SCENARIO Belinda is a Certified Industrial Hygienist with more than 25 years of experience. Her commitment to serving her community steered her career in the direction of public health. After earning her PhD in environmental and occupational health, she is now the director of public health for a U.S. county and reports directly to the county’s board of commissioners. The county, bordering a large city in the eastern United States, has a population of 2,000,000, comprised primarily of upper middle-class families.

Belinda’s responsibilities include monitoring and solving public health outbreaks, educating the public about health issues such as disease prevention, and developing plans and policies focused on public health concerns. The COVID-19 pandemic has consumed her time since it began to affect her county. Belinda now finds herself constantly monitoring case, hospitalization, and fatality rates and educating the public on practices intended to help them stay safe and healthy. Her message to residents of her county on controlling the spread of the virus include recommendations that they stay out of bars and gyms, avoid non-essential travel and large family gatherings, wear face coverings, practice social distancing, frequently wash their hands, avoid crowds, and obtain COVID-19 testing. She has also been entrusted with developing public health policies for the county based on these practices, those of other countries, states, and municipalities, and the latest scientific data from CDC, the World Health Organization, NIOSH, and the state health department.

Belinda has proposed a plan for the county. The plan calls for eliminating indoor dining at bars and restaurants, mandating mask-wearing in public, closing gyms and classroom education, limiting public gatherings to those held outdoors with 50 people or fewer (and social distancing in place), and prioritizing healthcare workers, nursing home workers, nursing home residents, and those over 65 years of age for vaccinations. The restrictions and vaccination plan may be modified as infection metrics change and vaccines become more widely accessible.

Belinda’s policy recommendations have met opposition from the politically divided board of commissioners. The commissioners are elected to serve four-year terms and must always consider constituent attitudes and opinions. Pushback has come from community members that include media editorialists and parents with school-age children who believe the virus’s risk level is greatly exaggerated.

Belinda’s defense of her policy recommendations, while based on ethical principles, is problematic. At times, the scientific consensus has varied on mask effectiveness; on whether and for how long the virus lives on hard surfaces or in the air; the significance of numbers of positive cases, symptomatic cases, and hospitalizations; and reported number of fatalities. At the time that Belinda made her recommendations, scientific data also suggested that the spread of the virus from dining inside at restaurants accounts for only a small fraction of the reported cases and fatalities. In addition, social scientists and educators’ present data indicates that children who attend classes are at extremely low risk for infection; however, they may be at higher risk for developing infections that present with minimal or no symptoms. Likewise, teachers younger than 65 are at little risk for developing serious infection. Finally, abundant data exists on the financial and social-emotional impact from the restrictions put in place to prevent the proliferation of the virus.

The major ethical conflict that troubles Belinda is that the science so integral to making ethical decisions, namely those specific to the COVID-19 public health policies, speaks with different voices at different times, or even at the same time.

FOR DISCUSSION What should Belinda do, given the constantly developing nature of scientific data related to COVID-19? How can she best evaluate risks in various settings and circumstances, given the great diversity of public health guidelines across the U.S.? How can she best make the case for the ethical justifications of her decisions to county commissioners who are motivated by the upcoming elections and the potential political fallout from controversial public health policies? How does Belinda use the Board for Global EHS Credentialing Code of Ethics (PDF) to guide her in mitigating widespread skepticism of the need for at least some of her proposed restrictions? And what good are ethics if not backed by enforcement, since Belinda’s county does not have the resources to enforce restrictions?

How should Belinda respond to media criticism of her plans and proposals? How can she best protect her professional ethics, credibility, trustworthiness, and reputation without self-aggrandizement?

How hard should Belinda push the county commissioners to accept her public health policy proposals? To what extent should she study and understand the pressures on the county commissioners from various stakeholders? How much should she factor in her own future career aspirations in making these decisions?

What ethical principles come into play when Belinda decides the priority order for vaccinations? The principle of utility? The principle of double effect? The precautionary principle? Are all three relevant to her decision-making?

Ethics force safety and health professionals such as Belinda to consider, above all else, the impact of unhealthy and risk-taking behaviors on the part of some people at the expense of the well-being of others. How does Belinda convince a skeptical segment of the population of their ethical responsibility to protect the health and safety not only of themselves, but of others?