Interview with Dr. Ruth Faden, Johns Hopkins University

Regulation | January 14, 2021 | by Jill Schumann

Dr. Ruth Faden, Professor of Biomedical Ethics at Johns Hopkins University, joined the LeadingAge Coronavirus Update call on January 14, 2021.

Dr. Ruth Faden, Professor of Biomedical Ethics at Johns Hopkins University, joined the LeadingAge Coronavirus Update call on January 14, 2021. She answered questions from Ruth Katz and from callers.

(Listen to the interview here.)

Q: What is bioethics and why is that framework important?

A: Bioethics involves many academic disciplines. Bioethics asks these questions: What kinds of health policies and practices are preferred? Which are acceptable? Which are unacceptable? We ask which virtues to cultivate in healthcare practitioners, and which we are less enthusiastic about.

Q: Many LeadingAge members are seeing residents eager to receive the vaccine, but reluctance among some staff members. How can ethics inform the way we work with those staff members?

A: There is concern and longstanding justified distrust on the part of people who are in communities of color, and in low income and rural communities. They have good reasons for mistrusting government and medical institutions based on history as well as recent and ongoing systemic issues. We have not done a good job of earning the trust of these communities. Therefore, while it is worrying that we are not getting the acceptance rates we would like, it is not surprising.

Q: What might our members do?

A: Two tried and true methods are: trusted communicators and listening. It is important to listen carefully without judgment, shaming or coercion. And, it is important that the communicator be someone well-trusted.

Q: Why don’t we just require vaccination? Are there ethical insights on this?

A: We might get there at some point, but the question is whether this is the ethically best or most prudent course. Let’s first try to make progress by listening and offering conversations with trusted communicators. Do your staff trust you? Can they be honest with you? Be aware of power dynamics and ensure that there are others who can also serve as communicators, too. Peers who have had successful experiences with vaccination can be helpful.

Q: From an ethical perspective are incentives to receive the vaccine a good idea?

A: T shirts are one thing and can create a sense of team spirit. As ethicists we talk about conditional cash transfer – there is a history of using money to get people to get vaccinated. It works sometimes, but can have unintended consequences. We sometimes see the undermining of internal motivation by external motivation. Payment undermines a person’s ability to serve as part of a chain of people in a community to get vaccinated for personal and group benefit. Payment may have a ripple effect across the wider community as people ask why some people are paid and others aren’t.

Q: There is so much misinformation on social media. What can we do about that?

A: It is Important to realize that people who are not getting vaccinated are acting for a variety of reasons. There are people who are simply against vaccines and they are unlikely to change their minds. There are those who are historically mistrustful. And there are those who are acting on misinformation and sometimes even conspiracy theories. It is difficult to break through. This is not simply a U.S. phenomenon as I have learned from research we are doing in Nigeria. Among some movements, vaccines have become a vehicle to build a wedge within the population and to tighten the in group. Nonetheless, we need to be honest and transparent and try to understand why people are reluctant, asking, ‘Is there anything about the vaccine that you are unsure about?”

People have different systems of knowing – epistemologies of fact and truth. We are operating within a scientific method framework for how you provide evidence. Others operate with different ways of knowing and don’t subscribe to the way we evaluate truth and evidence. We are public health people and based on the results of the data from the trials this is what we believe to be true. You can ask people “What do you believe to be true and why?”

Q: We sometimes hear the line of ageist thinking that wonders why, given the limited supply of the vaccine, it is being given to old people who don’t have long to live anyway. What does that look like through the lens of bioethics?

A: I am part of a group advising the World Health Organization on vaccine prioritization. We are seeing a record burden of disease right – cases, hospitalizations and deaths. In this crisis context the decision to vaccinate older adults makes ethics sense. We want to preserve the functioning of the health system, so we want to prevent severe disease and deaths. There is a tension between that public health priority and a side- by -side consideration which is addressing the fact that the epidemic has disproportionately affected people from systematically disadvantaged social groups. So, we need to balance those two concerns.