What Are One’s Moral Obligations During a Pandemic?

“…masks became a scapegoat, a symbol of government overreach, inspiring protests, petitions and defiant bare-face gatherings. All the while, thousands of Americans were dying in a deadly pandemic” (Hauser, 1). 

This quote, although written seemingly in reference to the Covid-19 pandemic, is actually taken from an article about the Spanish Influenza of 1918. Mask wearing, along with many other safety precautions taken, is among the things that has caused a debate of morality during pandemics. The many sources that contain information on ethics in pandemics show the overlaps that occur regardless of if it is about a plague occurring in the thirteenth century or the current Covid-19 pandemic. The struggle to find a common set of morals among both the public and the healthcare workers treating patients has proved to be a very difficult task. The World Health Organization has made efforts to encourage society to act a certain way during pandemics, but with much of the population refusing to listen, their voices have gone unheard. Among the hundreds of thousands of opinions on the subject the question still remains, what are one’s moral obligations during a pandemic? 

The Mask Resisters of the 1918 Flu 

The Spanish Influenza of 1918 was a critical time for mask wearing in society. The efforts to control the spread of this disease were and still are shrouded in controversy as people continue to evaluate the effectiveness of masks and whether it is the public’s moral responsibility to wear one. A mask ordinance signed by the mayor of San Francisco in 1919 sparked outrage among “mask resisters” and the public began to join in with complaints about freedom, appearance, and comfort. By this point nearly 200,000 Americans had died, yet socially, mask wearing was still being frowned upon by many people (Hauser, 1). Many did believe that mask wearing was a sign of respect to the community, showing one’s morals and lack of selfishness, but this was not enough to convince “anti-mask” members to wear one. 

Mask Wearing During Covid-19 

Comparably, the Covid-19 pandemic has brought out the division between mask wearers and mask resisters in the United States. Not only has this separation of beliefs caused social issues, but it has also become politicized. With so much attention placed on mask wearing, many people have used this opportunity to make masks a clear issue of morality, calling out their peers if they don’t follow mask guidelines. In a nationwide study conducted by the University of Southern California, it was recorded that 63% of Americans came into close contact with non-household members in the last seven days, but only 51% of that group wore masks (Key, 1). With the population split, many believe that only half of the public feels a moral obligation to wear masks, while the other half has selfish motives and is putting the nation at risk for further disease spreading (Chan, 1).  
 

Ethics of Healthcare Workers During HIV/AIDS 

As the morality of the public is debated during past and present pandemics, doctors and healthcare workers are also facing ethical dilemmas. In the HIV/AIDS epidemic of 1981, a plethora of moral problems emerged concerning the treatment of patients as healthcare workers faced this stigmatized disease. This epidemic opened the door to who was allowed to contribute to the search for a cure. The gay community, a minority group that faced extreme prejudice at this time, was requested by researchers as collaborators, seeing that they were most highly affected (AIDS, Ethics, and Activism, 1). One of the most prevalent moral issues these groups disagreed on was the amount of privacy that should be awarded to those affected. The Center for Disease Control played a role in supporting researchers as it called for the names of AIDS patients to be reported to public health authorities. This inspired fear among not only the gay community, but also drug users and undocumented aliens that were also patients. With their names being reported, these people faced the threat of social judgement and legal action if the names were leaked, thus came the ethical dilemma of healthcare workers who had to make decisions about patient confidentiality. This problem created the opportunity to open talks between the government and the gay community, which eventually led to compromises that would give both sides peace of mind. A board would be created to assess when it was absolutely necessary to provide confidential patient information to the government, and in all other cases the patient would remain anonymous (AIDS, Ethics, and Activism, 1). This compromise was a turning point in government morality as they essentially sided with the patients, despite the stigma of the gay community. 

Healthcare Worker’s Moral Responsibility During Covid-19 

Although Covid-19 does not carry the same prejudice as HIV/AIDS, a number of ethical dilemmas have still shown up among healthcare workers. Resource allocation has become one of the most prevalent problems in society, as the number of people infected reaches millions (Supady, 1). Whether it be due to poor preparation or just poor distribution, healthcare workers face the constant threat of finding and handing out resources for their patients. It is clear that in the current pandemic, there is both a lack of space and a lack of materials, specifically personal protective equipment (PPE), testing, and ventilators, for the sick. With no clear idea on the “right” thing to do, healthcare workers across the United States have made it a general rule to distribute resources as equally as possible, but if a choice must be made, distribute it to those who have the highest chance of survival. They specify that this has no impact on how similarly all patients should be treated, in regards to how doctors view them and their chance of survivability (Sese, 1).  
 

