THE ESSENTIAL PARADOX Martin Huecker , MD
DOCTORS ' LOUNGE
I have striven not to laugh at human actions , not to weep at them , nor to hate them , but to understand them . - Spinoza Definiton of Essential : adj . Constituting or being part of the nature or essence of something ; inherent . adj . Fundamentally important or necessary : synonym : indispensable .
Reflecting on the COVID-19 pandemic , I notice many phenomena that appear contradictory or perhaps paradoxical . To display support for vulnerable citizens , we cover our faces . To keep each other safe , we put distance between us . Frontline health care workers face more danger , but in several studies report less psychological stress . The pandemic strained our health care system , exposing flaws and weaknesses , but this might save the human race when the next pandemic comes . Groups considered ideologically conservative , usually quite careful around germs , seem and act less afraid of this virus . As we together face a pathogen that has no intention or agency , we as a country are divided in apparent conflict . Public health experts prohibit large gatherings one month , then support them the next . We shouldn ’ t wear masks , we should wear masks , we should wear two masks . At a time we need human social connection the most , we must avoid congregation to limit spread .
During potentially unhealthy efforts to stay informed of current events , I followed the Supreme Court cases related to social gatherings ( I had never read a Supreme Court decision in its entirety ). I read Dr . Kolter ’ s Louisville Medicine piece with great interest and agree with many points . In the case , the Roman Catholic Archdiocese of Brooklyn challenged the constitutionality of Gov . Cuomo ’ s executive order on public gatherings . In red zones , the order imposed a 10 person limit regardless of normal capacity and precautions taken - “ social distancing , wearing masks , leaving doors and windows open , foregoing singing , and disinfecting spaces between services .” 1 From Justice Gorsuch ’ s statement :
People may gather inside for extended periods in bus stations and airports , in laundromats and banks , in hardware stores and liquor shops . No apparent reason exists why people may not gather , subject to identical restrictions , in churches or synagogues , especially when religious institutions have made plain that they stand ready , able , and willing to follow all the safety precautions required of ‘ essential ’ businesses and perhaps more besides . The only explanation for treating religious places differently seems to be a judgment that what happens there just isn ’ t as ‘ essential ’ as what happens in secular spaces . At the flick of a pen , they have asserted the right to privilege restaurants , marijuana dispensaries , and casinos over churches , mosques , and temples . 1
In line with the puzzling year of 2020 , this case presents another paradox . The US Supreme Court used its authority to limit the reach of government . The ruling put the decision of which risks can be taken onto individuals . One could argue that Gorsuch paradoxically revealed his own moral bias in his call for impartiality in how laws affect citizens and groups . Without overtly stating a disregard for hardware stores , alcohol or acupuncture , Gorsuch ’ s call for equal treatment seemed to imply devaluation of these businesses rather than elevation of religious attendance . Judges should uphold the law regardless of their personal viewpoints , just as physicians should not judge patients for their medical conditions .
The underlying dispute in the case surrounds the dichotomy of essential versus nonessential : open economy versus lockdown , mask versus no mask , in person versus remote schooling . These are important debates , often with middle ground . But the case in New York regards which businesses and activities can proceed despite infectious risk . We risk harm driving to work , riding a bicycle , giving our kids freedom , and leaving the house during a pandemic . COVID-19 is not a problem with solutions ; it is a dilemma requiring strategies that acknowledge tradeoffs ( hospital visitors , continued masking after vaccination , funerals and school closures ). 2 , 3 Most governors and world leaders have decided that the tradeoffs do favor opening essential spaces .
The Supreme Court case is also about equitable access to community . The benefits of participating in a community only increase during turbulent times . Connection , considered by many people indispensable for coping with tragedy , became and remains dangerous . Most of us strive to be inclusive , accepting individuals with different belief systems . Religious attendance , especially during crisis , might be the most essential activity in a particular person ’ s life . Religion rituals in infancy , childhood , adolescence , adulthood and end of life ( cool essay !) 4 cultivate the sacredness that humans crave . 5 Yes we must consider externalities that impact public health . Could church services present more danger for community spread than other buildings full of people ? Although a few events garnered early attention , the Centers for Disease Control and Prevention ( CDC ) does not deem religious service higher risk than other indoor gatherings . 6
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