Flattening the Curve and Public Health Ethics

Dear Editor,

Quarantine policies have historically been less severe and encompassing than today. Several policy makers, presumably advised by public health, curiously withhold important concepts from voters. They plan on extending increasingly stringent restrictions until a vaccine is produced, despite natural immunity development. Elected officials are increasing restrictions unnecessarily due to fear of looking unresponsive. Many are trying to outdo each other to criticize opposition. Our rights are at risk. Public health is getting a black eye.

Traditional medical care providers are bound by the ethical concepts of informed consent and autonomy. These providers recommend evidence-based care that ultimately patients can refuse. Despite even the strongest evidence, every procedure, diagnostic test and treatment involve medical tradeoffs. Medical care often involves implications resulting in nonmedical tradeoffs. In the end, patients are in a better position to judge the breadth of care implications. These ethical concepts strengthen the provider patient relationship. Everything a provider does could cause unintended harm. Informing patients of tradeoffs, informed consent, and involving them in decision-making autonomy, reduces patient anger/mistrust when something invariably goes wrong.

There are several differences between traditional medical and public health providers. Traditional medical providers treat individual patients. Public health providers treat the public. These differences have traditionally reduced public health consideration of these two ethical concepts. As an example, it is important to recommend legislation requiring people to be vaccinated. Despite vaccination and distancing orders, both being public health policies, several important differences exist. Vaccine effects are much narrower with fewer implications outside medicine. Stay-at-home orders have wide social and economic impact outside medicine. We have time and ability to control external factors to conduct experimental research. In the end, evaluating stay-at-home orders are extremely difficult to judge until after it is over and factors can be standardized. This means trial and error are inherent in this process. While it makes sense for public health to strongly recommend vaccine policy, the current situation clearly demonstrates importance of informed consent and autonomy in public health.

We live in a highly educated democracy. “Flattening the curve” is a tradeoff between maximum impact at one point in time and length of epidemic. Traditional medicine allows patients to make decisions involving tradeoffs. Public health providers should do the same. We should be allowed to openly discuss risks and benefits of restrictive mitigation policies.

Alan Burke