We’ve been hearing a lot about lying related to the coronavirus pandemic. Wanting to hear from an ethicist, I reached out to Dr. Charles E. Binkley, a cancer surgeon who is director of bioethics at Markkula Center for Applied Ethics at Santa Clara University, a Jesuit institution in Silicon Valley. (See our post about lying here.)
This is a transcript of our conversation, abridged and lightly edited for clarity.
Let’s talk about lying and vaccines.
Charles E. Binkley
When I think about lying, in general, I think about when does a wrong means justify a good end? And in general, are there exceptions?
In law, there is the “fruit of the poisonous tree.” If evidence was was gathered in an illegal fashion, it’s inadmissible because it’s an evil or bad means, and it doesn’t justify a good end. So almost universally, we acknowledge that an evil means doesn’t justify good ends — you can’t justify bad actions by the outcome.
But are there exceptions? And how would that look? I think proportionality is the judge there. The bad means has to be so much less bad than the good that it does or the lack of harm that it does.
A classic example is self-defense. Do you have a right to defend yourself? It’s thought that that’s justified, but it has to be proportionate. So if somebody is coming at you with, with their fists, you can’t shoot them. Because that that’s not proportionate. You can use your fists, or you can use something else, but you can’t just shoot somebody because they come at you with their fists.
A cargo ship carrying vaccines — and pirates
So when it comes to vaccines, like what would justify a lie? Here’s an example. Let’s say that there is a cargo ship headed for a country in which lots of people are dying of Covid, a country where there are no vaccines. And this is the first shipment. And there are two doses for everybody in that country.
You’re steering that ship, and the pirates come on board, and the pirates say, “Do you have vaccine on the ship?” You would be morally justified to lie to them and say, “No, there’s no vaccine on the ship,” and then the pirates could get back on their ship and they would go away.
So we have the idea of the means and the end.
Although it’s a bad act, the good that would be done would be so much greater than this, this relatively less magnitude bad or evil act.
Where’s the greater good?
This is fascinating.
So when you think about vaccines, would you be justified in lying about the age of your child, or lying about not having gotten two doses in order to get a third dose, without any good reason to get a third dose? And I can talk about some good reasons in a second.
I don’t think you’d be justified in lying for a couple of reasons. Because first of all, the bad act of lying isn’t justified by any greater good.
In some ways, in both of those situations, getting a third dose yourself or getting a dose for your child, when your child’s age group isn’t approved for the vaccine, could actually turn out to be harmful. Because first of all, we don’t know for certain that all that it’s equally safe in all age groups. So until we know that, then it’s not always not justified as a good — it’s potentially harmful.
The other thing about the third dose is there’s this is a phenomenon of the immune system where the immune system can be primed, such that each successive exposure actually causes a greater immune response. And so there is this potential that repeat exposure could actually turn out to be harmful, and that it could sort of overshoot the immune system.
Until we know that a third dose is safe, then it may actually be harmful. So not only would it not be justified as a good, either a third dose or getting your child a vaccine, it could actually turn out to be harmful.
A doctor’s orders, with no one to fulfill them
Now, are there are other situations. For instance, I was just giving an example of a friend of mine last night, whose father has cancer and is getting chemotherapy. He’s gotten two doses of vaccine already. But for some reason, I can’t really remember why, he had his blood drawn recently and they tested for Covid antibodies, and he had not mounted any the antibodies because he’s immune-suppressed.
His oncologist said, “you really do need to get a third dose,” and wrote an order and sort of handed it to my friend’s father and said, “Go get your third dose.”
He has had the darndest time, because there’s no protocol out there for third dose. No one’s going to want to give it, especially the commercially available places like the CVS’es, and other large immunization clinics. They’re not going to give you a third dose because it’s not approved — there’s no protocol for doing it.
He’s called the Health Department, and they said, “No, you can only get two doses. We don’t have approval to get third doses.”
And he said, ”Well, I have this doctor’s order.” So would he be justified in lying and saying, “I’ve only had one dose?” Would he be justified in doing that? Honestly, I don’t think so. I don’t think lying would justify that.
I think that the moral burden there is on the physician, to do more than simply say, “You need to go and get a third dose.” I think that the moral burden there, the ethical burden, is not just to write an order, but to actually make sure that the patient gets what the patient needs. So I don’t even think in that situation, it would be justified to lie to get a third dose.
So I don’t think there are many instances when an individual would be justified to lie in order to get that individual or one other individual a dose of vaccine.
It’s not just about us — it’s our communities
Hmm. So that’s exactly what we’re hearing about right now.
It’s also fascinating time to be a bioethicist right now – there’s lots of very rich conversation.
One of my colleagues at the Markkula Center got a grant from the Hilton Foundation recently. Conrad Hilton has this foundation that basically supports Catholic nuns, and the center applied for a grant from the Hilton Foundation, to make some educational materials to address vaccine hesitancy in the Catholic community.
We’re working with the California Catholic Conference, because initially, there was lots of concern about the cell lines that may have come from aborted fetuses. We did some webinars on that, but also to really talk about vaccine hesitancy and to try to increase rates of vaccination amongst vulnerable populations.
We’ve been thinking a lot about how do you address hesitancy. Then how do you increase vaccine acceptance? For some people, there are reasons why they may be hesitant. Other people, they kind of feel like, “Oh, this isn’t going to happen to me, I’m unhealthy. And if I get it, I’ll be fine.” But it really extends beyond that, to the idea that, we get vaccinated not just for ourselves, but for our communities, for our neighbors, and so on.
I’ve asked myself, you know, is this is this medicine? Is this ethics? Sometimes those lines are somewhat arbitrary, but I think it matters when it comes to helping facilitate good decision-making.
Covid fatigue and its effects
Sometimes we ask whether what we are doing is journalism — finding stuff out and telling people about it, right, or helping society organize its information, or it’s not about, you know, printing a newspaper and dropping it on somebody’s doorstep. I think a lot of us are having trouble thinking in a complex fashion during the pandemic.
It is a lot of Covid fatigue. For me, masking is such an easy thing to do. I have spent most of my adult life wearing masks when I was in surgery.
In Asia, it’s very common to see people wearing masks there, just because of the pollution is so bad. But people see it as such a huge burden.
Also I think people get bombarded by information. Your CNN alerts, your New York Times, your Washington Post, and then you ask Google in the mornings to read you the news. You listen to NPR, Morning Edition, you scroll through Facebook between meetings, and then you see what alerts you have on Instagram.
It’s really very interesting, like how many different conduits we have to get information and turn how we balance that out.
(See our post about lying here.)