COMMENTARY

If You Refuse to Distance, You Should Bypass Care if You Get Ill

Arthur L. Caplan, PhD

Disclosures

June 16, 2020

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This transcript has been edited for clarity.

Hi. I am Art Caplan at the Division of Medical Ethics at the New York University (NYU) Grossman School of Medicine.

The United States is deeply divided about whether it is time to open up and come back to some semblance of normalcy. We've seen many groups demonstrating vociferously to get their state to open up more quickly, sometimes in ways I think are ethically dubious. There were demonstrations in Michigan with armed people going into the legislature. I know that is an open-carry state, but it's one thing to carry weapons and a different thing to use them to intimidate. I think that was going on and I don't support that kind of demonstration. But there were other demonstrations in many states where people basically stood in the street, did not social distance, did not wear masks, and said, "We want to reopen. We think that the economy is being too damaged by this behavioral strategy for dealing with COVID-19 which keeps us quarantined and unemployed." I understand that and I have sympathy for that.

On the other hand, it seems to me that these groups are assembling in ways that create public health risk. They are not wearing masks, which has become almost a political protest. The President does not wear one. Mike Pence sometimes does not wear one. (People seem to be ignoring the fact that because the White House did not insist on it, the virus got into White House staff and into the White House itself.) Be that as it may, many people at demonstrations don't protect themselves. They don't stay apart. They don't wear a mask. I don't see any Purell. They are not doing any behavior that would minimize their risk. Ethically, I believe that liberty is great where one goes out and demonstrates, saying, "I'm not going to follow orders, I'm going to go to a bar, I'm going to open my business prematurely." I can be for liberty. But historically, as philosophers have always said, liberty has responsibilities and it has limits. To paraphrase John Stuart Mill, the great proponent of liberty in the 19th century, "Your freedom to swing your arm ends at the tip of the next guy's nose." Meaning, you can move your body around, but if you are hitting people and hurting them, then you don't have the freedom to do that.

We ought to take seriously the duties, responsibilities, and messaging that goes along with groups assembling in ways that are not safe. I propose that we ask people to sign a pledge card that says, "If I get sick and need hospitalization, then I want to go to the end of the line in terms of getting healthcare resources." I know that sounds radical because many doctors believe firmly (which I support) that you don't sort out patients on the basis of who is a good or bad person or who is or is not virtuous. On the other hand, if we are in rationing circumstances and you got yourself sick because you didn't follow the rules and recommendations and deliberately flouted them—you went to places and were recorded flouting them publicly—then I think you should have the guts to say, "I know what I'm doing. I want liberty and I'm willing to pay the price if I get sick." I'm not arguing that we should not treat them. I'm arguing that they should volunteer not to be first in line, but to be the last people treated if they were to set off a local outbreak that overwhelmed the hospital and rationing were to happen, or if we got a rebound of the virus that required a lot of hospitalizations, which I hope does not happen later in the year.

Tough policy, but at the end of the day, I think part of the message should be that you are free to choose. You are free to demonstrate, you are free to let your priorities be known. But if you make yourself sick and you don't follow basic safety precautions as part of what you are doing, then you should have the moral fortitude to say, "I understand the consequences and I'm willing to accept them." I'm Art Caplan at the Division of Medical Ethics at the NYU School of Medicine. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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