Public Health Crisis Warrants Liberty Restrictions

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Parker Crutchfield, PhD

Preventing Harm
Suppose your colleague was diagnosed with tuberculosis on Friday but tried to come into work on the following Monday. You would be right to call local public health officials, and they would be warranted in isolating him. Now suppose instead that he was diagnosed with lung cancer on Friday but came into work Monday. You would be wrong to call local public health officials and they would be wrong to isolate him. When a person’s health or behavior are a threat to others’ well-being, there is greater moral justification for restricting the liberties of that person. This is just the converse of Mill’s Harm Principle, which states that the only time it is permissible to restrict a person’s actions is when those actions threaten to harm another person.

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Image description: A dry and cracked river bed in Sri Lanka. Image source: Bioversity International/S.Landersz/Flickr

Recently, the Australian Medical Association declared climate change a threat to the public’s health. This comes after a similar declaration was backed by organizations such as the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, and the American Lung Association. Climate change is a health emergency that threatens the health and well-being of the public. Just as your colleague is a threat to the health and well-being of those around him, climate change is a threat to the public’s health and well-being. Thus, Mill’s Harm Principle applies—in principle it is permissible to restrict liberties to prevent the harm that ensues from climate change.

Public Health Ethics
When your colleague sees his oncologist about his lung cancer, the physician likely prioritizes the patient’s well-being. But public health ethics takes a more utilitarian approach: the individual’s interests are secondary to the greater good. Instead of balancing values such as patient autonomy and the physician’s judgment about what is most medically appropriate, public health ethics primarily balances liberty, equality, and utility (benefit). This to say that, for example, one person’s liberty may be justifiably restricted so that greater utility to the public may be achieved, or that it may be permissible to sacrifice some utility so that everyone can be subjected to the same treatment. Other values such as transparency or solidarity may be incorporated secondarily.

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Image description: A large stack billows dense smoke into the air that appears pink against blue sky. Image source: Billy Wilson/Flickr

Viewing climate change through the lens of public health ethics, which interventions best balance liberty, equality, and utility? There is significant disutility of not doing anything—there will be incalculable harm to very many people. The cost of doing nothing is so high that there is almost no benefit we might achieve presently that could outweigh it. Trading the harms we will suffer by doing nothing for the benefit we might achieve by doing nothing is a bad deal for us and a much worse deal for the next generation.

It is not commonly noted, but the same could be said for liberty—by doing nothing we trade future liberties for present ones. If we want to promote liberty in the future, we need to restrict it now. Currently those who are best positioned to intervene on climate change enjoy an extensive scheme of liberties. We can cool our houses to 68 degrees in the middle of summer; we can travel by jet to anywhere we might want to go; we can preserve our food in disposable plastic containers; we can mostly go outside without fear of catching a mosquito-borne illness; we can even use plastic rather than paper straws!

Inaction and Liberty
If we do nothing in the name of preserving these liberties, we stand to lose much more. It’s pointless to travel by jet to a place that’s underwater or that’s so hot it could kill you, to say nothing of the prospects of actually living there. When the changing climate displaces those living in New Orleans, Phoenix, Miami, the mid-Atlantic, or anywhere else in the world that will be uninhabitable, those people have to go elsewhere, increasing population density in those areas. Cooling our residences and workplaces may be prohibitively expensive, along with refrigerating our food, manufacturing plastic straws, or going outside in shorts and a t-shirt. Such effects will only exacerbate social inequalities.

Or consider the worst-case scenario, one in which climate change exerts too much pressure on governments, undermining their ability to uphold the laws that democracies have agreed to, such as laws prohibiting taking another person’s stuff. In such a scenario one’s scheme of liberties might be as extensive as it could possibly be. But in that case life is solitary, poor, nasty, brutish, and short—all conditions that make it impossible to exercise those liberties and that significantly limit one’s self-determination. The dead have no liberties. For people who want to preserve and promote individual liberty, it makes sense to intervene now.

