Responding to Patients Who Refuse to Wear Masks During the Covid-19 Pandemic
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Harvard Global Health Institute, Cambridge, MA, USA; 2VA New England Healthcare System, Bedford, MA, USA; 3Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06323-x © Society of General Internal Medicine 2020
around the country begin lifting restrictions put A sinstates place to slow the spread of Covid-19, public health officials are calling for universal masking in crowded spaces, such as grocery stores, pharmacies, and hospitals. SARSCoV-2 spreads person-to-person through close contact and despite current guidelines from the Centers for Disease Control recommending face masks, only a third of Americans wear a mask outside.1 With concerningly low rates of the public embracing the recommendation to wear a face mask, patients around the country are showing up at healthcare facilities without masks and some are refusing to wear one. This leaves healthcare professionals with the difficult decision of whether or not to treat patients who do not adhere to masking guidelines. We provide an ethical analysis of the duty to treat patients who refuse to wear a mask and argue that there are justifiable limits on this obligation. We also provide guidance for how clinicians can respond to patients who refuse to wear a mask, encouraging patient engagement and offering the alternative of care through telehealth. There are many reasons people choose not to wear a mask. Some believe that masks are only needed if you have Covid19, and a lack of symptoms precludes one from needing to wear one. Early messaging from health experts likely contributed to this misconception as health officials, including the U.S. Surgeon General, communicated that masks were not necessary for the general public’s protection.2 Guidance has since changed, as it is estimated that over 40% of people who have the virus are pre-symptomatic or asymptomatic spreaders and are likely unaware of their infectious potential.3, 4 Others refuse to wear a mask for political reasons, seeing it as a symbolic statement. Republicans are less likely to wear masks than Democrats, with less than 50% of Republicans wearing masks compared with over 75% of Democrats. For some, mask-wearing can be viewed as a sign of weakness and
Received July 27, 2020 Accepted October 15, 2020
shame, particularly for men. Sixty-seven percent of women reported that they wore masks outside compared to just 56% of men.1 Others may actually choose to not wear a mask as a form of self-preservation. Some Black people have expressed fear of being arrested and targeted by police for wearing masks, leaving them with the difficult choice of deciding which danger is greater—an increased risk of infected or being a target for police.5, 6 Despite people’s reasons for not wearing a mask, doing so significantly reduces the risk of infection and transmission of SARS-CoV-2. A recent review found that the chance of infection when wearing a mask was 3% compared to 17% without a mask, a reduction of 85%.7 Patients who refuse to wear a
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