Baltimore figures in the book as a place where the ethics of disaster medicine were not left solely to hospital experts. In a city marked by low public trust in medicine and a history of discrimination, residents took part in discussions about how scarce medical resources should be allocated—bringing the practical stakes of triage into a community setting.

A City Shaped by Unequal Medical Trust

The deliberations took place in the shadow of Johns Hopkins Hospital, whose pandemic planning exposed a stark mismatch between the supplies available and the needs anticipated. The hospital stood beside a low-income neighborhood where trust in medicine was already poor, shaped in part by ethically questionable research and historical discrimination. That context made decisions about who might be denied intensive care more than a technical exercise: the legitimacy of such decisions depended in part on who helped shape them.

Community Deliberation at Zion Baptist Church

One session met in the basement of Zion Baptist Church, in a Baltimore neighborhood of boarded-up row houses. Participants considered whether age should serve as the primary basis for allocating medical resources during a disaster. A young man objected to a system that might give him a ventilator while denying one to a twelve-year-old or a four-year-old. A mother responded from the standpoint of her own responsibilities, resisting the idea that younger people should automatically take precedence over her.

The exchange showed the difficult personal judgments behind an apparently simple allocation rule. Participants were not merely asked to endorse a plan already devised elsewhere; they were invited to weigh competing claims and explain what mattered to them.

Baltimore’s Role in the Experiment

Baltimore was one of several settings for a Maryland effort to involve ordinary residents in pandemic planning. The sessions were held across the state over two years, and the book contrasts the church basement with a wellness center in wealthy Howard County. In both kinds of places, participants were able to engage with complex ethical questions that some officials had assumed belonged only to specialists.

The Baltimore discussion therefore connects public participation to the conditions under which medical authority is trusted. Where historical discrimination had damaged confidence in medicine, inviting community members into deliberation offered a way to confront allocation choices openly rather than treat them as decisions for professionals alone.