To What Extent?
If ethical intervention upon threats to the public’s health requires finding the best balance of liberty, equality, and utility, then we have justification to restrict present liberties. Doing so not only promotes greater future utility, but it also promotes greater future liberties. I have not addressed equality, but as things stand now doing nothing will exacerbate social inequalities. But to what extent can present liberties be restricted?

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Image description: two brown and white cows are shown within a crowded group of cattle. Image source: Beatrice Murch/Flickr

Given the severity of the threat climate change presents to future liberties, it may be reasonable to prohibit air travel, driving vehicles that fail to meet certain emissions standards, eating beef, or even using plastic straws and incandescent light bulbs.

I mention above that there are other values that may be considered. If it is permissible for states—in the name of public health—to restrict present liberties to promote future liberties, how can they do so transparently? Does restricting present liberties promote or undermine solidarity among the population? If restricting present liberties undermines solidarity, does it do so to the degree necessary to outweigh the promotion of future liberty, equality, and utility?

parker-crutchfield-cropParker Crutchfield, PhD, is Associate Professor in the Program in Medical Ethics, Humanities, and Law at the Western Michigan University Homer Stryker M.D. School of Medicine, where he teaches medical ethics and provides ethics consultation. His research interests in bioethics include the epistemology of bioethics and the ethics of enhancement, gene editing, and research.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, October 10, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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References

  1. Murphy, Katharine. Australian Medical Association declares climate change a health emergency. The Guardian. Retrieved September 18, 2019, from https://www.theguardian.com/australia-news/2019/sep/03/australian-medical-association-declares-climate-change-a-health-emergency
  2. Climate change is a “health emergency,” 74 medical and public health groups warn. NBC News. Retrieved September 18, 2019, from https://www.nbcnews.com/health/health-news/climate-change-health-emergency-74-medical-public-health-groups-warn-n1020961
  3. Miller, Kayla. Three dead amid ‘outbreak’ of mosquito-borne virus in Michigan. com. Retrieved September 18, 2019, from https://www.mlive.com/news/kalamazoo/2019/09/three-dead-amid-outbreak-of-mosquito-borne-virus-in-michigan.html
  4. Stevenson, Seth. Plastic straw bans and the paper straw culture war. Slate. Retrieved September 18, 2019, from https://slate.com/business/2019/09/plastic-straw-bans-paper-culture-war.html
  5. Ivanova, Irina. Climate change worsens economic inequality, scientists say. CBS News. Retrieved September 18, 2019, from https://www.cbsnews.com/news/climate-change-global-warming-worsens-inequality-scientists-say/
  6. Kormann, Carolyn. Miami faces and underwater future. New Yorker. https://www.newyorker.com/news/news-desk/miami-faces-an-underwater-future
  7. Irfan, Umair. 122 degrees for days: the looming Phoenix heat wave that could harm thousands. Vox. Retrieved September 18, 2019. https://www.vox.com/energy-and-environment/2019/9/9/20804544/climate-change-phoenix-heat-wave-deaths-extreme-weather
  8. John, Tara. Combat climate change by cutting beef and lamb production, report says. CNN. Retrieved September 18, 2019. https://www.cnn.com/2018/11/15/health/beef-lamb-diet-climate-scli-intl/index.html

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22 Responses to Public Health Crisis Warrants Liberty Restrictions

  1. Mike Zandstra says:

    This post does a great job articulating exactly what some of our struggles are in promoting a healthy global climate, and living in a nation where individual liberties are at the core of our daily lives. It seems to me that on the societal level, much like the individual, we get caught up and stuck in our “comfortable” way of life, doing things the way that is most convenient, or that have been done for generations. This way of thinking butts directly in the face of the impending changes that our global society faces when examining climate change, as it requires systemic changes to our way of life and operation, which doesn’t sit well with many in a nation who claim that individual liberty in their choices as an inherent, even spiritual, right. While I agree with the principle of prohibiting certain liberties in the interest of public health and well-being, putting it into practice with these things in mind seems like the logical next step for public health officials.

