Dr. Birx is struggling with a nearly impossible choice

Life in a pandemic is filled with ethical and moral dilemmas for everyone. We have to weigh the cost to ourselves and others of decisions that barely merited a second thought in pre-pandemic life. But few people have had to wrestle with their conscience in full view of the world the way the government’s top scientists do these days.

Standing at the White House podium next to their boss, President Donald Trump , now-familiar figures — including Dr. Deborah Birx, Dr. Anthony Fauci and others — face ethical predicaments that may keep medical ethicists, philosophers and theologians debating for years to come.

Government scientists have to decide how to preserve their integrity while working for a president that tells lies; they have to keep their dignity while working for a president that demands unwarranted praise; and they have to keep their jobs without becoming accomplices of a president whose reckless advice can lead to more loss of life.

What should these scientists do when Trump tells tens of millions of Americans to do something that they know will harm them? Should they correct him immediately, risking his rage and perhaps bring an end to their careers? Or should they keep quiet and hope they can find another moment to correct him, calculating that staying in Trump’s good graces will allow them to do their jobs — perhaps saving even more lives than might be lost by allowing the bizarre presidential advice to filter into the community?

For now, Birx, the White House coronavirus response coordinator, and Fauci, the nation’s top infectious disease specialist, have chosen the latter. But it’s not completely clear that they, particularly Birx, have managed to thread the needle successfully.

Fauci has been more willing to openly correct the president, even if we sometimes wish he’d done it more quickly. “I can’t jump in front of the microphone and push him down,” he explained in an interview with Science Magazine. He now needs special security to protect him from some of Trump’s most passionate defenders.

Birx has struggled visibly with her all-but-impossible dilemma.

We saw it during and after that immortal briefing on Thursday, when she sat against the wall of the briefing room, as Trump suggested that disinfectant, “injection inside,” or perhaps ultraviolet light inside the body, might cure Covid-19.The close-up of her reaction, shifting in her seat; tightening her facial muscles and staring into the floor, went viral (in the old, pre-Corona sense of the word.)

Now rumored to be in the running to replace Health and Human Services Secretary Alex Azar, Birx has become something of a Trump whisperer. But at what cost?

In addition to a respected scientist, she is also a diplomat, and diplomacy often requires praise through clenched teeth. On Sunday, Birx defended Trump’s irresponsible televised musings that ingesting disinfectant could kill the virus. Trump’s words triggered urgent warnings from the makers of Lysol and Clorox not to drink or inject their product, it also sent much of the world into gales of laughter, a shameful moment for the United States.

More importantly, it prompted many people to take the president seriously. Who knows how many desperate relatives of the sick thought maybe Trump found his desperately sought magic bullet. Maryland Gov. Larry Hogan said hundreds of people in his state called to ask about injecting or ingesting disinfectants.

In the midst of the uproar, Trump claimed — in a transparent lie — that he was being sarcastic when he brought it up. His new press secretary, Kayleigh McEnany, blamed the media for taking him out of context.

Birx offered a third defense, telling CNN’s Jake Tapper that Trump was having, “a dialogue” about the subject, as if it had been a perfectly normal discussion, adding that Trump “understood” when she told him it was not a treatment. In fact, it’s doubtful Trump understood, because he persevered, “I think it’s a great thing to look at. I mean, you know. Okay”

Birx has done a superb job in the US-led global campaign against HIV-AIDS. Making her the pandemic point person is one of the best moves by the administration. But her efforts to please Trump have cut into her dignity and credibility.

It was excruciating to watch clips of her disturbing interview with the Christian Broadcasting Network last month, after the president had spent weeks downplaying the pandemic and ignoring the experts. Birx gushed that Trump has “been so attentive to the scientific literature,” praising Trump’s, “ability to analyze and integrate data.”

By then, Trump was busy proving exactly the opposite, promoting the use of hydroxychloroquine as “very, very promising,” even as Fauci tried to warn against it. The research now indicates that following Trump’s prescription, as tens of thousands apparently did,can lead to potentially fatal cardiac problems.

Birx surely knew that what she was telling CBN was false. Perhaps she was calculating that this was the price she must pay to gain the trust of a president for whom no currency is more valuable than lavish praise. Perhaps Birx decided that she would surrender a bit of her integrity to secure a position that would allow her to steer the country’s coronavirus battle and ultimately save lives.

If so, she sold a piece of her soul to do so. Was the transaction ethically justified? Was it morally correct?

Those are questions that have no conclusive answer.

Birx has a habit of nodding, presumably approvingly, when the president speaks. Some people have told me they find that indefensible. They wonder if Birx is a Trumpist, a true believer. None of us knows what’s in her heart, other than what her history tells us. She has a distinguished and honorable record of fighting disease around the world. Whatever compromises she’s making now, we should respect that she has followed her calling throughout her professional life.

Her latest challenge is an immense one, not just because the coronavirus is a tough foe, but because fighting it in the shadow of a self-serving, pernicious boss creates new wrenching moral dilemmas.

If she gets the top HHS job let’s hope she will strengthen her courage and call out the president quickly when that is needed. She owes that to the American people.