The Center for Ethics and Humanities in the Life Sciences is excited to announce the first event of the 2020-2021 Bioethics Public Seminar Series (formerly the Bioethics Brownbag & Webinar Series). You are invited to join us virtually – events will not take place in person. Our seminars are free to attend and open to all individuals.
U.S. physician shortages affect rural healthcare access, including access to maternity care. OB deserts, which are geographical high-risk areas for care delivery, exist in the Upper Peninsula and northeast Lower Peninsula of Michigan. How might lack of access impact maternity care options for rural women in our state? Dr. Wendling will present recent work that identified and characterized access points for prenatal and delivery care in Michigan’s rural counties and explored access to Trial of Labor After Cesarean (TOLAC) services for rural Michigan women. We will discuss how lack of access may impact maternity care choices for rural women and will strategize ways to address this issue.
Join us for Dr. Wendling’s online lecture on Wednesday, September 23, 2020 from noon until 1 pm ET.
Andrea Wendling, MD, is a Professor of Family Medicine and Director of the Rural Medicine Curriculum for Michigan State University’s College of Human Medicine. She has received the Rural Professional of the Year Award from the Michigan Center for Rural Health and was named the Outstanding Educator of the Year by the National Rural Health Association in 2020. Dr. Wendling is Assistant Editor for the Family Medicine journal and a founding Associate Editor of Peer-Reviewed Reports in Medical Education and Research (PRIMER). She participates on rural workforce research groups for the National Rural Health Association (NRHA) and Association of American Medical Colleges (AAMC) and has presented and published in the areas of medical education and the rural health workforce. Dr. Wendling is a family physician in rural Northern Michigan.
The New York Times Magazine recently published a long-form story about the tension between treating patients with COVID-19 by any means that might improve their chances of survival and recovery, and enrolling them in clinical trials to establish the safety and efficacy of these treatments, thus improving care both for future patients and for those who survived the trial. As with many stories about health care in the current pandemic, this article both raises perennial issues in bioethics and shows them in their starkest form: the seriousness of the condition of these patients and the lack of knowledge about how best to help them mean that the ethical dilemma described in the story is particularly clear. But a closer look at work in bioethics and the epistemology of clinical research suggests that, while the dilemma is clear, there are more ways forward than the two incompatible ways portrayed in the story.
The story begins by describing the clash between a critical-care physician faced with a COVID-19 patient whose condition was worsening, and a researcher who had enrolled that patient in a clinical trial. The former wanted to give the patient a higher-than-standard dose of the anticoagulant she was being treated with, even though this might mean that she would need to be withdrawn from the trial. The latter advocated for the importance of maintaining the integrity of the study, saying that acting on instinct instead of on evidence “was essentially ‘witchcraft’.”
Unsurprisingly, this characterization did not go over well with the other doctors in the meeting. A less contentious way of describing the situation might have been to say that, while doctors use their clinical judgment to make decisions about how best to use available evidence in caring for a particular patient, this only works when there is evidence available. And everyone agrees that, in the case of COVID-19, there is horrifyingly little evidence. This means that enrolling COVID-19 patients in clinical trials is not depriving them of standard care (care that such patients would ordinarily receive if not in the trial)–standard care for this condition does not yet exist.
Image description: An illustration of a health care worker wearing blue scrubs, head covering, and face covering. Surrounding them are a stethoscope, face mask, syringe and surgical tools, thermometer, and microscope. The background is light pink. Image source: sunshine-91/Vecteezy.
There is a lot to think about here. Importantly, it’s not the case that the doctors treating seriously ill patients had no idea what to do. They had a wealth of experience treating patients with severe viral infections, with acute respiratory distress syndrome, with cardiac arrest, or with pathological immune reactions (the “cytokine storm” sometimes seen in chemotherapy patients). Some of this knowledge informed the care of early COVID-19 patients, raising the question of which treatments could be successfully generalized to this new patient group.