    • Parker Crutchfield says:

      Thanks, Mike. You’re right–it’s very easy to maintain our habits when the real threat is not right in front of us. So far, focusing on future welfare has failed to move people into collective action. But maybe if the problem is framed as one of individual liberty, then some people might be more inclined to act.

  2. Jacqueline Michelle says:

    Thank you, Dr. Crutchfield for focusing on this particular subject area of bioethics. I really like your take on how public health ethics should also apply to the illness of our planet, due to climate change.
    I agree that public health ethics should also include climate change under its umbrella, because it is a health epidemic we are facing worldwide, one that people are widely denying still despite all of the proof and evidence that’s out there. Everybody can see how our society’s overconsumption culture has created more waste and pollution of resources than ever before. So why deny it?
    We as humans are causing great harm, not just to animal and plant life, but to ourselves. Our health starts with our environment, and without a healthy ecosystem and planet, then we are going to have more health risks and complicated, hard-to-treat illnesses. The dramatic increases are not going to just slow down any time soon, either.
    I like how you addressed that this issue as not just a “public need” but it is a public health necessity. The public should be able to sacrifice some utility or benefit, to prevent more wastefulness and/or the unequal distribution of resources. Like you said, it could be something as little as buying LED lights, or recycled fabric softeners and recycling the plastics. Of course, we should be moving bigger, but that’s the general idea (start with baby steps).
    We have seen how bad it can get at this point, and maybe now another big step is electing a president and party that is more aligned with these ethical values and principles. Hopefully, in the very near future, public health and environmental wellness and sustainability ethics will be honored, followed and respected.

    • Jacqueline Michelle says:

      Also, I have a few questions about your blog, Dr. Crutchfield, if you could answer them for me. What do you think public health officials can do to intervene or get the word out somehow?
      I am a social work student and I’m going into medical social work. What role do you think social workers could have in public health ethics and getting involved in helping reduce our carbon footprint?

      • Parker Crutchfield says:

        Good questions. I have a paper, “Compulsory Moral Bioenhancement Should be Covert,” in the journal Bioethics that argues that we should all be drugged without our knowledge so that we can muster the moral behavior that is up to the task of combatting climate change. A more mundane action would be to outlaw or tax beef consumption in the way that tobacco products are regulated (which would achieve multiple moral goods). Or to raise emissions standards…

        I’m not sure about the role of social workers, because I’m not sure what anyone’s role would be. But a public health response to climate change might look something like a public health response to polio, measles, chickenpox…As a social worker, what is your role in compulsory vaccination? Whatever it is, your role with respect to climate change might be similar.

    • Parker Crutchfield says:

      Thanks for the comment, Jacqueline. It hits close to home. Currently in Kalamazoo it is recommended that we not go outside without significant protection from mosquitos, as there is an “outbreak” of Eastern equine encephalitis in the area. I’m not saying the outbreak is due to global warming, but it is likely to continue to be a threat until the first hard frost, which might–due to global warming–come later. This is very clearly a matter of public health and, given our patterns of consumption, a self-imposed liberty restriction.

  3. Elizabeth Alexander says:

    This is a terrific stimulus for conversations with colleagues, students, and our friends and families. I am often asked by students why we continue to use plastic disposable specula in our teaching of women’s health, and often in out clinical settings. It is fairly clear women patients find the metal specula more comfortable, and they prefer them, without much hesitation ,when asked. I have no answer for this question, other than, the people who make this decision say it is more convenient. More convenient??? I asked students who will have a choice in this in the future to to consider the impact on the environment of throwing away hundreds and thousands of plastic specula and disposable batteries, just because of “convenience,” and I ask them to consider this lack of environmental stewardship as a public health issue. Because some of these students in the future may have a say in choice of disposable medical equipment into our landfills. I have brought this up with our curriculum leaders who re-iterate that it is because of convenience that we make this choice. I have offered to donate an hour after every time I teach this section to clean the specula (or teach students how to clean them). How we make everyday decisions in our practices and teaching policies about waste is important, just as taking the opportunity to discuss these decisions with our students. I would submit that environmental stewardship should now be a section within the curriculum, as the time is now, to take this issue personally, and model that in our teaching practices. This article should be required reading for every student, every faculty, and every hospital and medical administrator. Thank you so much for re-invigorating the conversation.

