Chapter Three: Public Adherence

Hastings Center Reports Bioethics Briefing, “Pandemics: The Ethics of Mandatory and Voluntary Interventions”
This bioethics briefing provides an overview of the ethical issues involved in the mandatory or voluntary recommendation of non-pharmaceutical interventions (NPIs) such as physical distancing, self-isolation, and mask wearing in public.

Havi Carel, Matthew Ratcliffe, and Tom Froese (30 June 2020), “Reflecting on Experiences of Social Distancing,: The Lancet.
What can phenomenology tell us about the experience of social distancing? Phenomenologists hold that embodied interactions with others are foundational to human experience. How does prolonged social distancing affect this foundation? Carel, Ratcliffe and Froese suggest that social distancing can be destabilizing, as norms of interaction that were once taken for granted disappear. They write: “Various elements of pandemic experience are characterised by suspicion, uncertainty, and doubt. We may distrust the air we breathe and the surfaces we touch, while strangers suddenly seem unpredictable sources of potential danger.”

Aidan Hayes (14 May 2020), “Civil Liberties and the Rhetoric of Physical Distancing,” Impact Ethics [blog],
One common way to frame the ethical issues involved in physical distancing and self-isolation is to describe them as measures for the common good that are in tension with individual freedom. Hayes argues that this is a mistake and that we can justify these measures “without placing social responsibility in opposition to freedom.” We are not in general free to harm others or put others at serious risk of harm. This explains why we have speed limits, prohibitions on assault, and restrictions on the disposal of toxic materials. Hayes claims these kinds of limits “do not circumscribe civil liberties, because they are necessary if others are to live freely.” The “freedom” of presumed healthy individuals to attend anti-lockdown protests puts those who are immunocompromised at risk and limits their freedom. Hayes argues that some of the arguments against requirements of physical distancing and self-isolation are grounded not in freedom but in supremacy of the strongest.

Solomon Hsiang, et al. (8 June 2020), “The Effect of Large-Scale Anti-Contagion Policies on the COVID-19 Pandemic,” Nature
One important empirical concern when considering the ethics of non-pharmaceutical interventions (NPIs) is whether these measures are effective at controlling the spread of an infectious disease. If the measures are not effective, then it would be difficult to justify the limits on liberty and other harms caused by physical distancing, self-isolation, and the resulting economic slowdown. Hsiang et al. provide empirical evidence suggesting that the measures have been effective in the countries they’ve surveyed.

Face Coverings and Masks

Trisha Greenhalgh, et al. (9 April 2020), “Face masks for the public during the covid-19 crisis,” BMJ
Greenhalgh et al. argue that even if evidence for the efficacy of mask wearing is incomplete, the precautionary principle justifies policy makers’ encouragement of mask use.

Graham P. Martin, et al. (9 April 2020) “Response to Greenhalgh et al.: Face masks, the precautionary principle, and evidence-informed policy,” BMJ
Do Greenhalgh et al. use the precautionary principle as it is commonly understood? Martin et al. believe they do not. Martin et al. are concerned that the public is not well-trained in the proper use of face masks and that in the absence of this training masks could become a contaminated hazard rather than protection. They also worry that encouraging mask use might lower compliance with other measures such as handwashing and physical distancing.

Trisha Greenhalgh (26 May 2020), “Face coverings for the public: Laying straw men to rest” Journal of Evaluation in Clinical Practice.
In this article, Greenhalgh responds to the concerns raised by Martin et al. above.

John Finn (28 July 2020), “The Constitution doesn’t have a problem with mask mandates,” The Conversation
Finn, a scholar of constitutional law, examines the claim that mask mandates violate constitutionally protected rights. Finn argues that such mandates are indeed constitutional and do not violate rights.

Katie Anderson (30 April 2020), “Wearing of face masks can trigger trauma for some,” Altoona Mirror.
In reading 3.2 of The Ethics of Pandemics, “Social Distancing is a Privilege,” Blow argues that racism poses dangers for Black people (and Black men particularly) who wear masks and might be seen as a greater threat. Anderson adds that there can be particular difficulties for survivors of sexual assault when mask mandates are in place.

Nicole Hassoun (20 September 2020), “Philosophy and psychology agree – yelling at people who aren’t wearing masks won’t work,” The Conversation
Hassoun asks whether it is appropriate to express moral outrage at people who refuse to wear masks. She considers this from utilitarian, Kantian, and virtue perspectives, concluding that empathy is better than outrage, both morally and practically.