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COVID's "politicization tragedy" and physician obligations to public health · Health Ethics Podcast

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Welcome to the COVID Ethics Series podcast, a conversation with leading experts about bioethical
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issues that have been exacerbated due to the COVID nineteen pandemic. I'm Brian Pilkington,
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and I teach bioethics at Seatonhole University and at the Hackensack Marine School of
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Medicine. I moderate the COVID Ethics Series in cooperation with the IHS Library and
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IHS Student Life. This podcast is a spin off collaboration with the IHS Library
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where we'll have the opportunity to go deep with the experts from our series.
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Thanks for joining our conversation. Everyone, Welcome to the COVID Ethics Podcast.
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I'm especially excited about this session where I will be talking with Scott Schweikert,
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who is the senior Research Associate at the American Medical Association and Scott is also
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the legal editor of the AMA's Journal of Ethics. Scott, Thanks Tom,
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Thank you so much for taking the time to join me today. Yeah,
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absolutely, thank you thanks for having me today. So as folks who tune
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in regularly know with the COVID Ethics Series and now the COVID Ethics Series podcast,
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we get folks from diverse areas thinking about big bioethics questions, big healthcare
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ethics questions, questions about the ethics of medicine, and bring them together.
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And one of the reasons that I'm especially interested in this conversation with Scott is
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given the work that the AMA has done to pull together an ethics resource center.
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So, Scott, in a couple of lines, could you tell folks
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what this is and how they might get there if they want to avail themselves
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with the resource. Yeah. Absolutely, So the easiest way to get there
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is if you just google AMA nineteen Resource Center, you'll get a link to
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it, and we have a page that has resources on clinical information advocacy.
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You'll kind of see a header at the top and one of the tabs as
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medical ethics, and that specifically gives resources on ethical questions. And so what
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our goal was is we have at the start of the pandemic, a lot
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of physicians were having just ethical questions about what to do in these different scenarios
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in the pandemic. And what we realized is, you know, a lot
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of the ethics guidance was already there in the am A Code of Medical Ethics.
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So we didn't feel like there need to be to re event the wheel,
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like the guidances there. It was just kind of more we wanted to
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put together something that point people in the right direction, to give them a
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start to say, here are things you can look at in the code that
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can help you analyze your problem, help you answer your question, and then
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kind of give maybe a brief analysis of a broad scenario to say, here's
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how you might want to think about it, to kind of give people a
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starting off point about how to answer their question, because there really is not
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a set yes or no this this is ethical or unethical. Ultimately physicians will
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have to make that judgment. But this tool is just kind of a nice
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starting off point, and it kind of we kind of we feel like we
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broke down a lot of the key questions we were getting with regards to you
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know, physicians being vaccinated, allocation of scarce resources, caring for patients remotely
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in the pandemic, and you know a variety of other issues all health equity
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and the pandemic, so you know, many different facets of it. So
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Scott, that's great, and I really appreciate. I was just teaching some
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research ethics content to some of our med students and just thinking about sort of
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the Beaumont Report and other kinds of early research ethics documents which took these broad
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principles, whatever you want to say about the principles, and applied them well.
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And it sounds like that's I mean, that's been super influential and hugely
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helpful. And it sounds like you guys have something similar to this, because
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there's so much in the am A Code of Ethics. There was a great
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section I was using not too long ago on cirguin decision making. It was
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just so clear and helpful and I didn't even realize it was in the code.