    • Parker Crutchfield says:

      Thanks, Elizabeth! Your comment highlights the immense challenge of taking action. Changing from plastic specula to metal specula is one of millions of individual choices groups will have to make. If we have any chance of leaving anything to future generations that’s worth having, we will have to forego certain “convenient” liberties.

  4. Emily Mayer says:

    I appreciate the steps you included to enact in an attempt to prevent irreversable climate change, like stopping beef consumption and use of single use straws. However, I think the capitalistic society we live in poses a challenge in doing this. Corporations are driven by their goal of making money – if we were to prevent them from selling or producing certain items that are harmful to the environment, there will be a huge backlash. I’m curious if you have thoughts about how to counter this idea? How can we encourage the shift of focus from capitalistic gain to well-being of the environment? I believe that if larger corporations start this transition, consumers will be more likely to follow, because our society is so strongly impacted by the large corporations in our country.

    • Parker Crutchfield says:

      I think you are absolutely right, Emily. At least in the U.S., I don’t see much hope unless voters start becoming single-issue voters, with the single issue being policy to prevent suffering from climate change. While certain companies do take stewardship seriously and have long-term views, I don’t see how any progress can be made without policy changes, and that takes different representatives than most of what we currently have.

  5. rhoadesi says:

    Thank you for your post, Dr. Crutchfield. I agree with you that the climate crisis is a public health crisis, and that we can make progress if we start treating it like one.

    To that end, I tried to think about how politicians (who control public health funding that is distributed to public health initiatives around the country) would respond to public pressure to create a mandate that we forego some liberty or increase equality now in order to increase the likelihood of utility and liberty in the future. Frankly, I think many of them would balk at the suggestion of increasing equality by restriction of the liberty of some in favor of survival of all. What I believe to be a very logical step some people are advocating for is taxation of the uber rich to pay for the initial infrastructure changes that need to occur to reduce our carbon emissions quickly—that is, taxation of a few rather than the entire population. While the uber rich would experience little to no impact on their day to day lives (or their future lives, or their children and grandchildren’s lives) if compelled by law to give up some proportion of their accumulated wealth via taxation, I think the mentality of Americans in general and our fixation on a capitalist economy would predispose the hyper wealthy to consider this taxation to be persecution and theft.

    What are your thoughts when considering the relative liberties and utility afforded the super wealthy in comparison to those of the people who are not super wealthy? Is there any way you can think of to inspire beneficence or altruism from people who are inclined to hoard wealth? I think a major part of this issue is that as a culture we are territorial about our wealth because we see wealth as liberty, a freedom, and we have had decades of politicians promoting messaging that frames taxation as a reduction of liberty, rather than a utility that provides us with the things we need. How can public health officials, the administration of our government, and our citizens begin the work of shifting this perspective?

    • Parker Crutchfield says:

      Those are great points, and excellent questions. There is simply no way to do anything without significant cost. Regardless of how it may be accomplished, the utlra-rich must bear that cost, either in the form of giant donations to science, technology, and policy, or in the form of higher taxes. If to accomplish this it is necessary to change the way Americans view taxes and liberties, I don’t hold out much hope. This is why elsewhere I, and several others, argue that we should be morally enhanced so that as a population we can make moral judgments that position us to do something about climate change.

