This post is a part of our Bioethics in the News series
By Sean A. Valles, PhD
In a twist of fate, there was an outbreak of COVID-19 at a White House celebration of the nomination of Amy Coney Barrett for the Supreme Court of the United States. This elicited a wide range of reactions to seeing a gathering of opponents of strict COVID-19 control measures being hurt by the very pandemic they have downplayed. While others have worried about the moral philosophy of taking pleasure in others’ suffering, or the hypocrisy of evading rules one publicly espouses, I have a different worry. A poll shortly after the White House outbreak found that a majority of respondents believed that Trump had acted “irresponsibly” in how he had handled his personal risk of infection from people he interacted with. While I do not worry about the president being blamed for his illness, I do worry about the wider cultural practices of 1) victim-blaming by attributing a person’s illness to their personal moral failure, and 2) insisting that health is a matter of individual choice. While the distinction might not seem important at first, I will argue there is an important difference between victim-blaming the ill and holding leaders accountable for setting bad examples with their conduct and other leadership failures. The first kind of blame is toxic in a society, and the second kind of blame is an important part of a well-functioning democracy.
Blaming people for their ill health is a strategy with an awful track record. It doesn’t do any good for the people subjected to “you’re too fat” messages. It doesn’t do any good for survivors of sexual assault or domestic violence. When directed inward, we self-blame for failing to do enough de-stressing self-care, rather than directing our blame to more appropriate targets like the needlessly bad working conditions or economic insecurities that make us stressed in the first place. Repeated messages that “sickness is the result of individual moral failure” also reinforce stigma. Stigma is a nasty phenomenon, with a “corrosive impact on the health of populations” and is particularly bad in cases of infectious diseases like COVID-19 because it actively encourages people to hide their infection, which is obviously bad for them and for others who interact with them.
A second problem with blaming people for their ill health is that ethics of blaming individual behavior reflects a misunderstanding of how health behavior works in the first place. Seemingly individualistic choices like diet, condom use, smoking, alcohol consumption, etc. are not made independently. We choose such things in roughly the same way we “choose” our religions or the languages we speak at home. Yes, each of us can choose to practice an entirely different religion (or lack thereof), and each of us can learn and use a different language in the home. Some of us do. In all of these cases, though, the vast majority of us don’t venture too far from a combination of what we learned while growing up and the cues we get from the people we interact with. We eat the foods familiar, convenient, and affordable to us. We adopt the values and beliefs (including trust in aspects of the scientific endeavor) of our communities, etc. Individual choices exist, but they exist within larger social contexts that have powerful but subtle effects on our choices.
Each of our everyday behaviors related to COVID-19 exist in a complex ecosystem of influences. Mask wearing and other social distancing measures have become intensely politicized and tied to masculinity. Masks and other health behavior measures also create new inconveniences and financial expenses. Social pressures also vary vastly from one setting to the next—in one store there are prodding questions and judgmental stares for wearing a mask, at an adjacent store there are similar pressures on those who don’t wear a mask. How we move our bodies and (un)cover our faces within these intense social pressures is not simply an individual choice.
Take the case of one of the attendees of the party at the White House, University of Notre Dame President, the Rev. John I. Jenkins. He did not wear a mask at the indoor/outdoor party, shook hands with attendees, and otherwise did not follow the standards he had imposed on members of his own university. He knew better and did not do better. Many of us have likely also gone against our better judgment to fit the incautious social distancing norms of a setting. Whether it is the university president or the university student, this is indeed hypocritical, and irresponsible in a sense. But, such blame is aside from the point, and more importantly it contributes to the sort of harmful cultural practices mentioned earlier—especially victim-blaming and stigmatizing the ill. Pointing out hypocrisy and the assigning of blame for individual health behavior distracts from the far more damaging thing Jenkins and the other leaders at the White House party did. As cultural leaders, they undercut efforts to build new norms, like public mask-wearing, the habit of greeting people without needlessly touching hands, etc.
We ought to blame Trump, Jenkins, and many other leaders who attended that party. We ought to blame them for failing in their relationships to the people they lead. That is a devastating form of irresponsibility. And it is very important to separate that kind of blame and irresponsibility accusation from the destructive form of blame discussed above: blaming people for having irresponsible relationships with their bodies/health.