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So that's great. And then you've set up, you know, the
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schematic for the for physicians to sort of go through and then help them think
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through these right. So yeah, a great, a great resource center,
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and I just googled it. So I would recommend Google has resource center just
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right up at the top. Absolutely, I'm sure the second most hits,
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of course, the first is for the COVID Ethics series podcast featuring right got
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Schwiker. But so let me jump to some content questions. Just because you
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guys have so much there, we we couldn't go through it all. One
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of the topics that comes up a lot with students, and I know it
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was increasingly I think challenging for well, for lots of folks, is vaccine
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hesitancy or vaccines and aisles among healthcare workers. So a lot of wos of
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concerns about vaccine hesitency. Some folks are vaccine hesitants themselves, but healthcare workers
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carry sort of a we might say, in fact, I think might carry
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a special obligation to be vaccinated or maybe even to model the best kinds of
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health behaviors. Now, I think that's a controversial claim, So take what
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you can with that. What might you say about vaccine hesitancy? And I
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know, and you may want to reiterate this, I'm asking you. I'm
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not asking for opinions, right, what's your take on vaccine hesitency and healthcare
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workers? Yeah, yeah, absolutely, I'll just reiterate. I'm just kind
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of speaking on on myself today. I'm not representing the AMA or their opinions
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or views. So just from my perspective, I think there is a strong
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ethical obligation out there for healthcare workers to get a vaccine. It's not the
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say, there might be some you know, exceptions and it's not you know,
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it also depends on you know, a lot of different factors, like
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what has this vaccine been proven to be safe and effective? I mean,
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that is gonna be part of the calculus about whether or not UH, physicians
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or healthcare workers should be taking such a vaccine. So I mean, and
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so that you know, looking at our own situation with the COVID vaccine that
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has been proven safe and effective. So that's gonna be part of the calculus
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about whether or not there should be a mandate or whether or not healthcare workers
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should be taking such a vaccine. But I think the ethical impetus is more
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leaning on the sides of providers or healthcare providers having to take them, to
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be honest, And we did have our our COVID Research Center did have one
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analysis on there. So and the one thing I'll just kind of point,
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I'll just kind of reach from a little bit of the Code of Medical Ethics
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does touch on this a little bit. And like we have like Opinion eight
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point seven about routine universal immunization of physicians, which provides that in general,
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when a safe, effective vaccine is available, physicians have responsibility to accept the
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immunization and interest of protecting their patients, their colleges and community. So the
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ethical obligation is out there in a broad sense. Uh, the code does
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recognize it. It also does recognize it in the context of pandemics, like
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we have also opinion a point four ethical use of quarantine and isolation. So
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the code does, the code does speak to it. So I think in
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a broad sense that ethical obligation is serious to consider. Thanks those are hel
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in drawing folks back to the resource center into the AMA Code. I think
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is most helpful because it highlights that this isn't something new, This isn't something
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that popped up. I mean, the resources great guide in the question,
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right, but it's a long standing obligation and sounds like it comes from care
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and concern for one's patients and one's community, right and all that, right,
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right, Yeah, it's exactly. It's not a new obligation. It's
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been there because it's not like this is the first vaccine that's out there.
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I think. What's also but also it's going to have special considerations the fact
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that we're in there, we are in this middle of this pandemic as well,
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and there's going to be there's kind of a broader public health obligation to
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try to and so I think that's also kind of an ethical you know,
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it's a factor to consider an ethical analysis. Is also just the broader context
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of what this vaccine is for, so not beyond just then obviously safety of
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patients and other you know, healthcare workers. But it's just it's kind of
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we're in an emergency situation, which is also part of the factor. Yeah,
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yeah, that's helpful. I mean, and it's this isn't a strong
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legal or philosophical argument, but just rhetorically, especially in speaking with some,
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uh, the undergraduate students. I haven't seen all the grad sudents at the
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Men's Hackensack ready and school medicine as well. And you have lots of folks
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who are interesting going into healthcare, but then they see folks refusing to be
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vaccinated, refusing to take good care and reasonable measures, and think, oh,
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do I want to go into a profession and give up you know,
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a variety of things in order to help people out who don't seem to I
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mean, this is my language, don't seem to be holding up an end
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of a social contract. So at least rhetorically right, physicians as models of
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good health behavior and lots of respects and becoming vaccinated. Well, it makes
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my teaching life easier. That's not a great reason to do it, but
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it does seem to, yeah, maybe serve as a good model for lots
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of folks in the public and maybe continue a sort of yeah, a good
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social contract, social relationship and all that. Yeah, I mean, I
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yeah, exactly, I agree because it goes to broader, broader themes about
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you know, public health themes and being aware, you know, of solving
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these public health problems and encouraging it. So it's beyond just just the specific
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health need of the vaccine. So like also like looking back at like going
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back to the Code a Code opinion A point four about ethics of quarantine and
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isolation, which is kind of in you know, the context of pandemics,
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and it's just there's a broadly where it's as physicians should use quarantine and isolations
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public health interventions and situations of epidemic disease, and you know in the lists,
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you know several you know, measures of what physicians should do educate patients
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in the public about the nature of the public health threat and so on.