The notion of generalizable knowledge is in fact central to research ethics. The Belmont Report, which guides research ethics oversight in the United States, draws a bright line between research and clinical practice on the basis of their ostensibly distinct goals. Research aims to provide generalizable knowledge, while clinical practice aims to benefit an individual patient. This way of drawing the distinction meant that when physicians depart from standardly-accepted care in the treatment of an individual patient, it does not count as research (and therefore does not require ethics review). It also leads to the problem described above: enrolling a patient in a research study requires that they forgo their right to individualized care and are treated according to study protocol. Deviations from the protocol, such as the one described in the opening of the New York Times story, are prohibited. Patients whose care does not follow the protocol will usually be withdrawn from the study.
But this sharp distinction between research and practice also makes assumptions about the kind of clinical research being conducted. Schwartz and Lellouch (1967) distinguish between “explanatory” and “pragmatic” approaches to clinical trials. Explanatory trials are designed to minimize the influence of any factors, other than the experimental therapy, that could affect the outcome being measured. These other factors include additional medications and the presence of comorbid disease. Pragmatic trials, by context, are designed to resemble actual clinical practice, where patients often take more than one medication and often have more than one health problem. Pragmatic trials may also enroll a wider variety of participants (especially older participants), permit alterations in the study protocol, be more flexible in the timing of outcome measurement; in general, they are more flexible in their design and analysis. A given trial will fall somewhere on the spectrum between “highly explanatory” and “highly pragmatic” in its design.
In the case of COVID-19, there are good reasons to favor trials that are more pragmatic. First, there are so many factors that might affect prognosis (or were previously thought to do so) – age, gender, weight, blood type, various pre-existing conditions – that the study population cannot be narrowly defined. If it is, then the results of the study will apply only to people in that narrow population. Second, care for critically ill patients is rapidly developing. Even in the absence of an established drug regimen, survival rates have been improving. This means that by the time a trial is completed, the experimental therapy will be implemented in a very different context of care. Perhaps more importantly, because of these first two reasons, a strict, explanatory trial is less likely to give generalizable knowledge than a more pragmatic one (Bluhm and Borgerson, 2018). Research that reflects clinical practice is more likely to be useful in improving clinical practice.
Robyn Bluhm, PhD, is an Associate Professor with a joint appointment in the Department of Philosophy and Lyman Briggs College at Michigan State University. She is a co-editor of The Bloomsbury Companion to Philosophy of Psychiatry.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, September 3, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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Center Assistant Professor Dr. Laura Cabrera and Dr. Robyn Bluhm, Associate Professor in the Department of Philosophy and Lyman Briggs College, are co-authors of a commentary published in the latest issue of AJOB Neuroscience.
In “Fostering Neuroethics Integration: Disciplines, Methods, and Frameworks,” Drs. Cabrera and Bluhm comment on two papers that are part of the journal’s special issue on the BRAIN 2.0 Neuroethics roadmap.
Drs. Cabrera and Bluhm are co-investigators on an ongoing NIH BRAIN Initiative project,
“Is the Treatment Perceived to be Worse than the Disease?: Ethical Concerns and Attitudes towards Psychiatric Electroceutical Interventions.”
The full text is available online via Taylor & Francis Online (MSU Library or other institutional access may be required to view this article).
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” -Audre Lorde
Much has been written about finding meaning in illness. Others have written about finding meaning in caregiving. But taking care of someone else’s s!#t has its own intrinsic meaning, and for much of the time, it’s not all good.
For some, doing this work may allow them redemption—to repent for past wrongs, or it might allow them to display their humanity in ways they have not done before. Some may experience joy with self-sacrifice. I wish you well. Amid the crucible, women are performing all sorts of gendered work, and especially gendered care work. What do I mean by that? Women perform the majority of caregiving work to family and friends, i.e. women are the ones taking care of someone else’s s!#t. This work is unpaid, labor intensive, and career limiting if not career destroying.
Image description: An illustration of a faceless woman with six arms, each arm holding objects that represent a particular set of tasks: correspondence, computer work, food, entertainment, cleaning, and childcare. Image source: Multitasking Vectors by Vecteezy.
