Bioethics Forum Essay
Love Thy Neighbor as Thyself: Building Community During Covid
The opposition of certain governors to mask and vaccine mandates transcends the issue of individual liberty. Those choices have dire consequences for others, all the more so now that the Pfizer vaccine has received full approval from the Food and Drug Administration.
Current reports say there are nearly no ICU beds in Alabama. The health care system there could soon crack. This nearly happened in New York City last spring. But what is happening in Florida, Texas, Arkansas, Mississippi, Alabama and other vaccine and mask resistant states is even worse than the horror that became New York during the spring surge.
This Sunbelt surge is far worse because this iteration was preventable. It is a crisis wrought by vaccine resistance and an opposition to mask mandates, measures that have kept Covid-19 in check elsewhere in the country where mask adherence and vaccination rates are high.
While we are all more vulnerable to the Delta variant, the true pathology is not the nature of the virus but human nature. It is an ideology that motivates people to make choices that ignore the science and masquerades under the false flag of individual liberty. These “personal” choices are anything but that. They are public choices that have a direct consequence on others. A failure to wear a mask, or to be vaccinated, places others at risk of contagion. It also expands the size of the reservoir within which variants can stew and evolve, placing the entire community at risk of more resistant or transmissible strains like the Delta variant.
Everyone who is hospitalized because they were not vaccinated–the overwhelming majority of patients currently hospitalized with Covid-19–has a direct bearing on their local hospital systems and the clinical welfare of others. Their use of hospital resources, from a preventable illness, limits the availability of ICU beds and clinical staff for others who may be sick or injured. Those who have Covid because they could not be vaccinated (or are immunocompromised) plus patients with all the other conditions that still require ICU care are in jeopardy. Car accidents, heart attacks, strokes, and everyday medical needs continue during a pandemic whether or not there are ICU beds available. The demand persists even if the supply of resources does not.
All those who are wanting will suffer because of the choices of others who disregarded public health guidance. And because of their disregard other people will die. The images are stark. Ambulances are lined up in front of hospitals waiting to transfer patients, and hospitals in the South are ordering portable morgues like the ones we saw outside of hospitals in Queens, New York, last year. It is all too eerily familiar and tragic now 20 months into this pandemic.
At this stage in the pandemic, libertarianism becomes cruelly selfish, when arguments about liberty become fanaticism. There are clear limits to one’s freedom as Oliver Wendell Holmes, Jr., wrote. Channeling J. S. Mill, the jurist observed that “the right to swing my fist ends where the other man’s nose begins.”
It is an apt illustration for the current debate over individual liberty. It places the limits of one’s liberty into the context of the other. The reach of one’s swing speaks to social distancing. No harm, no foul from the arc of that swing of the fist if the other man’s nose is six feet away. So, too, the decreased risk of contagion if the other man’s nose is masked. But when one’s refusal to wear a mask or take a vaccine places others at risk, that choice is beyond the purview of individual choice. It no longer a question of personal liberty. Those choices constitute communal harms.
Threats to the community are precisely what governments are charged to mitigate and avoid. The role of government is to protect the common good and act in our common defense. Here the common threat is not a foreign war or a terrorist threat but an even more deadly global pandemic. This challenge to our collective well-being becomes the communitarian justification for public health measures like vaccine or mask mandates.
Of course, it would be better if compliance could be motivated by common sense, common purpose, or by a shared sense of community. Regrettably, this hasn’t happened. Too many of our fellow citizens have been motivated by a libertarianism that fractures the commonweal sometimes, perversely invoking religious liberty as rhetorical sustenance for their opposition to mandates.
But these pleadings, which fuse the political and theological, ring false. Religious traditions call for the respect for persons. It is a deontological stance stemming from each of us being created in the image of God. If one prefers scripture over science, then one can seek guidance from Leviticus. There one is commanded to love thy neighbor as thyself. It is a theocentric argument not a biomedical one. If you loved thy neighbor as thyself, you would get a vaccine to protect yourself and your neighbors. You would wear a mask to spare your community, especially those who are most vulnerable: kids who don’t yet have access to vaccines, the immunocompromised, the elderly whose immunity may have waned, and those who haven’t yet had access to vaccines.
What is needed is a little love for our neighbors in these perilous times.
Joseph J. Fins, MD, M.A.C.P., F.R.C.P, is the E. William Davis Jr. M.D. Professor of Medical Ethics and a professor of medicine at Weill Cornell Medical College and a visiting professor of law at Yale Law School. He is a Hastings Center fellow and a member of the Center’s board.