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So I feel like, you know, the vaccine, you know, taking
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the vaccine kind of fits into that because it's it's kind of making example of
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what society should be doing, So it's it does have a broader, I
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think, public health theme as well. So yeah and yeah, and that's
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a nice segue to the sort of next topic that I want to ask about,
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which you're a big public health topic trust in medicine, and I guess
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relatedly trust in science. So I know the AMA's COVID Ethics Resource Center has
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a couple of videos, so videocasts from June and the titles are perfect.
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Could trusting science me not trusting particular FDA decisions? And the bigger one that
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I think is more philosophically interesting, building trustworthiness and ethical public health practice.
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So not asking for you to speak for the anime right. Trust in medicine
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is a recognized concern. AM is picking it up here, lots of folks
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think about it. What's your take on, like, how might physicians,
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how might those of us interested in ethics, how might we improve among the
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broad populace trust in science and medicine, especially given the challenging history. So
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now rambling go yeah, yeah, no, YEA very challenging question. I
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think, uh, it's it's a big problem with seeing in the country right
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now. I mean, I think it's largely it's such a political problem because
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so much politics have been infused into this, and so there's so and it's
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also fused into the problem with we have so much information in our society right
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now that anybody can go online and get any information that they want to seek
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to validate their views, and you know, anything you want is there,
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and it's it can be difficult for some people to just you know, differentiate
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between what is you know, good and bad information, or what's accurate and
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inaccurate. It's exceptionally challenging. And as things become more and more political,
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you might say, well, the FDA would be a trusted the CDC and
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FDA or a trusted resources, but now they've been politicized, so a segment
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of the population doesn't trust them. I don't have a good answer to it.
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I mean, I think, you know, education is key and being
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able, you know, to learn how how to discern what's accurate and what's
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not, and how to learn to ask the right questions and all of that
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I think one I think physicians can do. It's possibly, you know,
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is it working with their in building their trust with patients. If they have
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good trust and rapport with patients, they might have a certain obligation to kind
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of get in there and get the right information to these patients who might be
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misinformed. So that can be part of what physicians can do and other healthcare
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workers is you know, we have this information if I, if I have
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a patient who trusts me, I can go in there and give this,
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you know, give them the right information. And I think if they can't
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do that, they absolutely should. In my opinion, I don't think there's
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a simple answer to it right now in terms of this trust of science.
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It seems like it's getting worse all the time, and it's a I think
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it might be one of the monumental problems, you know, societal problems of
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our time right now. Yeah, and so I think I think you're absolutely
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right. So we're in lock stuff here. You know, if you had
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the answer, then you know more listeners than than it currently does. But
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yeah, you know, I mean, so what especially for the students,
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the undergrad students in the future who are interested in going to medical school and
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the current medical students in my classes. Right, that asking the right questions,
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right, that's what you're answering, the right questions. It's key.
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And that information literacy and the ability to navigate sort of challenging informational echo chambe.