The “personal responsibility” blame game has been the go-to talking point of conservative governors as they use their power to obstruct or dismantle public health measures. “You shouldn’t have to order somebody to do what is just in your own best interest and that of your family, friends and neighbors,” according to Alabama Governor Kay Ivey. Scolding people about “personal responsibility” during a public health crisis is a strategy based on how one wishes the world worked and not how it is actually working. Along similar lines, abstinence-only sex education doesn’t work (“teenagers: be sexually responsible by just not having sex before marriage!”), and neither does “just say no to drugs” education. Jenkins was at least right to point out that his behavior was a failure of leadership. As many of my colleagues in population health science say, we need to build a “culture of health.” That will require leaders suited to the task, and we ought to blame them when they fail in that leadership. Just skip the personal health blaming.
Sean A. Valles, PhD, is an Associate Professor with an appointment in the Michigan State University Lyman Briggs College and the Department of Philosophy (where he is also Associate Chair). His research spans a range of topics in the philosophy of population health, from the use of evidence in medical genetics to the roles played by race concepts in epidemiology. He is author of the 2018 book Philosophy of Population Health: Philosophy for a New Public Health Era. He is also co-editor (with Quill R. Kukla) of the Oxford University Press book series “Bioethics for Social Justice.”
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, November 5, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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More Bioethics in the News from Dr. Valles: We Need Healthier Schools, and Student Activists Are Stepping Up; Recognizing Menstrual Supplies as Basic Health Necessities: The Bioethics of #FreePeriods; Trump’s Attempt to Reignite the Coal Industry Is Another Health Policy Blunder; Politics and the Other Lead Poisoning: The Public Health Ethics of Gun Violence; Climate Change and Medical Risk
References
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- Harvard Law School HALT. 2020. “How to Avoid Victim Blaming”. Accessed 10/14/20. https://orgs.law.harvard.edu/halt/how-to-avoid-victim-blaming/.
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- Krusei, K. 2020. “Governors stress ‘personal responsibility’ over virus orders”. APNews.com. Accessed 10/14/20. https://apnews.com/article/abd3150c6329984133126c805b5131b0
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- Santelli, J.S., Kantor, L.M., Grilo, S.A., Speizer, I.S., Lindberg, L.D., Heitel, J., Schalet, A.T., Lyon, M.E., Mason-Jones, A.J., McGovern, T. and Heck, C.J., 2017. Abstinence-only-until-marriage: An updated review of US policies and programs and their impact. Journal of Adolescent Health, 61(3), pp. 273-280. https://www.sciencedirect.com/science/article/pii/S1054139X17302604
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MSU Bioethics 
Hi Sean,
I enjoyed reading your take on our society and its leaders in the wake of COVID-19. I agree that we embark in dangerous territory when our culture does not support a culture of health. I believe that we, as a society, need to demand a better response from our leaders in order to engage as a whole. I also found your research regarding health shaming highly interesting and thought provoking. Although the research supports that shaming is not an effective mechanism to encourage safe health measures, our society heavily relies on it. Although we have never experienced a pandemic as large as COVID-19 in our lifetime, has your research indicated positive approaches for leaders to take to encourage public health safety? Thanks so much for your entry!
Alexandra Kruger
Thank you for the thoughtful comments and question.
Dr. Sandro Galea is a particularly effective communicator about how leaders can act in ways that support health (for instance, his book, “Healthier” is a good resource. The followup book, “Healthy” is coming next year.). For some really concrete examples of good health leadership, the Robert Wood Johnson Foundation offers prizes (and nice accessible explanation articles to go along with the prizes) to communities that demonstrate exemplary health leadership: https://www.rwjf.org/en/library/features/culture-of-health-prize.html
COVID-19 offers some unique challenges, of course. But the habits of being a good leader in public health matters isn’t vastly different then being a good leader in other ways. E.g. setting appropriate priorities (some leaders have obviously not made public health a high priority even during the pandemic), humility (some leaders routinely arrogantly insist they know better than their advisors/agencies that have relevant expertise), transparency (some leaders conceal their reasons or processes for making decisions, etc.).
Dr. Valles,
I really appreciate the distinction made between victim-blaming for personal health conditions and failure of leadership. I believe that it is wrong, no matter how much you may dislike an individual, to feel a sense of satisfaction that one has gotten sick, as many have reacted to the news of President Trump being diagnosed with COVID-19. What I didn’t think about prior to this blog post, is that that mindset contributes to a culture of blaming one’s ill-health to moral failure, as has been the case for years in regards to views on substance use along with a host of other health conditions. Certainly, work remains to be done in this area no matter what the condition, as that mindset is still prevalent in many individuals today. Your statement of “stigma is a nasty phenomenon, with a ‘corrosive impact on the health of populations’” I believe was an astute one, indicating the wide-reaching, negative effect of this mentality.