Care work offers few rewards, but it is necessary, and it is often silently expected of women. Unpaid labor that diminishes or denies opportunity for growth and sustenance is unfair, unjust, unsustainable, and wrong. Caregiver resilience may be a thing but is most likely a statement of privilege. Women do the work to the detriment of self-care, careers, outside friendships and interests, and other family relationships. Un- and under-paid gendered care work is a real and present danger to the overall wellbeing of women. As a society, we cannot keep telling women that this kind of gender discrimination in care work, especially for their family, is okay. It is not okay. Women must acknowledge all the ugliness that comes with taking care of someone else’s s!#t—the resentment, anger, frustration, disappointment, loss, fear, disgust, exhaustion, defeat.
So, who will do this work?
Dare I say, salaried home health assistants with all the benefits afforded fully employed persons—health insurance, retirement, educational assistance, PTO, etc. BUT then, who will do that work? Women, and more specifically women of color and immigrants. Whether women do it as unpaid family labor or as salaried health aides, women do care work. It may be reasonable to assume that the salaried worker may be better able to handle the emotional demands of the work. The unpaid family care worker is burdened with history, regrets, slights, insults, lies, disappointments, unforgiven and unforgivable acts, whereas the salaried care worker is not burdened with that baggage, and thus, may be a better and perhaps even a more caring caregiver. Absent the burden and weight of historical relationship bonds, women—as daughters, sisters, spouses, and mothers—may be able to find meaning in just being themselves.
Although the inequity of gendered work has always been there, the COVID-19 pandemic has shed revealing light on this inequity, just as it has on racism. Women are performing job duties remotely from home, becoming teachers, chefs, activity directors, housekeeping staff, laundry workers, and of course the calm in the storm, etc. Working the second shift does not go far enough in describing that reality—women hold on average about 100 jobs that are unpaid! These jobs historically have been the purview of women, but gendered work in the home is the cause of much friction in marriages. Moreover, women are balancing care of children with the care of parents, at times both their own and those of their spouse. Those women fortunate enough to retain their jobs and work remotely were immediately immersed in work that was unfamiliar and, in many cases, unwanted—24/7 care and attention to children, spouses, and others. For those caring for the ill, the disabled (mentally, physically, or cognitively), or the aged, or any individual with any range of functional and psychological limitation, the pandemic significantly increased the workload. Many people do this care work because they want to, out of whatever love and obligation they have for the care receiver. For others, there is no one else to do the work and it may feel, and indeed be, life limiting. Engaging in this work during a pandemic is especially challenging.
Oftentimes, a crash course in highly technical aspects of care (flushing ports, inserting feeding tubes, cleaning wounds, managing LVADs, etc.) leaves one completely bewildered. This disjuncture between necessary specialized care exposes the schism in care work that overwhelms and burdens.
Image description: Image description: A woman sits on the floor leaning against the back of a couch. Her elbows are resting on her knees with her hands clasped together over her face, eyes closed. Image source: Pixabay.
Because of shelter-in-place orders, the pandemic has also heightened concerns about domestic violence, child abuse, elder abuse, and alcohol and substance use disorders. We consequently will need to ramp up behavioral health and trauma-informed care services. Sadly, history predicts how unlikely we are to effectively meet this challenge. Essential caregivers unable to work remotely have had to expose themselves and their children to increased risk of disease, because their children had to remain in daycare or in multigenerational spaces with no means to isolate.
Gendered care work can no longer hide under the auspices of family love and selflessness. Caregivers oftentimes die before the care receiver. There is nothing heroic or laudable about a preventable early death. Too much togetherness can breed resentment. There is always something needed, an ask or a want. There is little give in return. Even a sincerely offered “thank you” neither diminishes nor alleviates profound fatigue.
Recognize the gender inequity of care work and the harm such blindness inflicts.
Pave the way for long-term care access, regulation, and insurance.
Pay care workers (both in institutional and home health settings) a salary with PTO, retirement, and benefits (educational and promotion opportunities).
Provide paid family leave for family and friend care workers, so that they can focus on the care work they want to do without worrying about economic self-harm.
Ensure enhanced respite care and family mental health support.