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In our last episode, we had professor Jason Ebroll from Saint Louis University
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runs the Healthcare Ethic Center out there right, a similar point about the importance
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of the information bubble you find yourself in and sort of getting into accessing the
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right information. And because this podcast is hosted by our wonderful IHS Library and
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supported by Alison Piazza, who is excellent helping me navigate through all sorts ofchallenging
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the large literatures of information, I mean that's that's crucial because you have folks
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who culpably or not put that to decide, don't have access to the right
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information. So that's yeah, that's really right. Yeah. And then yeah,
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and like you said, and the combination with the politicization of certain sorts
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of information has to become really hard. I mean, I think at some
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point I take it for granted. If I have a legal question, I'll
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give you a call. If I did have an epidemiological question. We're going
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to run this race, and I'm like, oh, jee, you've got
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a little kid, what do we do. I'm very fortunate I called up
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an epidemiologist and got it. But not everyone has access to that, those
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kinds of informational resources. And yeah, given the politicization of these sorts of
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things, people sort of tied up with a political identity. Yeah, now
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I'm rambling, but I recently heard it say there are places where you can
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get a COVID vaccine who have some sort of like private areas and no one
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will know you got the vaccine. I don't know, I should double Yeah,
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somebody has just told me about this because they're folks looking to get vaccinated.
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But it's you know, couldn't do that given my neighbors because of receive
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So it's right, yeah, no, it's it's it's just crazy. I
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mean, it's it's crazy. What's happened. How the pandemic has been politicized
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is such a tragedy, uh, in the United States in my opinion.
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I mean, the misinformation is rampant, and it has been politicized. I
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mean to a point where I don't know what's salvageable. I mean, you
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know, I've seen this discussed from other public health legal scholars that just kind
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of throwing up their hands at this point, are just like maybe, and
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I think Larry Gastin's and Georgetown tweeted this. He's like he goes to the
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United States just seems ungovernable in a pandemic crisis or public health crisis, and
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it just like, yeah, I think it is. I mean, it
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just seems that way. But you know, the federalist system, all these
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different states, the political nature of Washington, d c. Right now,
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when it comes to a public health crisis and what that kind of crisis entails,
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it's our government's just not equipped to deal with it, at least as
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it seems at this time. It's kind of like the dichotomy of the United
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States because it's like we have this unbelievable strong medical system in terms of like
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the science and innovation. We got this vaccine produced incredibly quickly. It's like
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we have great resources and great you know, medical schools and medical institutions and
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public health institutions. It's like all of that's here, but it can't be
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like fully utilized on the political scale because of you know, so it's very
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frustrating, I know for public health, you know, public health professionals,
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legal scholars in the public health space, and I wish there were better answers
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to it. But I think and especially because compared the United States to like
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other countries, you know, like South Korea and things, it's just what
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what other countries have accomplished in this pandemic. It's just we can't do it,
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and it's unfortunate. Yeah, I know, that's I think that's an
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astute observation, right, And then we can get sort of political feorists or
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something on on one of these shows, because I mean, so many individual
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units, obligations at the local level, questions about resource sharing, travel,
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I mean, there's so much with a big federal system. That's just it's
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complicated. Let's I want to shift to another topic. So there are on
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the AMS COVID Ethics resource page again which is excellent, super helpful and connects
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up really well to the code. There are a couple of topics which are
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super interesting and important hot topics in medicine, so in the medical education.
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So there resources on structural structural inequality which you mentioned before, on voting and
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I've got some wonderful colleagues at Seat and Hall or doing work on voting as
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an occupation, So good ots. So this is like an interprofessional conversation too.
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You've got stuff on that you've misd on clean water. So here's the
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question. How much should physic in your opinion, not the animes, how
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much should physicians do? And really how much can physicians do before they've overstepped?
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So to take that point before, if I show up to a physician's
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office and I fundamentally misunderstand how COVID gets transmitted, there's a proper medical question.
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Recommend the vaccine. Explain the science to me. That's well and good
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once we start moving past medical encounters, even though we're talking about things which
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totally impact people's health, maybe even to a greater degree. Right, if
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you don't have clean water, whether you show up to your GP or not
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once a year, isn't really going to do a lot, you know,
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I mean clear has such a great impact as a legal scholar, help me
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think through sort of maybe the bounds of medicine of that big gassy philosophical question.