  6. Alyssa Platte says:

    I appreciate this post because it captures a larger societal issue that can be approached at the micro level. The majority of the population would rather complain about something, like the harm in using plastic, but also be upset when their drink at a restaurant does not come with a straw. There is a nature of hypocrisy and selfishness with our actions. Small changes to our daily habits now can make great impacts to our future. However, I agree with Mike’s comment about our societal comfort. We become comfortable numb to the toxins of our routines. We understand that littering is terrible for the environment and are quick to make comments, such as “I cannot believe these people could not wait until they got to a trash can to throw their garbage away.” On the other hand we do not bat an eye on throwing cigarette butts, straw wrappers or McDonald’s bags out the window when they are unwanted in our space.

    States could be transparent through media that is published by a neutral party, such as CDC. There could be an explanation that there is a limit, but does not mean resources are being eliminated. If there was an option for the public to give feedback or ask questions, they would feel as if their voice was important.

    • Parker Crutchfield says:

      You said there is a nature of hypocrisy and selfishness with our actions. I think this is absolutely true, not just of actions pertaining to the environment, but to everything we do. We are, overall, very bad at making decisions and acting in ways that most promote our interests and the interests of others, at least on a routine basis. People simply cannot maintain that level of consistency of behavior. So, if so acting is necessary to prevent suffering from climate change, we’ll have to repair this deficit. What often gets overlooked in the discussion about climate change is that it is largely a problem of psychology.

  7. Leah Mannino says:

    Dr. Crutchfield,
    Thank you for sharing your knowledge on a very concerning topic within our society. Climate change is a serious problem within our world that I often time see being pushed off as if it doesn’t exist. There are serious environmental problems that are also threating humanity as a whole. How do we even begin to address it? I really like your ideas about restriction for plastic straws and incandescent light bulbs. I think as a society we have tried to make steps towards finding better solutions for the sake of the environment. I also really like your idea about setting standards for vehicle emissions to make them more ecofriendly. We are currently living in an environment where everything is always accessible to us no matter what the costs. This means that our “comfortable lifestyles” can have severe effects on the environment for future generations. Changes will need to be made by individuals well known amongst society. However, what are some steps we can take as students address this issue? I often feel hopeless when even thinking about the effects of climate change and I know many others that feel the same way!

    • Parker Crutchfield says:

      I’m with you, Leah. I also feel mostly hopeless, not so much for me but for my young children. There is a good chance they will be hurt, in some way, by climate change. Right now adults have a choice whether they want to experience minor discomfort now or major discomfort later, children are given no such choice. As a student, I think the advantage is that it can often be easier to organize with others. But money and votes talk, and making sure that these are going to the right people and organizations is important.

  8. Megan Jones says:

    Dr. Crutchfield,

    Thank you for this perceptive look at climate change through the lens of public health. As many other commenters have mentioned, it is incredibly easy for many to “brush off” climate change due to the massive, almost unimaginable consequences this impending issue carries. The apprehension in modifying one’s actions to become more sustainable or the complete denial of the issue may have to do with these modern luxuries associated with insularity. Defining climate change as a public health crisis is a great way to spark new ideas for combatting the issue together as opposed to separate pieces. If there were a more collectivist nature in this country I believe it would be a lot easier to send this message across. The cultural ideals of privacy and personal choice are often upheld at the highest degree in the U.S., so making progress on climate change on a policy level is often a difficult task. Advocacy, informing policy change, and educating others about climate change are now important functions of healthcare professionals and bioethics officials in our modern society.

    • Parker Crutchfield says:

      Part of it is definitely cultural. Many people in the U.S. aren’t motivated to consider the health and well being of their neighbors and others in their community. You can see this with recent rise in opt-outs for vaccination, among other safe public health interventions that serve a collective benefit. It’s hard to combat this. But I think it’s also psychological (as if there is a difference). The environmental pressures that helped shape our social behaviors are very different than the pressures that we are faced with now. We aren’t very good at behaving in ways that prevent distant, abstract existential threats–I don’t think we’re well built for that. As you point out, though, advocacy and education can repair some of that.

  9. alyssamlyons says:

    Dr. Crutchfield,

    As an MSW candidate interested in public health and environmental justice, I enjoyed reading this blog post!