Taking care of someone else’s s!#t is hard, labor-intensive work, both physically and mentally, and it must be recognized as such. We can no longer silently accept the gender discrimination inherent in care work. We all must bear the burden and the weight, and take care of each other’s s!#t.
Disclaimers: The title is gendered caregiving, which, for the purposes of this blog, focuses on the traditional gender binary of women and men doing caregiving. While clearly in the minority, men do provide unpaid care work. I afford no special credit for doing this work because one is a man. It is akin to saying, “my husband is babysitting the kids”—um, no they are doing the hard work of parenting. My goal is to highlight the burden of care work that is performed primarily by women. Women do not get gold stars for work that they have historically been expectedto do.
The author acknowledges her own lifelong role as a caregiver. I do not aim to speak to every person’s experience with doing this work. Instead, I seek to highlight that the continued gender inequity and unpaid labor of care work harms women. If we are to be a just society, it is imperative for us to take care of the caregivers.
Karen Kelly-Blake, PhD, is an Associate Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine in the Michigan State University College of Human Medicine.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, July 30, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
You must provide your name and email address to leave a comment. Your email address will not be made public.
Center Assistant Professor Dr. Laura Cabrera and co-author Dov Greenbaum have written an editorial published in Frontiers in Genetics, titled “ELSI in Human Enhancement: What Distinguishes It From Therapy?”
The open access editorial, published June 23, is available in full from Frontiers in Genetics.
Avoiding the Impending Calamity: Our Ethical Responsibility
United Nations Children’s Fund (UNICEF) has warned that COVID-19 is disrupting life-saving immunization services around the world, putting millions of children in both rich and poor countries alike at risk of diseases like diphtheria, measles and polio. UNICEF, the Sabin Vaccine Institute and Gavi, the Vaccine Alliance are also worried that thousands of children could die needlessly from the diseases that were hitherto controlled through vaccination but are now being redundant because of the lockdown and compulsory quarantine by the government of the day. UNICEF Executive Director Henrietta Fore stated that there is going to be a real problem as many of these already conquered preventable diseases for children such as measles, diphtheria and cholera are in the increase across the world.
“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”
There is no doubt Africa will be the worst hit by this quarantine and lockdown policy. In a place where lack of education and poverty are commonplace, the rebound of these preventable diseases as a result of improper policy and control implementation will be unprecedented in the near future after we are done with the pandemic. Most governments especially in Africa did not take into consideration the sustenance of immunization programs and were more focused on the COVID-19 pandemic – the devastating effect of the disease cannot be equated to some of these childhood preventable diseases.
The quarantine and social lockdown have resulted in a drop in vaccination rates leaving several numbers of children open to diseases that were hitherto prevented. There is a need to step up campaigning once again on the importance of sustaining immunization that has been in place before the COVID-19 pandemic.
The Philosophy of Objectivism in Public Health Emergencies Such as the Coronavirus Pandemic
The mandate from a responsible government to ensure and protect the health of the public is an inherently moral pursuit with obligation to care for the well-being of its communities. In doing so the government should refrain from immediately engaging extreme measures. Further, the widespread deployment of uniform measures should first understand the peculiarity of the environments in which they will operate. Africans across many nation states, for example, live in a diversity of settings where communicable diseases are all too common. Many individuals live in poor living conditions necessitating proper advance planning of COVID-19 pandemic management. With that management, such planning should carefully consider the sustainability of the on-going vaccinations of childhood preventable diseases. Vaccinations have had an enormous beneficial impact on population health, and the related prevention of disease has been one of the single greatest public health achievements of the last century.
The questions I pose center on an exploration of which disease should rightly be given priority based on established fact. I question why there has been so much panic and fear about COVID-19. With the introduction of this novel disease, with a mortality rate lower than that of those diseases preventable by vaccination, should we permit gains made in vaccinating children against common childhood diseases to stop? With respect to more preventable diseases, especially those that affect children, why is there such an emphasis on COVID-19? Should mothers and caregivers give precedence to the COVID-19 pandemic, deferring their children’s routine immunization? Again, in an isolation and quarantine situation with strict governmental constraints on movement, how might childhood immunizations continue, especially in rural areas (assuming that accessible immunization centers are even open and operating)?
