I am writing this in the service of health care colleagues and citizens of my state of North Dakota, a state straining with the impact of COVID-19. I write as an individual physician, with intentions to represent only myself.
I was born and raised in rural North Dakota. In years past, I was the medical director of our state’s Department of Human Services. I am currently an academic psychiatrist, with additional training in public health.
We find ourselves struggling to bridge ideological and social divides during a time of profound challenges, not the least of which is the current pandemic. Is there common ground? The psychologist Jonathan Haidt and colleagues have studied political “camps” in their work on Moral Foundation Theory. They find that while Libertarians cherish liberty and Progressives caring, Conservatives espouse, in addition to those qualities, group loyalty, sanctity and authority. Where all groups meet, however, is in the arena of fairness.
My hope is for leadership and our citizens to come to a point of mutual agreement on fairness as relates to public health recommendations.
I have watched my health care compatriots (including physicians, nurses, public health officials and others) dauntlessly provide care and medical leadership as cases continue to rise. Our hospital system beds are currently “full.” Which means the options for our ill loved ones are fewer, and likely positive outcomes less.
As a person with experience in disaster mental health, I believe people can tolerate significant difficulties and sacrifices if they know the decisions made by leadership are based on fairness. Such engagement requires compromise. Unfortunately, the idea of mask-wearing and limitations in physical gatherings have taken on a symbolism beyond their intention. They are basic public health tools, utilized only in true disasters for the purpose of preventing the need for draconian measures, such as lockdowns. Lockdowns are the result of either an acute need to quickly control a devastating exposure, or the result of unsuccessful prevention using more tempered adjustments. We are currently on the cusp of the latter.
So, regarding fairness and compromise. I believe it is fair to wear a mask and limit the size of gatherings in order for:
- a small-business owner to have a fair chance at keeping his business open.
- a nursing home resident to have a fair chance of receiving visitors.
- a student to have a fair chance of being with her classmates in person.
- a health care provider to have a fair chance of not compromising her care to others.
- a rural resident to be able to have coffee and pie, or a beer at their local establishment.
Another psychiatrist, in whose company I am associated only by profession, was Victor Frankl, author of the classic, “Man’s Search for Meaning.” If anyone knew the meaning of sacrifice and liberty, it was Dr. Frankl, who was a concentration camp survivor. (Another who knew that meaning was my uncle; a prisoner of war at the same time in the same region.) Frankl saw freedom and responsibility (toward self and others) as two sides of the same coin. In fact, one of his favorite quotes was “I recommend that the Statue of Liberty on the East Coast be supplemented by a Statue of Responsibility on the West Coast.”
I would be incredibly proud of my fellow North Dakotans if at this time masks and physical distancing were seen only as symbols of responsibility; of fairness, and nothing more.
Dr. Andy McLean is chair of the Department of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences, and a member of the ND Department of Health Medical Advisory Committee.
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