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So point me in the right. Yeah, you know, it's it's
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it's Actually it's something we've been discussing it and work more about, you know,
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where you know, how does public health ethics fit into medical ethics,
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and so we've it's been you know, there is have been more discussions on
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it. One thing I could just kind of say, like outlining the problem
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like medical ethics, like traditionally it has been focused on, like the physician
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patient relationship. It's very insular. It's not looking at public health more broadly,
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and so a lot of physicians, like traditionally it's it's more like my
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obligation is to this individual patient. I will treat them. They come in
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and they have their disease, and I treat them. But you know,
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lately, you know, in recent years, there's been a shift, you
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know, health equity focus shift that that's saying you have to look beyond just
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individual patient physician relationship. We have to look upstream to all these problems that
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are causing these health inequities, because you know, you want to you don't
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want you want to get to the point where these patients don't have to come
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before the physician to begin with, but these problems, you know, and
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so I think there's greater awareness now that physicians should try to do more in
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kind of a public health space or like kind of broader public health obligations and
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what that looks like. I mean, obviously I don't know what the extent
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of that obligation is, and obviously some physicians can do more than others.
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So I don't know that there's just it's kind of maybe do what you can
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do, but maybe become more awareness of it. I feel like there's more
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talk about this in the beginning stages now. I mean, no, maybe
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it's long overdue that, you know, but I think there is a place
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for it for physicians to kind of take a more open look and say,
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Okay, what obligations do I have to my society more broadly as a physician
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rather than just to my individual patients. Even though that but but these with
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these obligations would still affect my individual patients, but more maybe indirectly. So
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I think it's there. I don't know where that line is drawn, and
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I you know, and there might be some pushback for certain physicians to say,
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well, I'm not you know, I'm not in the public health space,
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because I think sometimes there's that dichotomy between you know, medical professionalism and
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then public health, but it really is all interconnected. So I think I'd
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like to see a shift more towards obligations in that public health space. I
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don't know exactly what that would look like, but I think physicians being more
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aware of saying there are things I can do here that would help health equity
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and health justice concerns I think is great. So and I feel like there
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is a shift. I feel like there is a shift going that direction,
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which I think is good. Yeah, that's a real one, I mean,
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and I agree with you. I think there's a series of really big,
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sort of pressing ethics questions that will be facing us sort of now but
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also the next five to ten twenty. I mean, this is the next
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big so for the PHUC listening and this is a big dissertation. Right,
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Oh yeah, how do we and probably even broad us, right, I
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mean, how do we think about those obligations? Because you can build them
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from within the doctor patient relationship, and you can say, look, I'm
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not gonna You're not going to tell me, Brian, you need to stop
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eating pizza, you need to eat better food, and then find out I
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don't have access. Right, So talking about food desert, right, specifically
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medical problem, but when we start thinking about broader structures. Yeah, it's
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right, it's huge. No as well said, that's that's great, and
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we are unfortunately running up against the end of our time. So I've been
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speaking with Scott Schweikert, who is the senior Research Associate at the American Medical
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Association as well as the legal editor of the AMA Journal of Ethics. He's
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been talking to us about the COVID, the AMS COVID Ethics Resource Center.
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So google it, check it out. There's super helpful stuff there, and
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he gets you out of this last most important question, Scott, how is
24:10
the new puppy? Uh? Yeah, thanks, thanks for asking that we
24:14
have a new puppy. He's doing really well. His name is Cyrus.
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He's a bowl mask stiff, so he's like he's like four months old now
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and like fifty pounds and so he's huge. But he's really sweet and doing
24:26
very well. So thank you. This is good and I am heartened by
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the fact because I know so many people we're able to take in animals during
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the pandemic. Right, we have all these pandemic animals, and it sounds
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like some folks aren't staying with their obligations to their pets. So yeah,
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the puppy's working well and that's right, right, Scott. Thank thanks so
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much for being here with me and everyone else. We'll have another episode coming
24:52
soon, so keep checking out the covid Ethics podcast and the covid Ethics series.
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Thank you all for joining us, and thank you yeah. Check out
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the AMS covid Ethics resource page. Thank you, yep, thank you so
25:04
much, Thanks God. Thank you for listening to this episode of the covid
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Ethics Series podcast. Be sure to check out video versions of our episodes online
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