Currently, keeping to a routine immunization regimen by parents and caregivers is a challenge, especially for those who come from remote areas. The government, through the health ministry, should ideally put procedures in place for the duration of the pandemic to encourage all women to ensure that their children get access to these vaccines. It would be tragic to view this situation as a tradeoff, thus incurring the risk of returning to the horrors of polio, diphtheria, cholera and smallpox, and in doing so, allowing many to die of already controllable diseases.
Government Needs Proper Strategizing, COVID-19 Should Not Stop Normal Existence
There is no doubt that ethical challenges abound in quarantining people compulsorily, potentially against their decisions and will because of the COVID-19 pandemic. But more challenges abound when the government fails to take the precautionary measures necessary to ensure the continuity of the vaccination program for known and preventable childhood diseases. Because some of the latter are transmitted person-to-person there is, therefore, a need to provide both individual and public protection against the disease in addition to focusing on COVID-19. Though the COVID-19 pandemic may pose a health threat to many people across the globe, I suggest that there is even greater threat to personal liberty by compulsory quarantine and economic lockdown.
There is suspicion among some that the COVID-19 pandemic has been exaggerated, and that the measures currently in place across the world are not supported by the data. This doubt is illustrated by the Tanzanian President who had samples collected from goat, pawpaw and sheep for COVID-19, assigning human names to those animal samples. Reportedly, the related test results were positive, thus feeding the concerns on the accuracy of information regarding the incidence and prevalence of the infection, influence of co-morbidities, etc.
Demystifying the COVID-19 Pandemic While Achieving Health for All
Conflicting data notwithstanding, there are those who hold the opinion that measures taken by governments around the world are based on fear and speculations, and ultimately, might prove ineffective. It is argued here, that denying people their right to personal movement has a preventable impact on established vaccination programs, programs with known effectiveness in the reduction of mortality among children. High numbers of people are still being infected by those preventable diseases. It might also be argued that at present the imposition of a uniform isolation strategy is premature, especially with conflicting reports on its mode of transmission and degree of virulence. Perhaps it would be prudent to lay emphasis on practicing safe habits, building and supporting one’s immune system, maintaining proper hygiene, social distancing, and taking care of those most vulnerable ones among us such as the children and the elderly.
Felix Nzube Chukwuneke, is a Fogarty Trained Bioethicist and Professor of Oral & Maxillofacial Surgery and Dean of Dentistry in the College of Medicine, University of Nigeria Nsukka (UNN) Enugu Campus. He is Chair of the UNESCO Bioethics Unit at the College of Medicine, University of Nigeria; Chair of the College of Medicine Research Ethics Committee (COMREC) and Chair of the Eastern Nigeria Research Ethics Forum (ENREF).
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, July 9, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
You must provide your name and email address to leave a comment. Your email address will not be made public.
Center Acting Director and Professor Dr. Leonard Fleck has a commentary in the July 2020 issue of Cambridge Quarterly of Healthcare Ethics. The commentary is titled “Medical Ethics: A Distinctive Species of Ethics.”
Dr. Fleck writes, “Like the sciences, medical ethics has evolved with its own distinctive ethical norms and understandings as a result of emerging technologies (ICUs, organ transplantation, preimplantation genetic diagnosis, and so on) as well as chancing political, economic, and organizational structures and practices relevant to health care.”
The full text is available online via Cambridge Core (MSU Library or other institutional access may be required to view this article).
As members of the MSU community continue to work remotely and practice social distancing, Brews and Views has pivoted to online-only “at home editions” of the series that addresses the implications and ethical considerations of biomedical innovations and topics at the forefront of scientific investigation.
The first Brews and Views: At Home Edition was held on March 20 on the topic “Novel Coronavirus Pushes our Limits— We Need to Push Back, Thoughtfully and Fast.” Discussants were Brett Etchebarne, MD, PhD (College of Osteopathic Medicine), Leonard Fleck, PhD (College of Human Medicine), Maria Lapinski, PhD (College of Communication Arts and Sciences and College of Agriculture & Natural Resources), and Richard Lenski, PhD (College of Natural Science). Dr. Chris Contag, Director of the Institute for Quantitative Health Science & Engineering (IQ) and Chair of the Department of Biomedical Engineering, served as moderator.
