Bioethicists and Others Call for Action from U.S. Federal Government on COVID-19
“We are a group of bioethicists and health care leaders, familiar with the ethical challenges that arise in pandemics. We write to encourage actions on the part of the federal government that will enhance the public’s health, protect the health of individuals, especially the vulnerable, and preserve the nation’s vitality.”
That is from a letter signed by nearly 1,400 people that calls for the United States government to take various steps to combat the COVID-19 pandemic and help medical professionals avoid the difficult decisions involved in rationing medical care. They ask the government to:
- Ensure the manufacture and distribution of needed supplies.
- Commit to payment for COVID-19 care and treatment.
- Provide sick leave for all.
- Protect the vulnerable.
- Build a comprehensive, trustworthy communication strategy.
The letter, initiated by Mildred Solomon, president of The Hastings Center and faculty member of Harvard Medical School’s Center for Bioethics, and Lawrence Gostin, director of the O’Neill Center for National and Global Health Law at Georgetown University, elaborates on each of these points.
You can view the letter and its list of signatories here.
One thing that I worry about here is the reliance on the federal government. (Note the the most infected states almost all have Democratic governors, almost all of whom have been imploring the federal government for help.) Why do we think the federal government is the best-situated to deal with this, as opposed to the states?
Or, to put it a different way: this arguably isn’t even how our government works. We have a federalist system that substantially empowers states. We also did that on purpose, as we were seceding from a British monarchy which, in our view, overly-concentrated power to a centralized monarchy. We also have the Tenth Amendment, which codifies this relationship, only granting the federal government the enumerated powers contained in the Constitution, with all the rest reverting to the states (or to the people).
So I’m just curious as to why the federal government is the proper vehicle to petition here? What specific constitutional powers do we see as grounding our appeals? (Provocatively, would commander-in-chief work? Could we look at this as a wartime situation?) But equally provocatively: we can’t just throw out moral platitudes about masks, sick leave, and so on, if those platitudes really fail to take seriously how our government even works, or derives its constitutional authorization.Report
“What specific constitutional powers do we see as grounding our appeals?”
I am reasonably confident that a pandemic has implications for interstate commerce.Report
In an addendum to my post below, as well as your post, there is the preamble’s invocation to “promote the general Welfare.” That might be seen as overly expansive in some contexts, but for now, not a worry.Report
The federal government is the right entity to petition here because it’s the only entity that has the information, resources, and power to achieve the ends set out in the letter. The federal government knows, or can quickly come to know, e.g., in what state there exists resource X, in what state exists factory Y, such that if the resources from X can get to Y we’ll be able to manufacture more PPE. And the federal government can coordinate the allocation and distribution of the relevant resources.
Just as we need the federal government in times of war, we need the federal government in times of acute and widespread crisis, where both the problems and the solutions are distributed widely, beyond state borders.Report
It’s also true that, for better or worse, depending on the circumstances, the Federal Government has abilities related to monetary and fiscal policy that states do not have. For instance, there are numerous states, including the one in which I reside, in which not only are the state coffers at the breaking point ( no money in the till), there are constitutional provisions that prohibit deficit spending. Granted, there may be ways of finessing the latter, but those are generally quite limited. In the face of a crisis that requires massive infusion of financial resources, that requires the Fed to take the lead. No other option.Report
But that’s just an ahistorical, non-constitutional answer that trades on exactly the sorts of platitudes that the original post was trying to challenge. In other words, we can agree with all that and just say the US doesn’t work that way.
A more appropriate answer can’t just be armchair morality, but needs to be grounded in other sorts of things—again, history, political science, or law would be the obvious places to start. (Not that your answer isn’t normatively informative, just that that isn’t the only thing in play here.)Report
First, my response wasn’t “armchair morality.” I gave a specific example, grounded in the real world, of how the federal government can help solve a problem that states are ill- equipped to solve.
Second, perhaps rather than raising a rather vague objection to the letter, those worried about the letter’s purportedly addressing the wrong entity can say, exactly, which demands/requests are, in their view, inappropriate and why. It’s kind of hard to address the objections as they stand.Report
The point is that, simply because the federal government *can* solve the problem, doesn’t mean it’s within the federal government’s purview. Simply being able to point to some benefit the government might be able to confer–or harm the government could avoid–does not gain any traction on that point because that’s not how governments work, or at least not how ours works: ours is a limited federal system that only enjoys constitutionally-enumerated powers. And equally to the point, there’s constitutional text (in the Tenth Amendment) that further limits the federal government’s purview.
The main objection isn’t vague at all. It’s quite simply: should the *federal* government be the entity to whom the petition is addressed, specifically given our political system and constitution? And, again, just pointing to some upside of them doing it doesn’t really answer the question. I’m not sure what the answer is here, but the challenge is pretty simple and should be pretty easy to engage on its own terms, even if it’s less philosophical than legalistic. (To be sure, this is exactly what many of the legal blogs are now debating, so thought it’d be useful to cross-fertilize the conversation.)Report
I think Moti Gorin understands that you are asking whether or not the federal government would be overreaching it’s power by stepping in. In response he wants you to tell us which of the 5 requests petitioned for do you think would result in government overeach and why. This is a reasonable and relevant question.Report
I’ve provided one concrete example of where the federal government can do what the states cannot do–coordinate the production and distribution of PPE across states. This would provide a great benefit. And we know the federal government has the legal power to exercise this power via the Defense Production Act. That’s just one example of a benefit the federal government, but not individual states, can relatively easily and legally bring about.
Again, can you say which of the listed suggestions in the letter are inappropriate to put to the federal government and why? Some of the authors and signatories are experts in both constitutional and health law and also in the various domains pertinent to the various policies the letter touches upon.
Thus far, you have given no reason at all to think that any of the recommendations/demands set out in the letter are inappropriately put to the federal government.
I don’t have much to add at this point, as no arguments have been given for why the benefits spelled out in the letter should not be pursued in the manner the letter suggests (i.e. via federal action).Report
You may be bioethicists (emphasis on ethics). You took too fucking long. Where were you 2 months ago when you saw the Trump admin. not doing a damn thing and in the ensuing weeks making light of the dangers of covid19. As biologists you must have known about this virus early on maybe even, before the Trump administration. When it comes to policy that hurts people you professional doctors, biologists ect. acting in the best interest on behalf of the public are always way too late to make any difference.
Biologists maybe, ethicists hardlyReport