Regarding the failure of leadership evidenced by the unmasked welcoming party of Amy Coney Barrett to the White House, I think that Trump-supporters and Trump-opposers can (probably) agree that that was an unwise decision. As the common phrase accurately notes, “actions speak louder than words,” thus, when a leader of any kind – let alone a national leader – in the spotlight or not, behaves in a way which contradicts what is expected of the rest of society, people will understandably be confused, upset, and let down.
Finally, as an aspiring healthcare social worker, I can really appreciate your acknowledgement and emphasis on the impact of one’s environment (rather than individual choice) on beliefs, values, and behaviors, particularly in concerns to health. Thank you for an insightful and timely post!
Kerri Knoll
That is so kind of you to say. Thank you very much. You show a clear sense of these complex issues, and that will surely serve you very well in your future career.
Hello Sean,
I really enjoyed this blog post. I think you did an incredible job of touching on pieces of this situation that many, including myself, have overlooked. There are other implications that need to be seen and understood. I think that people should be educated and assisted, before they can be “blamed” for their situation with their health. There are MANY people who are never taught how to have a good relationship with their body/health. How can that person be blamed when they do not know any better? I also believe that all those leaders were taught better, and we need to expect better from those who do lead us.
Thank you,
Kalli Feldpausch
Thanks for your nice comment. And yes, I totally agree we need to expect better from our leaders. It is a slow process, though, to change cultural habits around things like this, if the leaders are steeped in a lot of those same habits (even if their advisors tell them how/why to do better).
Hello Mr. Valles,
I enjoyed reading your thoughts on the recent COVID-19 outbreak that occurred at the White House gathering. As a society, we need better leadership that encourages its members to follow safety guidelines and who also follows those protocols themselves. How can we expect members of our society to follow social distancing guidelines and mask wearing mandates if some of our own leaders cannot do so themselves? I wonder if we can expect a positive outcome from the White House outbreak in regard to members of society possibly thinking more for themselves and following safety guidelines or will our leaders still have the greater influence over whether someone wears a mask or not? In regard to your note on victim-blaming, I think that is still important to take into account because some people can go into a grocery store and follow all proper COVID-19 safety guidelines with wearing a mask, social distancing, and washing their hands, but then still become infected. Victim-blaming is not helpful nor will it help to solve any of the issues we are facing.
Thank you,
Hannah
Thank you! And I agree that it’s really important to recognize that a person can do everything ‘right’ and still get infected. I probably should have said so more directly in the original post. A very good point.
Dr. Valles,
Thank you so much for sharing your insight on such a hard topic to talk about, especially lately. After reading and listening to your response to this event, it allowed me to think deeper about how we as a community see and view each other’s problems. When we talk about victim-blaming, we forget to see how easy it is to do. In your examples provided, we see that sexual assault, unhealthy-related behaviors, and even bullying are all forms of victim-blaming. We start to victim-blame when we are uneducated and unaware of everything that comes into play. We don’t think about others’ experiences, or how they felt at that moment, or even about the basic idea of dopamine and how that equates to motivations. We only recognize what we have seen or done in our personal lives. I find it hard to judge others on their behaviors solely based on how I would react to their same experiences.
I feel that as a community, we forget to acknowledge that yes, we all have differences and yes, they do make us better, but we also all have similarities among each other. These similarities could equally be defined as a quick example of us all being tired of COVID. I do not think anyone, especially seven months into this pandemic, would say that they don’t mind COVID or the many regulations and guidelines in which we follow. It’s hard. Yes, but getting through this pandemic and over these continuous speed bumps, is harder when the people who are leading you are not following the guidelines either.
I appreciate your willingness and continuous education about this topic. I appreciate your ideas and thoughts about how we perceive critically irresponsible leaders and how we can all try to move forward as a community. Thank you for sharing once again and allowing us all to connect our thoughts and ideas with each other.
Thank you very much for sharing these detailed and thoughtful comments. And yes, we are all SOOOOO tired of this pandemic, and it’s good to remind each other of that fact.
Dr. Valles,
Thank you for your provoking thoughts on this matter. I have heard a few of my peers say things such as “serves them right” or “maybe now they’ll take it seriously…this is karma” in response to members of the White House, especially President Trump, get COVID. Much like what my colleagues have already said, and as you pointed out, it is not ethically sound to attribute a person’s illness to their moral failures. We press on the matters of self-determination and the choices our patients make when they are of sound mind, but how can we use that as a justification when the consequences and actions of neglect effect others around us? Many people have made statements “my body, my choice” in defensive matters when saying that they do not want to wear a mask, that they are not “sheeple”. However if the President were to wear a mask, then they would have no problem following suit, but otherwise they refuse it as an infringement on their rights. It is truly mind-boggling to me that people think this way, especially when I never thought that people could make science so political.
