MARK KATCHEN, CIH, FAIHA, is the managing principal of The Phylmar Group Inc. in Los Angeles, California. Send feedback to The Synergist.
Ethical Public Health Policies for COVID-19
This month, we examine ethics in the context of public policy: specifically, in public health policy responding to the COVID-19 pandemic. The pandemic has presented policymakers with unprecedented ethical decisions that involve competing stakeholder interests and inconclusive, constantly developing scientific data and tested their respect for human dignity, especially regarding minority groups and other vulnerable populations.
The double effect principle holds that public policymakers are ethically bound to rule in favor of public safety and duly consider all scientific data. Policymakers’ duty has been tested by resistance toward the recommended public safety measures. Because of the frequently changing nature of public safety policies aimed at disease prevention and politically charged interpretations of the published scientific data, many people are frustrated and confused. They have then chosen to disregard their safety and that of others regarding measures aimed at controlling the spread of the COVID-19 virus.
The utility principle calls for organizations to be held accountable for the conduct of their employees, business decisions, and outcomes. For example, food processing plants and delivery warehouses have recently been charged with neglecting worker health and safety through their failures to prevent disease spread in their facilities. Furthermore, some businesses have been investigated for alleged retaliation against employees who protect or file complaints and for prioritizing business interests, such as production goals and output, over employee health and safety. An investigation by Reuters identified 106 U.S. workplaces where OSHA largely ignored workers who reported sloppy pandemic safety practices.
A third frequently ignored ethical approach is the precautionary principle, which advises that actions and policies carrying a suspected risk of harming the public should be considered harmful in the absence of scientific consensus on their effects. The burden of proof that actions or policies are not harmful falls on those implementing them. Public response to the pandemic has been plagued by a lack of scientific consensus. States, counties, and municipalities have adopted diverse, often conflicting actions and policies related to COVID-19. Many jurisdictions have made little attempt to prove their actions and policies do not harm the public. Precaution, in many cases, has been thrown to the wind.
These issues have posed several challenges to the occupational health profession. In the following scenario, we will raise some of these issues and questions for your consideration.

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?
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RESOURCES ANU Press: On the Dual Uses of Science and Ethics: Principles, Practices, and Prospects (2013).
Reuters: “Special Report—U.S. Regulators Ignored Workers' COVID-19 Safety Complaints Amid Deadly Outbreaks” (January 2021).