The group of experts addressed scientific, communication, medical, societal, and ethical challenges presented by the novel coronavirus called SARS-CoV-2 that causes COVID-19 disease. Their goal was to inform and help those in the audience as we all navigate this global crisis. A recording of the event is available to watch on the IQ website.
On April 17, a second “at home edition” event took place, titled “COVID-19 and Our Children: Worry Now or Worry Later?” Moderators Dr. Chris Contag and Dr. Keith English, Professor and Chair of the Department of Pediatrics and Human Development, were joined by discussants from across the university: Carrie Shrier (MSU Extension), Kendal Holtrop, PhD (College of Social Science), Dawn Misra, MHS, PhD (College of Human Medicine), and Amy Nuttall, PhD (College of Social Science and C-RAIND).
Given the various ways that the current pandemic will impact children, they considered several questions: How will social distancing impact children? How can we use online learning to facilitate education? How can we prepare for the next epidemic? How do we deal with the direct and indirect effects and the social sequelae of this pandemic? How do we effectively communicate information to our children without increasing or generating fear?
To receive notice of future Brews and Views events, subscribe to IQ’s email newsletter. The next Brews and Views: At Home Edition is scheduled for Friday, May 29 from 5:00-7:00 pm on “The Dollars and Sense of Economic Convalescence from COVID-19.” The discussion will feature members of the local business community as well as Sanjay Gupta, PhD, Dean of the Eli Broad College of Business. Registration for the online event is open.
In the advent of the novel coronavirus (COVID-19) pandemic, there is an underlying belief in the United States that a COVID-19 vaccine may be the Holy Grail, the silver bullet to assuage the pandemic and open up the quarantine doors. Yet, there is a divide in the United States regarding vaccination acceptance. The Centers for Disease Control and Prevention (CDC) reports less than 50% of adults receive the vaccine for influenza (flu). In the 2017-2018 flu season, 37.1% received the vaccine, the lowest rate in ten years. The rate increased to 45.3% in 2018-2019. In a recent study reported in The Boston Globe, authors Trujillo and Motta found that 23% of persons surveyed said they would not get the COVID-19 vaccination. The study breaks it down further regarding anti-vaccination attitudes (also known as “anti-vaxxers”) and found that 16% of respondents identified themselves as anti-vaxxers, and of those, 44% said they would not get the COVID-19 vaccine. The researchers contend that anti-vaccine sentiment still exists in spite of the deadliness of COVID-19.
Image description: An illustration of a light green circle with a vaccination syringe in the center that is surrounded by green viruses. Image source: Alexandra_Koch/Pixabay.
As Americans, we want what we want how we want it. For some of us, the vaccine cannot come fast enough, and it better be effective. Others don’t plan to get it even when it is available. I have set up a dichotomous choice, but indulge with me in thinking through the debate. Many philosophical and ethical discussions occur in academic research—and particularly in mainstream and social media—highlighting opposing views of those who choose to vaccinate and those who do not. Often, these two positions fall along partisan lines, but not in the way that we might expect. The anti-vaccine movement began with the political left, but spread to the religious right, conservatives, and libertarians.
Approximately 20 years ago, a flawed but influential study linked the Measles, Mumps, Rubella (MMR) vaccine to autism. It started a hot debate fueled by staunch supporters of anti-vaccination from both sides of the aisle. The anti-vaxxer movement took hold with powerful liberal voices, but in recent years has become convenient for the religious and far-right who aim to keep government out of personal decisons. A 2015 Pew Research Center Study found that 12% of liberals and 10% of conservatives are opposed to vaccination. Herein lies my question: to what can we attribute the strong stance that anti-vaxxers take regardless of political position? Why does this question matter? America is a free country. However, the movement warrants an understanding in the midst of a pandemic of an extremely deadly disease whereby science tells us that a vaccine may mitigate infections and death.
