Infusion of public health ethics can improve COVID policy

Distrust and, at times, outright rejection of evolving public health guidance on the pandemic may have been minimized by relying more on input and guidance from moralists, the authors of a New Perspective article argue in New England Journal of Medicine.

“Policy-making always includes trade-offs based on evidence and evolving values, and public health ethics are particularly good at identifying and working through conflicts between the two while keeping in mind the best interests of the broader community.” Amy FairchildDean of the Ohio State University School of Public Health, who co-authored the article Euthymios ParasidisHe is an expert in health law and bioethics at Ohio’s Colleges of Law and Public Health.

The authors acknowledge public health errors, including oversimplifying messaging by describing policy as “following the science,” and the ramifications of this approach.

Amy Fairchild 2They wrote that public health decision makers often failed to “explain the reasons behind their decisions about interventions such as mask mandates, quarantine and isolation policies, mandatory testing, telecommuting, and learning… without acknowledging that their data models were based on scores of varying accuracy and reliability, that the available evidence will evolve and require reassessment, and that reasonable people may disagree about how to translate the data into policy.”

In fact, officials sometimes relied on “noble lies”, deliberately misrepresenting the facts in order to

Support their decisions, simplify communications, or keep calm,” Fairchild and Parasidis wrote. These tactics have eroded public confidence, impeded the adoption of COVID mitigation measures, and fueled social movements opposed to policies and health officials. Once the phrase “follow the flag” was revealed as a mantra Oversimplified, different segments of the public have chosen for themselves the direction they will follow.”

Public health ethicists, who are concerned with the balance between individual freedom and the good of society, are too few and often called upon to help sort through the murky territory of guiding policy in the face of changing evidence and understanding about COVID-19, write Parasidis and Fairchild, a public health historian and ethics expert.

Euthymios ParasidisThe authors write that the authority of public health ethicists to guide policy is limited in places where the political landscape is unfriendly to the field and has backed away from public health authorities. But there are opportunities for ethics to further influence policymaking and influence how those policies are communicated to the public, Fairchild and Parasidis say, including through federal offices such as the Centers for Disease Control and Prevention and national organizations including the US Public Health Organization.

They note that the CDC’s primary publication, Ethical guidance for emergency preparedness and public health responsehas not been updated in 14 years, and none of the dozens of pandemic-related resources provided by the National Association of County and City Health Officials on how to incorporate ethicists or ethicists into public health decision-making has been updated.

The authors say that better hands-on ethics training for the public health workforce can make a difference in the university environment, explaining that few graduate programs have mandatory ethics courses and most cover ethics in a limited way.

They noted that it is important to distinguish public health ethics and its heavy focus on community health and social justice from bioethics, which often focuses on issues of patient care, emerging technologies, and protection of research.

Public health practitioners must address complex questions of health, equity, and social justice. We believe that deliberately and strategically engaging ethical people in these decisions is essential,” Fairchild and Parasidis wrote.

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