Category: Personal Responsibility

Colorful lottery balls in a rotating bingo machine.

Applying Luck Egalitarianism to Health Resource Allocation

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By Hannah Rahim

Luck egalitarianism is a theory of political philosophy that provides that inequalities resulting from an individual’s informed choices are just and need not be reduced, whereas inequalities resulting from circumstances over which an individual has no control are unjust and should be reduced. The application of luck egalitarianism to health inequalities has some value when allocating health care resources, but it often conceptualizes health too narrowly and risks exacerbating existing unjust disparities. If luck egalitarianism is to be applied in developing health care policy, it must only be used in clearly defined circumstances and with a holistic approach.

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U.S. Supreme Court

Context Matters: Affirmative Action, Public Health, and the Use of Population-Level Data

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By Wendy E. Parmet, Elaine Marshall & Alisa K. Lincoln

Last June, in Students for Fair Admissions (SFFA), the Supreme Court ruled that universities could not consider race in admitting students. In support of that decision, the Court dismissed the relevance of data about the varied experiences of racial groups, insisting that admissions decisions must be based solely on the experiences and merits of individual applicants. The Court’s rejection of group-level data evinces a critical misunderstanding about the uses and limits of such data that, if applied more broadly, portends troubling implications for health equity and health policy.

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Washington, DC – September 23, 2021: A person walks among the over 681,000 memorial white flags dedicated to each of the COVID Pandemic victims at the National Mall.

Running Cover for Death: Pandemic Minimizers Normalize an Inhumane Baseline

Nate Holdren Leave a comment

­­By Nate Holdren

Last week, David Leonhardt took to the pages of the New York Times to celebrate the latest COVID death figures, which he claims mean the U.S. is no longer in a pandemic, because there are no more “excess deaths.”

The hunger for good news is, of course, understandable amid this ongoing nightmare. But to respond to death with “smile everyone, it could have been more deaths!” is grotesque because of the disrespect to the dead and those most affected by the deaths.

It also lets the powerful off the hook, which is Leonhardt’s primary motivation, I assume. In other words, looking for good news is a political position.

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Hands with blue protective nitride gloves holding N95 respirator.

A Patient’s Right to Masked Health Care Providers

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By Katherine A. Macfarlane

In May 2023, Mass General Brigham instructed its patients that they “cannot ask staff members to wear a mask because our policies no longer require it.”

Following patient protests, the hospital updated its policies with an imperfect fix, announcing that “patients can ask, but providers determine when and if masking in a particular situation is clinically necessary.”

This episode highlights the uneasy circumstances that people with disabilities face in the U.S. while accessing essential care: On the one hand, the law surrounding reasonable modifications in health care is well-settled. On the other, the practical reality of U.S. health care leaves little room for individualized accommodation and self-advocating patients vulnerable to retaliation.

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Los Angeles, California / USA - May 28, 2020: People in Downtown Los Angeles protest the brutal Police killing of George Floyd.

Learning from the ‘COVID War’

The Petrie-Flom Center Staff Leave a comment

By Sam Friedman

Amid an emergent international consensus that the COVID pandemic is “over,” writings about the pandemic and its meanings have burst forth like the flowers of June.

This article will focus on one such book, Lessons from the COVID War: An Investigative Report. Produced by an eminently established collection of people, The COVID Crisis Group. The book is intelligently critical of what was done during the pandemic, but at all points it remains within the confines of what is “politically respectable.” This respectability, I argue, means that their recommendations are too narrow to protect Americans, much less the populations of the Global South, from pandemics ahead (barring unexpectedly marvelous advances in vaccine breadth and rapidity of deployment).

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Emergency room.

Hospitals That Ditch Masks Risk Exposure

The Petrie-Flom Center Staff Leave a comment

By Nina Kohn and Irina D. Manta

This month, New York became the latest to join the growing list of states that have ended their requirements for routine masking in hospitals and other healthcare settings.

