By Franklin G. Miller.

In the face of another surge in infections, hospitalizations, and deaths from COVID-19 in the U.S., 9 of 10 states with the highest number of cases per capita voted Republican in the 2020 presidential election and are headed by Republican governors.

A common refrain of Republican politicians and those on the right of the political spectrum is that wearing a face mask or getting vaccinated is a matter of “personal responsibility.” In a sense, this is true. Under current conditions of widespread infection by the readily transmissible Delta variant, it is the responsibility of individuals to wear masks in public settings and become fully vaccinated. And, if they fail to wear a mask or become vaccinated, then they are being irresponsible.

But this is not what is meant by invoking “personal responsibility” as an individual stance and a political statement in the pandemic context.  Rather, the mantra of political responsibility is meant to claim that individuals should be free to decide whether or not to wear a mask and to become vaccinated; and that these decisions should not be subject to penalties or constraints imposed by government, businesses, or other institutions. Mandates to wear masks and become vaccinated are viewed by many of those on the right and their political representatives as unjust interferences with the values of freedom and personal responsibility. Such a stance, however, misunderstands these values.

Everyone agrees that no one should be free to commit crimes, such as stealing or violently attacking innocent people. It is also widely recognized that people should not engage in conduct that unduly poses risks of serious harm to others, such as driving under the influence of alcohol. The classical philosophical statement regarding the legitimate scope and limits of personal freedom is that of John Stuart Mill in his book, On Liberty, published in 1859. In an often-quoted passage, Mill stated that “The object of this Essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion or control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightly exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant … The only part of the conduct of any one, for which he is amenable to society, is that which concerns others.”

Mill was a staunch opponent of paternalism—a stance that liberal, democratic societies have departed from, to some extent, as exemplified by laws mandating the wearing of seat belts or motorcycle helmets and restricting access to medicines via requirement of a doctor’s prescription. Yet, if wearing masks and becoming vaccinated were solely matters of protecting individuals from harm to themselves, then the claims of freedom and personal responsibility would be warranted. Individuals, however, are vectors of infectious disease. As the pandemic rages, refusals to wear a mask or become vaccinated exposes others to risks of infection, serious illness, hospitalization, and death. Moreover, with hospitals and their intensive care units filling up with unvaccinated COVID-19 patients, the health care of individuals suffering from other conditions is negatively impacted and societal resources are needless expended. Mandates for wearing masks and vaccination legitimately restrict the freedom of individuals in service of public health and the common good. A socially responsible understanding of personal responsibility makes mask-wearing and vaccination obligatory, not a matter of free choice that should be insulated from compulsion or control by means of the law or institutional requirements.

We rightly expect elected public officials to be devoted to protecting the public from preventable, serious harms. Those officials who intervene to proscribe mask and vaccination mandates in the name of freedom and personal responsibility are being irresponsible. All Americans should do their part—to share responsibility—for promoting public health.

Author: Franklin G. Miller

Affiliations: Professor of Medical Ethics in Medicine, Weill Cornell Medical College

Competing interests: None declared