EDITORIAL Social Distancing and Covid-19: Is It Ethical? Noor-Mah Khan The CDC recommended social distancing of 6 feet in public and quarantine for exposed individuals for 14- 20 days at the start of the COVID-19 Pandemic. (Centers for Disease Control and Prevention) The vast history of public health validates the need and effectiveness of social distancing over the course of documented history. (Qian 259-261) However, the widely debated question is whether it is ethical to impose the social and economic burdens that accompany social distancing, on the general population, in the midst of a Pandemic such as COVID-19? The value of imposing social distancing is not the conclusion of a debate rather the beginning of a very important discussion in the context of public health ethics. The burdens that come with social distancing fall disproportionately on different cohorts of society. While convenient for people in one domain of physical location, for example software engineers in the tech industry who have the privilege of working from home while having negligible effects on their work outcomes, it can take away the livelihood of a daily wage worker who has to go out every day in search of work and depends on engaging with strangers to be employed and earn a livelihood. This has highlighted the need of being sensitive to the distributive inequity associated with federal and public health policies related to policies regarding social distancing. The most important question we can bring up in trying to resolve this dilemma is to ask what do we as policy makers and public health professionals owe to the general public most affected by these policies? In trying to reach an answer, we need to categorize the individuals into two categories of harms incurred; the harm that an individual incurs in having to quarantine/isolate for a significant period of time and the harm the broader industries incur in having to implement social distancing as a policy. In trying to reach a balance where “fewest harms” are incurred, we need to address the responsibility that the government has towards the people. To lessen the socio-economic burdens of social distancing, we need to make sure that that person is cared for; food is provided, phone and internet is available for staying connected to loved ones, income is replaced and security is provided on an employer and government level. Albeit a grand expectation, in my opinion it is not just the responsibility of the elected government but the due right of its people. The ethical theory of Utilitarianism builds on the concept of consequential moral reasoning - meaning the onus of reasoning relies on the consequence of the act. (Sandel 31) It works to increase overall utility; defined as the net sum of pleasure over pain. (Sandel 103) Using the doctrine of Utilitarianism in the context of the evident benefits of social distancing (Qian), I believe imposing social distancing in a pandemic such as COVID-19 is ethical. By forming policies to halt the spread of the virus, protect the most vulnerable in the society and attempt at containing a disease that little is known about in the setting of no vaccines or credible treatments, it is the overall beneficial choice to make. It aims to reduce death and debility of near ones, which is by far one of the most painful experiences humans can go through, it buys time for solutions to evolve, it helps people live long enough to figure a way past such a situation with minimal losses. For public health professionals and policy makers who find themselves consumed by the ethical dilemma of structuring and executing time-sensitive policies in a pandemic caused by a respiratory infection such as COVID-19, they can take out a page from John Rawls' book. John Rawls created the thought experiment which he called, “The Veil of Ignorance” - it is a moral reasoning method used to test whether an act is fair and impartial by disallowing the thinker to use any information that might potentially bias his/her decision in favor or against a certain people/situation. (Huang) This experiment will allow the power holders to exercise a sense of consciousness when making policies and will help them analyze all their propositions through Correspondence: Dr. Noor-Mah Khan MBBS, MD 3585 Monroe St, Santa Clara, CA95051, USA E-mail: noormahnk@gmail.com Received: March 03,2022; Accepted: March 14, 2022 1 2 the lens of fairness and justice. As Rawls mentions, “ When addressing major decisions about the allocation of resources, we need only ask ourselves: 'how would I feel about this issue if I were stuck behind the veil of ignorance?” (Huang) In the context of COVID-19, it will help policy makers access the impartial state of the brain and allow them to reason beyond their position of privilege and from the point of view of the common man that makes up the larger part of the society. It will make it easier to help lead the population into a transitory phase of lockdown, ease their anxieties and provide for the basic necessities of living while socially distancing and isolating. It is important that policies such as social distancing, quarantine and isolation are imposed with the consciousness of distribution and its consequences. These policies need to be respected for the greater good and everyone's equal safety, provided that those people are given security of food, shelter, connection and financial and health coverage for that specified time. Norman Daniels wisely points out the matter of prioritizing the worse off and how it matters who is prioritized and how much. He also discusses how there is no sure way of knowing what is actually “just” and “fair” in allocating resources especially in settings such as a novel pandemic. Norman Daniels says and i quote, “ Fairness is even more problematic because we don't have a criterion for what counts as fair and we have to accept the outcome of a fair process as what's fair.” (Daniels 2- 16) In a situation such as the outbreak of COVID-19 and the ensuing pandemic, no government, public health officials or political party knew what to expect and how to go about imposing policies that were strict, safe and considerate enough for the general population. It was only after going through the process of forming and reforming policies while analyzing the outcomes on different strata of the society, did we get a clearer idea of the harms and benefits of the policies - in short, 'the outcome of a process' regardless of the procedural fairness. Daniels continues on to say, “ …how do we measure whether we get fairer decisions if we didn't have a prior agreement on what counts as fair? Since we don't have that agreement we need a process but the outcome of that process might not comply with some people's judgements about fairness, and if so, what do we do about that and the answer is “I don't know.”” (Daniels 2-16) In the case of mandating social distancing policies in COVID-19, I agree with this statement. If we consider a collective societal and global benefit that may be gained through containing the spread of the virus, we need to consider that the policy will not be received well by all segments of the community and it might sit well with some while getting high criticism from others. In such a context, I believe, tying in the utilitarian perspective helps us justify this policy by arguing that as long as the benefit of the larger community outweighs the harm caused as collateral damage, the policies are fair. It is granted that no one policy can be the right policy. Although it could be argued that it is every human's right to choose what they deem best for themselves, in a global situation such as a pandemic, it should also be weighed that one person's choice does not end up hurting other people's safety and health. Thus, it is important that policies such as social distancing and isolation are respected for the greater good and everyone's equal safety. However, these avenues should only be employed provided that people are given security of food, shelter, connection with loved ones as well as financial, physical and mental health coverage for that specified time. Governments need to plan ahead of time and be prepared to take on such a challenge if the need arises with the best interest of the people at its core. REFERENCES 1. Centers for Disease Control and Prevention. “How to Protect Yourself & Others.” CDC, https://www.cdc.gov/coronavirus/ 2 0 1 9 - n c o v / p r e v e n t - g e t t i n g - s i c k / p r e v e n t i o n . h t m l . Accessed 22 February 2022. 2. Samuel K. “ Treating Persons as Means (Stanford Encyclopedia of Philosophy).” Stanford Encyclopedia of Philosophy, 13 April 2019, https://plato.stanford.edu/ entries/persons-means/. Accessed 22 February 2022. 3. Qian M, Jiang J. COVID-19 and social distancing. Z Gesundh Wiss. 2022;30(1):259-261. doi:10.1007/s10389-020- 01321-z. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7247774/. 4. Sandel MJ. Justice: What's the right thing to do. BUL Rev.2011; 91:1303. 5. Daniels N. Justice, health, and healthcare. American Journal of Bioethics. 2001 Feb 1;1(2):2-16. 6. Huang K, Greene JD, Bazerman M. Veil-of-ignorance reasoning favors the greater good. Proceedings of the national academy of sciences. 2019 Nov 26;116(48):23989- 9 5 . h t t p s : / / w w w. p n a s . o r g / d o i / 1 0 . 1 0 7 3 / p n a s . 1910125116#:~:text=The%20%E2%80%9Cveil%20of%20ig norance%E2%80%9D%20is,least%20from%20the%20avail able%20options. JIIMC 2022 Vol. 17, No.1