As you mentioned “mask wearing and other social distancing measures have become intensely politicizes and tied to masculinity”. It seems as though people are thinking of only themselves and not seeing the bigger picture as social distancing and health guidelines are there to help themselves as well as others. I think it would bode well if the leaders of this nation would try and find some way to unify us, if they believe that politics are the best way to reach out to people, and set an example that is a positive one.
Thank you again for sharing your thoughts on this matter. The events have set off a whirlwind of emotions on both sides of the political agenda and we can only hope that there will be some sense of control of COVID and soon.
Thank you for sharing those experiences and interpretations. Your experience of peers saying things like “serves them right” lines up pretty closely with things I hear my peers say sometimes. It is a really hard habit to break.
Dr. Valles,
I enjoyed reading your blog post. I agree with your position that there is a crucial difference between victim-blaming those who are ill and holding those in leadership roles accountable for being poor role models. There may be a variety of ways one can contract a certain illness, and not all ways are from being irresponsible with one’s health. For example, someone may take all the necessary precautions such as wearing a mask, social distancing, and washing hands often, and still end up contracting COVID-19. Blaming those who are ill does not do our society any good.
When it comes to holding leaders accountable for their behavior, I completely agree that those in leadership positions should be setting a good example for those who look up to them. In the case of COVID-19, you would think that we would simply follow the science and do what we are told. In the early stages of COVID-19, there was a lot of mixed information going around regarding the severity of the virus as well as whether masks were actually an effective way to reduce rates of infection (one of the common things I heard was that COVID-19 was so small that it would easily go through the mask regardless of the material the mask was made of). As time has went on, we have learned a lot more about this virus, and since more evidence leads towards wearing a mask to protect ourselves and others, it is surprising to me that leadership still does not want to wear masks and practice other safety measures.
I also want to point out that while it is completely valid to be upset with Trump for not being the best leader when it comes to encouraging citizens to follow safety guidelines, he is not the only leader people look up to. In a sense, all of us are leaders and role models. Those of us who understand the importance of following the safety guidelines should make sure that we are setting a good example and are willing to educate others on why wearing a mask, social distancing, and washing our hands are crucial to reducing the number of cases and getting society back on its feet.
Thank you again for your thoughtful blog post. I appreciated reading your perspective on this topic.
Kaitlin Schutz
Thank you! And that’s a great point about leadership. There are a lot of leaders and role models out there, and we need all of them now.
Dr. Valles, you make some very good points! Is there truly one single person to blame for this outbreak, probably not. As distinguished leaders though, they should be providing examples of safe precautions in which our nation is being advised to follow. They played their hand and lost, not expecting to lose either. No one person is to blame for this outbreak, there could have been several people present that were positive unknowingly, and spread it to those who came down with Covid-19 several days later. Though no blame should be given, we should be able to look to our country’s leadership to set examples, not break the rules they have written and help our country fight this pandemic.
Thank you! And this is a timely point, since it is a reminder of the importance of democratic elections as a time to choose some of the leaders who set examples for us.
Dr. Valles,
Thank you for your insightful post! I really appreciated your thoughts on stigma, and agree that it is never a good idea to stigmatize the health of someone else. I resonated with your point that stigmatization surrounding our current pandemic is an especially negative phenomenon, and have unfortunately experienced this too much in my current field placement in a children’s hospital. Too many individuals choose not to disclose symptoms or the status of their test results in general, and so many of those same individuals do so out of fear of being perceived differently for having it. It is disappointing to see that people are hiding their infection (and potentially putting others at risk because of it) out of fear of judgement or stigmatization. As if it’s something that’s 100% in our control… like other commenters have emphasized, even if we do everything “right” there’s still a possibility that we become ill (whether that’s regarding COVID or any other “sickness”).
I also appreciated your emphasis on the importance of distinction, and agree that while it’s never okay to victim blame an individual by attributing their health/illness to their personal values, success, or choice, it IS okay to ask that leaders and role models (especially ones in such large public spotlights) be held accountable for the decisions they make and examples they set.
Thanks again,
Mackenzie
Thanks a lot! And I really appreciate your emphasis on the danger of unintentionally pushing people to hide their symptoms, which is absolutely not something we want to be happening.