    Public health ethics are fascinating to learn about. As you mentioned, the utilitarian approach places an individual’s interests second to the interests of the greater good by placing the emphasis on equality, liberty and utility. In social work, we are taught so much about patient autonomy and how important it is for ethical social work practice. While individual autonomy is certainly important and essential, I can see the merits in restrictions of liberty when the greater good (our planet) is at stake. As a social work intern, I have grown passionate about educating clients and communities about environmental justice. It is my hope that education will inspire people to make changes in their lives to live more sustainably.

    It took me a while to find an answer for your question, does restricting liberties promote or undermine solidarity among the population? In my view, restricting liberties can potentially promote solidarity among a population in some circumstances. In recent years, I have seen many people make changes in their own lives that restrict liberties (I.e. consumption of beef, use of plastic straws) for environmental justice purposes which has created solidarity in communities to promote climate protection.

    • Parker Crutchfield says:

      Thanks for the comment, and that’s a laudable goal. I agree with you: liberty restrictions increase solidarity, at least among those who are being restricted. They have a way of galvanizing the group. But there’s a flip side to that, too. The agent of restriction, for example the state, becomes the opposition, and trust in that diminishes. You see this a lot with people who refuse vaccines. They are group that sticks together, and has deep mistrust of the state and other institutions, such as the scientific community. The interesting and challenging thing about public health ethics is that there is so much interaction between the different considerations. Promote utility and you undermine liberty; promote equality and you undermine utility; promote solidarity and you undermine trust.

  10. Catherine Asteriou says:

    Thank you for providing such a stimulating article Dr. Crutchfield. I–like many other posters here on this article–am an MSW candidate and one of my more macro level interest areas lies within food sustainability and justice; an arena that is deeply effected by climate change and the expanding global middle class. I think that continuing to enforce and offer alternatives to the “modern conveniences” we face in this day and age is one step towards restricting certain liberties transparently, however it becomes a particularly gray area due to resistance from certain populations. An example that comes to mind is the advent of the “impossible burger”–which for all purposes–presents, cooks, and tastes like meat despite being composed of plant based proteins. Theoretically if people ate these more often and backed off of beef consumption (which definitely has a negative impact on the environment), this could lead towards positive change; however, there are people who identify anything “meatless” as inferior despite near-exact taste and texture to its counterpart, and continue to plug their ears and scream “you can’t make me do this!”

    A concern that comes to mind is, I’ve seen environmentally friendlier versions of modern conveniences cost more for the general public and become treated as a “status symbol” versus a solution to a climate crisis. Many vegan/vegetarian alternatives are expensive and not always widely sold in grocery stores–even if a consumer lives near one. Most energy efficient cars are tremendously unaffordable. What is a good way to make these products–which would definitely help the crisis at hand–be more accessible to people from all SES? I know some cities have shifted their transportation systems from diesel fuel to hybrid systems (Minneapolis comes to mind) so that is a start, what else might help?

    • Parker Crutchfield says:

      Many “green” alternatives are indeed prohibitively expensive, and this fact is a major obstacle to preventing the suffering associated with climate change. Market conditions often dictate the cost to consumer, and there are limitations to manipulations of the market. But the government offers subsidies and tax breaks to lots of companies and industries which makes products and services more accessible. So, for example, perhaps subsidies should go to clean energy rather than oil companies, or to organic farmers rather than companies who have in mind only profit. I think the only way to make sure that these products and services become more accessible is by talking with your money and and your votes. Enough people need to be similarly motivated to do the same. If they aren’t, then we’re stuck. How do we motivate people? I don’t know. That may be an insurmountable problem with our psychology.

      The fact is that we are all going to have to sacrifice conveniences now in order to keep future basic liberties. Some will have to sacrifice more than others. If you’re living in Miami, you may have to sacrifice the convenience of not having to move. If you’re in Phoenix, you may have to sacrifice air conditioning and the building practices that rely on it. If you’re in Michigan, you may have to sacrifice going outside in late summer early fall so that you don’t get a mosquito-borne illness.

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