum seems but not is, a great idea. I agree with a more specialized right rather than a universal right, but, in my opinion, it seems to be specialized to the point of little to no effect depending on the requirements of the groupings. Also, it could be argued as discriminatory. With more details to his specialization, Buchanan effectively eliminates the universal rule to the decent minimum policy. Overall Buchanan is relying heavily on societal duty, through the sums of individual action, and aspiration of a decent minimum of health care. He fails to ensure and solidify his different approach to dividing health care for society, but does offer an interesting opinion.

Alan Goldman: Priority of Health and Prolonged Life in Rational Thought

In “The Refutation of Medical Paternalism”, an excerpt from Alan Goldman’s The Moral Foundations of Professional Ethics, Goldman argues for faulty premises stated in medical paternalism. Specifically, he claims that it is intrinsically wrong to assume most human beings prioritize health and prolonged life in rational thought. In actuality, Goldman believes very few people classify health in this regard due to many other underlying motivations in one’s life that may be prioritized. Therefore, paternalistic interference would not be necessary and or matching the autonomy, values, and beliefs of the patient.

Goldman explains that if health and longevity are at the top of moral decisions, then social policy should follow the same. For example, our entire federal budget should be spent on health-related issues and defensive war, in which lives are risked and loss is rational, would not take precedence over biological existence and quantity of life. Furthermore, he states that personal lives often engage in “risky” activities just for pleasure and or convenience. It would not be irrational to trade quality for quantity when assessing one’s longevity. Lastly, Goldman brings up the point of people with bad states of consciousness, such as mental health detriments and depression. He argues that it may be better off to not prolong this suffering, so the instrumental worth of being alive is no longer a priority to those suffering from these mental illnesses. 

The logic behind Goldman’s thoughts and evidence for his argument is clear and concise. However, I do not agree that very few people do not prioritize health and prolonged life when it revolves around patient and physician, or nurse, relationships and moral action in our society. From an ethical standpoint, one’s autonomy can not be completely fulfilled without being fully aware of their moral view. To achieve this, they must be in good health (or consciousness) and have grown to a certain extent of moral thinking. For example, the claim that parents can make decisions regarding their child’s health due to less knowledge regarding their moral judgments. Hence, longevity is necessary to have moral growth and a “corrected” autonomy. With this longevity, quality and quantity of life both increase, countering Goldman’s claim. Autonomy is, arguably, the most important principle in bioethical reasoning with an imperative connection to health and longevity. Therefore, many people prioritize their health status and longevity in moral judgments. 

In respect of Goldman’s argument and evidence, I believe that the idea of social policy also prioritizing health and medical longevity is a strong assumption that every single person prioritizes their health. As a majority, most people prioritize their health when referring to morality. Yet, I do agree with Goldman that some people may have different priorities; but in different situations. For example, an elderly family member suffering to stay alive and preserving life may not be their choice. Combining my criticism and Goldman’s argument, most people prioritize their health and prolonged life for their moral decision-making, especially regarding a physician and a patient relationship, in most medical situations.