The Ethics of Perspective: COVID-19 and Community Risk Assessments

COVID-19 vaccines are prepared for administration at the Delta Flight Museum mass vaccination site.
COVID-19 vaccines are prepared for administration at a mass vaccination site in Hapeville, Georgia. (U.S. Army National Guard photo by Cpl. Isaiah Matthews)

In Relativity, a brief and eminently readable book, Albert Einstein described the inability to compare perspectives from any place but one’s own vantage point. Among other examples, he cited a train station and the road alongside it: 

“We imagine two clocks of identical construction; the man at the railway station is holding one of them, and the man on the footpath the other. Each of the observers determines the position of his own reference-body…It is clearly seen that there is no such thing as an independently existing trajectory…but only a trajectory relative to a particular body of reference.”

This discussion of math and physics could easily summarize the politics of the twenty-first century’s second decade. You see your view, I see mine, and never the twain shall meet. It was not long ago that science, medicine, engineering, technology — the lot of them stood apart from politics. Then came blogs (with every writer as his or her own fact-checker) and the “alternative facts” phenomenon. Vaccines dissolved into a philosophical concept, bound up in debates about whether they should be taken — even when they work nicely. 

In short: The choice to take (or not to take) a vaccine became a proxy for party affiliation and trust in government agencies, rather than in immunology and biomedical engineering. This is a corruption of science, not a celebration of it. In science, data matter more than who reads the results from the podium. A retrenchment was needed: “Why do we want a vaccine, anyway?” The ethics accompanying a vaccine can be stark — and uncomfortable. Is the goal to “get my life back” or to “keep you safe?” The topic matters because ethics should be a primary foundation of management policies in every industry. 

More from Jonathon S. Feit

Like most ethical dilemmas, however, there is no right or wrong answer here. Life is short and precious. We all empathize with wanting to live it. Moreover, people, families, and communities have needs. A year into COVID-19, we know that “I get my life back” likely means that you get your life back, too.

The other view, however, is special — a unique hallmark of Mobile Medicine. Besides the fact that one safeguard goes into the body and the other goes onto it, how is a vaccine so different from duty gear? One protects against heat and flame; the other protects against a virus. One cannot legitimately argue that duty gear protects Mobile Medical professionals themselves while the vaccine protects the community at large, because keeping themselves safe lets Mobile Medical professionals do their sacred work for the community. Thus, both duty gear and a vaccine arrive at the same place with respect to the Greatest Good.

How, then, can ethics guide a sense of whether Mobile Medical professionals should receive a COVID-19 vaccine? We posit that the answer stems from the question of whether the community you serve needs you to get one. Thus, for Mobile Medical professionals, the decision point is different: Is getting a COVID-19 vaccine really a choice, or is it just an extension of the community commitment that gets you up each day?

Whereas technology firms flex to market challenges and to advocate for the value of high-quality and sharable data, fire services in particular — and Mobile Medicine in general — pride themselves on being “all-hazards” responders who risk themselves physically, immunologically and psychologically for their communities every day. Imagine if the debate du jour were not about something that has become politically charged, like a vaccine. Imagine instead that it were about training for swift-water rescue or spotting patients at high risk of overdose. Would there be much debate, or would it start and end fundamentally with straightforward question: “Does our community need this technology/ training/process?” Is there a river nearby? Do we find ourselves resurrecting patients who are hooked on harmful substances? If yes, shouldn’t we be ready to serve them?

That vaccinations are now evaluated differently is proof of their politicization, because the risks are simply par for the course — neither substantially higher nor lower than what Mobile Medical Professionals do in the course of their everyday duties. Risk management is the omnipresent scissor in the “all-hazards” emergency responder’s Swiss Army Knife. Knowing the nature and needs of the souls under care is the whole point of a Community Risk Assessment. Our brave women and men run toward crises daily; they shield the desolate and raise the needy despite risks both known and unknown. Isn’t getting a vaccine an extension of what they already do?

Things might be different if the Larkspur (CO) Fire Protection District were situated on a college campus, amid a less-susceptible population. But the district’s patient mix made it easy to mandate vaccinations among its operational personnel: LFPD protects 110 square miles in Douglas County, Colorado, between Denver and Colorado Springs. Many of the patients are elderly, disabled and even homebound. Furthermore, an interstate that accommodates a high volume of commuter and commercial traffic bisects the district, resulting in its response to numerous patients suffering multi-system trauma due to crashes. Many of these patients are de facto immunocompromised by the nature of their injuries—however, these injuries were sudden, unexpected and possibly unavoidable.

Herein lay the challenge: Imagine a scenario whereby a member of the crew—either an asymptomatic carrier who does not know that she or he is harboring the virus; or else someone who is not sick, not infected, but came in contact with someone who is—were to accidentally infect a patient who is likewise unaware of his or her compromised state. The universe of possible negative outcomes includes life-altering disability and worse.

Whose risk weighs more? Of course, the lives of the patient and the care provider carry precisely equal value. But only the care provider has the ability to mitigate the potential risks. Therefore, the question transforms into a matter of ethics—a matter of should.

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