The magazine’s Ethicist columnist on balancing health care providers’ privacy against patients’ concerns, creating an equitable vaccine system and more.
I was planning to make an appointment with a hygienist working under my dentist and was told by a third party that one of the hygienists had contracted Covid, been treated and was back to work. I am 69, and my nephew died of Covid last May. Four other relatives contracted the virus and recovered. I am nervous about the pandemic.
I requested not to be treated by that hygienist and received this email in response: “To protect the privacy of our staff, just as we do for our patients, we cannot confirm or deny if someone has recovered from the coronavirus. This would be a violation of HIPAA. Your request to not be seen by someone who tested Covid-19 positive was not appropriate, as C.D.C. guidelines state that after 14 days of quarantine, individuals are safe to go out in public. In addition, our clinicians wear appropriate P.P.E. for treatment (including N95 masks, face shields, gowns, gloves), and our office has implemented additional infection-control measures. We monitor for symptoms, take temperatures and measure oxygen saturation daily for everyone that comes into our suite. If this policy makes you uncomfortable, our office may not be a good fit for you.”
I have a problem with putting the privacy of an employee ahead of the concerns of a patient. I also thought that HIPAA applied only to disclosures by a doctor about their patients. Am I out of line to make this request? Should a doctor or dentist tell patients if a staff member has had the virus so that the patient can make an informed decision about treatment?Jack L. Schwartz, Los Angeles
All employers, including medical employers like your dentist, are entitled to have certain kinds of health information about employees. But, like health care providers, they should generally keep that information confidential. It’s granted to them for a limited class of purposes and should be seen only by people who require access to it for those reasons. (The federal rules are complicated, but the basic idea is that information about people’s health shouldn’t be given without their consent unless necessary.) Your dentist is entitled to know that employees are sick in order to confirm that they have medical reasons for taking sick days and to be sure that they pose no risks when they return to patient care. But precisely because the dentist was allowed the information necessary to decide whether the hygienist could safely be at work, patients in the clinic don’t need this information.
The really important thing isn’t whether someone once had the virus but whether everyone in the clinic is taking the appropriate precautions with respect to hygiene and P.P.E. As it happens, people who have recovered from Covid-19 are thought to have immunity to it for some time, and people who have immunity to the virus are less likely to transmit it. So it doesn’t make sense to avoid a hygienist who has recovered. Someone who has never had the disease or has not been vaccinated poses the greater risk. (Though, again, a minimal one given proper precautions.)
The C.D.C. says that someone who has had Covid-19 can be around others if 10 days have elapsed since symptoms began, a full day has elapsed without fever and other symptoms are improving. Although your dentist’s précis was inexact, it sounds as if the office erred on the side of safety and is rigorous about protocols. Your dentist was making the point that there was no clash here between employee privacy and the legitimate concerns of a patient. Possibly, though, I wouldn’t have added that slightly barbed final comment (“If this policy makes you uncomfortable, our office may not be a good fit for you”). Dentists, of all people, should understand the power and prevalence of irrational anxieties, and one element of good medicine is an understanding heart.
I am a college student who spent my break working as an E.M.T. for a private ambulance service. My state’s Covid-19 vaccine protocol prioritizes first responders, and I have the option to receive a shot next week. Given that it can take up to a few weeks for the vaccine to promote antibodies, however, if I get the vaccine now, it won’t protect me until after I’m back at school. My early vaccination provides no benefit to the community, and I could be taking a dose from someone who is at greater risk. Is it wrong for me to get the vaccine knowing that if it weren’t for a few weeks of work, I would be waiting months?Elizabeth Hopkinson, Massachusetts
A fair and reasonable system that isn’t unworkably complicated will end up vaccinating some people earlier than others whose need is greater. It’s not your job to add further criteria of your own. What’s more, the available evidence suggests that significant protection starts to kick in about 10 to 14 days after initial vaccination, which could overlap with your period of work as an E.M.T. And being vaccinated does provide a benefit to your community. It lowers the chance of your transmitting the disease by reducing the likelihood that you’ll contract it and, very likely, by reducing the likelihood that you’ll transmit it even if you do. Adding to the overall vaccination rate, which this does, will be necessary in order to reach something like herd immunity.
An acquaintance asked me to refer him for an open position at my company. Normally, I would be happy to do so, but he mentioned that for New Year’s he rented a house in another state with a group of friends and later traveled to yet another state to ski. I think it is irresponsible of him to have engaged in recreational travel during the winter peak of the pandemic. The position he’s applying for is at a company where all employees currently work remotely. My concern is not that he’ll get anyone sick but that his recent travel indicates poor judgment, which may be obliquely relevant to his ability to do the job. Should I decline to refer him on these grounds or is that too big of a logical leap?Name Withheld
You’re not obliged to recommend an acquaintance for a job just because he asks. And if you do, you should not hide faults relevant to that job. But your resistance to recommending this person doesn’t seem to be that you think he wouldn’t do a good job; it’s that you disapprove of his behavior during the pandemic.
As an empirical matter, though, there’s reason to doubt that people’s character traits are “global” — that the careful accountant is a careful driver, that the faithless spouse is a disloyal friend, that the effective product manager will share your sensible concerns about unnecessary travel and socializing. So yes, that’s a big logical leap.
Still, you’re entitled to decline to recommend him because you think that he failed to display a concern for the common good; as an ethical matter, you can deny a favor to someone who, in your view, lacks an important virtue. What you can’t do is say you’ll recommend him and then not do so.
I’m in a high-risk group, eligible for a Covid vaccination in both the state I live in and a neighboring state. My state is doing a poor job of distributing vaccines, and I’ve failed to get an appointment. But the neighboring state has a terrific system. A friend who lives there got me an appointment. I know that they don’t ask for your address when you arrive for your appointment, which suggests that they’re not overly concerned about residency, and my friend didn’t misrepresent me when signing me up. Am I right to feel a twinge of guilt all the same?Name Withheld
Different states have different approaches. Our collective goal, as a nation, is to get as many people vaccinated — especially those at particular risk — as quickly as we can. But because states are allocated vaccines on the basis of their population, some are taking a firm line, restricting vaccinations to those who live or work there; they may require documentation or at least self-attestation to this effect. Other state officials seem OK with letting visitors in the line. So long as you don’t misrepresent yourself at any point, you can proceed with an easy conscience.
Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)
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