In response, at least one of the state’s largest hospital systems is throwing off the mask despite the continued high level of virus transmission in New York City and most of the rest of the state. NYU’s Langone hospital system decided that — outside of the Emergency Room — patients would generally only be required to mask “if they have fever and cough” (query what percentage of individuals with recent COVID-19 infections did not have this specific combo of symptoms — spoiler: it’s probably high). Similarly, the hospital announced that masking by direct care staff was optional in most situations, with masks required mainly during certain procedures, in particular patient rooms, or — more cryptically — when “there is concern for exposure to infectious aerosols.”

Ending routine masking in hospital settings is a dangerous move. It puts patients and staff at risk for infection, and its potential long-term effects. It also exposes hospitals to the risk of liability.

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Atlanta, Georgia - January 28, 2022: US Centers for Disease Control and Prevention (CDC).

Unmasking Public Health

The Petrie-Flom Center Staff Leave a comment

By Jane Moriarty

One of the U.S. Centers for Disease Control and Prevention’s stated “essential public health services” is to “create, champion, and implement policies, plans, and laws that impact health.”

Yet, as the U.S. slogs through its third COVID winter, one thing is clear: personal responsibility and autonomy are at the heart of public health messaging. As CDC director Dr. Rochelle Walensky famously said, “your health is in your hands.”

In other words, CDC and other public health bodies now highlight personal responsibility and autonomy, and minimize the institutional ability to champion policies and laws that would improve the health and safety of the citizenry.

Given the comparatively poor results that the U.S. has had compared to other similarly-situated countries that focus more on the common good, it is time for our public health entities to reinvigorate their role as a force of legal and moral suasion to protect the public’s health.

The moral value of protecting the health of the public should be at the forefront of their messaging. Personal responsibility and autonomy are no match for the reality of commodified and unavailable health care, internet disinformation, health vulnerabilities, age-related vulnerabilities, the lack of paid sick leave, poverty, and the plight of the institutionalized.

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person walking away from a surgical mask lying on the ground.

Personal Crusades for Public Health

Katherine Macfarlane Leave a comment

By Katherine Macfarlane 

Public health in the U.S. has collapsed. In its place, we are left with an insufficient, impoverished alternative: personal crusades. This essay describes the cost of casting aside what is best for the public’s health in favor of individual choice, especially to those who are high-risk for serious illness or death from COVID-19. It explores how they must negotiate public health measures on their own.

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Rome - statue of Cicero from facade of Palazzo di Giustizia.

Reclaiming Salus Populi

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By Wendy E. Parmet and Elaine Marshall

I. Introduction: The Threat to Public Health

As we reach the COVID-19 pandemic’s third anniversary, the warning signs for the future of public health law are everywhere. In the past three years, courts, led by the Supreme Court, have endangered reproductive health and handcuffed governments’ capacity to meet a wide array of public health challenges. Along the way, courts have displayed an alarming disinterest in science or the impact of their decisions on the public’s health.

At the same time, many state legislatures have rushed to introduce bills to limit health officials’ ability to act to protect the community’s health. Between January 1, 2021, and May 20, 2022, at least 185 of such laws have been enacted.

In this climate, public health law needs introspection, imagination, and regrouping.

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Failures of Imagination in Public Health Policy

The Petrie-Flom Center Staff Leave a comment

By Daniel Swartzman

If public health is to prosper, we will need to overcome the after-effects of several failures of imagination.

  • Failing to recognize the threat to liberal democracy from the last 50 years of coordinated conservative political and policy actions.
  • Failing to use litigation against inadequate public health actions, as did the early civil rights and environmental movements.
  • Failing to anticipate litigation that challenges our efforts, such as with the ACA or the upcoming attempt to “codify Roe v. Wade.”
  • Failing to demand moral leadership of governmental actors.
  • Failing to make political action and advocacy an integral part of professional education in public health.

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