“A shift in the perspectives of both patients and caregivers is necessary. If we are to be prepared to face the many challenges this pandemic will bring, we must prioritize the ethical demands of this disease as much as we do treatment and management concerns” (Sese, 1). 

What Are the Public’s Moral Responsibilities? 

Mask wearing, one of the top efforts to control the spread of disease during pandemics, has ultimately led to one of the most morally controversial times in the United States. Social and political division runs rampant as the mask wearers grow increasingly judgmental of the mask resisters and vice versa. Masks have become a symbol of being caring and compassionate, of looking out for the public, and of being ethically responsible. Mask resisters have their own reasons for not following health guidelines, which may not include anything about the moral aspect, but to the general population, it often comes off as disregard for the public’s well-being. Efforts to eradicate this divide in the country, while still slowing the spread of disease, mainly come from the government in the form of mask ordinances meant to get everybody on the same page and take away the choice, yet it seems that this does nothing except anger more people. The recurring theme of limiting the public’s freedom in order to protect the country is not a new issue, and it has come to light once again as the arguments of masks resurface during Covid-19. Through looking at the Spanish Influenza of 1918 and the current Covid-19 pandemic, the issue of finding morally correct efforts that nearly all the population supports still plagues the country. 

What Are Healthcare Workers’ Moral Responsibilities? 

Efforts to create an ethically sound healthcare community have been more successful. Groups such as the World Health Organization and the Pandemic Influenza Working Group played and continue to play a very large role in setting the standard for moral decision making. The Pandemic Influenza Working Group was created at the University of Toronto Joint Centre for Bioethics after the SARS outbreak of 2003. The document they created outlines the values that are at risk during pandemics, which then helped healthcare workers as they began treating patients during the Covid-19 pandemic (Sese, 1). The World Health Organization published a guide in 2006 titled, “Ethical considerations in developing a public health response to pandemic influenza”. Countries across the world who were members of the organization had access to the information, and when asked for more guidance, the WHO published “Research Ethics in International Epidemic Response” (“Ethical Issues in Pandemic Influenza Planning”). Although it is still difficult to get everyone to have the same morals, there is now a baseline for healthcare workers as to how they should be acting. 

Work Cited 

Supady, Alexander. “Allocating Scarce Intensive Care Resources during the COVID-19 Pandemic: Practical Challenges to Theoretical Frameworks.” THE LANCET Respiratory Medicine, 12 Jan. 2021, www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30580-4/fulltext. 

Chan, Eugene Y. “Pro-Mask or Anti-Mask? Your Moral Beliefs Probably Predict Your Stance.” The Conversation, 20 Nov. 2020, theconversation.com/pro-mask-or-anti-mask-your-moral-beliefs-probably-predict-your-stance-148774. 

“Ethical Issues in Pandemic Influenza Planning.” World Health Organization, World Health Organization, 25 Feb. 2015, www.who.int/ethics/influenza_project/en/. 

Hauser, Christine. “The Mask Slackers of 1918.” The New York Times, The New York Times, 3 Aug. 2020, www.nytimes.com/2020/08/03/us/mask-protests-1918.html. 

Institute of Medicine (US) Committee on the Social and Ethical Impacts of Developments in Biomedicine. “AIDS, Ethics, and Activism: Institutional Encounters in the Epidemic’s First Decade.” Society’s Choices: Social and Ethical Decision Making in Biomedicine., U.S. National Library of Medicine, 1 Jan. 1995, www.ncbi.nlm.nih.gov/books/NBK231965/. 

Key, Jim. “Half of U.S. Adults Don’t Wear Masks When in Close Contact with Non-Household Members > News > USC Dornsife.” USC Dornsife College News RSS, 21 Jan. 2021, dornsife.usc.edu/news/stories/3388/understanding-coronavirus-in-america-mask-use-among-us-adults/. 

Sese, Denise, et al. “Ethical Considerations during the COVID-19 Pandemic.” Cleveland Clinic Journal of Medicine, Cleveland Clinic Journal of Medicine, 3 June 2020, www.ccjm.org/content/early/2020/06/01/ccjm.87a.ccc038.