Facts are stubborn things
One commonality between the liberal and conservative anti-vaccine stance is a lack of trust in science and medicine, and belief in “alternative facts.” This is particularly true within the anti-vaxxer movement. Some don’t trust science based on real life experiences or notable past deceptions in public health interventions, such as the Tuskegee Experiments, Havasupai Diabetes Project, Henrietta Lacks, etc. Antithetically, the autism study was deceptive by negating the lifesaving MMR vaccine as harmful. This myth has persisted over time, fueled by the anti-vaxxer movement and the discount of science as faulty, dangerous, driven by big government, and against individual choice. Facts versus feelings further complicates the human cognitive decision-making process. For example, in the case of vulnerable children with autism for whom science has not fully unraveled a cause or treatment, anti-vaxxers feel they can place blame on the MMR vaccination. Feelings contribute to the uptake of faulty information and fake news via social media, in turn drowning out the facts.
Vaccines have been one of the greatest public health successes in the world due in large part to herd immunity. Herd immunity comes with centuries of science resulting in the reduction of deadly diseases. The cursory explanation for herd immunity is: if a large proportion of a community is vaccinated, the lower the collective risk to the community. The algorithm suggests at least 80-90% of a community needs to have immunity to a disease and/or be vaccinated to protect the proportion of persons with compromised health conditions who cannot be vaccinated. The range in vaccination rates is dependent on the effectiveness of the vaccine. We have seen the eradication of smallpox and polio because of a highly effective vaccine delivered to most of the children in the U.S. This was achieved through mass immunization and extremely effective public health messaging. Most recently, buy-in to herd immunity has devolved from a fear of deadly disease to a fear of the very thing that prevents deadly disease. As a result, we have seen a resurgence in measles, which can be deadly for children with compromised immune systems. The science of herd immunity is powerful but relies on collectivism and social responsibility. The requirement that a large proportion of a community needs to be vaccinated to protect others cuts across American values of individuality and freedom of choice.
Before COVID-19, we lived in a different era with some generations never experiencing or witnessing extremely contagious, deadly diseases, confirming a belief that we can individually control our own disease states. Now, we are faced with a history making, highly infectious, deadly disease. Will we adopt a philosophy of sacrificing a bit of comfort by quarantining, wearing masks, or experiencing the pinch of a vaccination to save the lives of others? The jury is still out on that debate. We have witnessed segments of our society rebel and even retaliate against the idea of vaccination. Yet, scientists are working faster than ever to develop an effective COVID-19 vaccine, and the U.S. government has promised to enable the Food and Drug Administration (FDA) to relax clinical testing protocols to push the vaccine out in order to save lives. No, the vaccine will not be the silver bullet, but it has the potential to augment natural immunity to work as a tool of collective protection. Is the deadliness of COVID-19 enough to override the need for anti-vaxxers to hold onto personal choice?
This is not an indictment on one’s personal choice not to be vaccinated, but an opportunity to ponder individuality versus social responsibility for the greater community benefit. COVID-19 has been a game changer on human behaviors, requiring us to social distance and wear masks for the greater good. Will we embrace social responsibility and be vaccinated to save lives? How do we reconcile our individualism with the adoption of collectivism?
Sabrina Ford, PhD, is an Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Biology and the Institute for Health Policy in the Michigan State University College of Human Medicine. Dr. Ford is also adjunct faculty with the Center for Ethics and Humanities in the Life Sciences.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Monday, June 1, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
You must provide your name and email address to leave a comment. Your email address will not be made public.
In the words of guest Mark Van Linden, “adversity can present itself to anybody at any time.” This episode features a personal narrative of life with a spinal cord injury. Center Associate Professor Dr. Karen Kelly-Blake is joined by Mark Van Linden, MSA, and president of Adversity Solutions LLC. Mr. Van Linden experienced a spinal cord injury in 2009. In conversation with Dr. Kelly-Blake, Mr. Van Linden candidly shares his story, discussing his life before and after his injury, and addressing not just the physical impact, but the mental, emotional, and relational impact of becoming paralyzed at age 39.
This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.
About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics. Episodes are hosted by H-Net: Humanities and Social Sciences Online.