Bioethics & Quarantines
Public Health vs. Personal Liberty
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When an outbreak of a deadly, communicable disease threatens to overwhelm public health services, one of the tools available to government officials is a quarantine: segregating the afflicted or even possibly affected people, restricting their movements, and preventing them from having contact with healthy people in order to limit the continuing spread of the disease. Obviously this involves a serious infringement on a number of basic civil liberties - but is it justified? And, if so, when and how?
Whenever we are faced with the question of balancing civil liberties against public safety, the first question we must ask is whether any such balance is in fact necessary. Sometimes calls for restrictions on people's liberties are made in the name of public safety even when there is scarcely a credible threat, if any. Where there is little or no threat, there seems to be little or no reason for the government to limit people's freedoms.
In the case of deadly communicable diseases, such a threat can indeed exist. The degree of danger is dependent upon issues like how easy it is for the disease to move from one person to another, how quickly it can be detected in a person, and how treatable it is once it has been detected. The first question, how easily and quickly the disease spreads, is the one which factors most highly in the decision to quarantine people.
This leads us to the second question that must be addressed whenever we are asked to balance civil liberties and public safety: will giving up these particular liberties really lead to an improvement in safety and security? The more freedoms we are asked to limit or give up, the greater the return must be in order for our sacrifice to be justified. After all, it doesn't really matter how great the danger is if the liberties we are asked to give up will not actually improve our situation.
When it comes to easily communicable diseases, it is certainly true that restricting the movement of people who are infected or who are likely infected should have a good chance at slowing down the disease's spread. On the other hand, a quarantine has to be widespread if it is to be effective; if too many infected people are loose, then even the quarantining of thousands will have little impact.
It sounds as though quarantines of people who are probably infected with a highly communicable and deadly disease meet the basic standards for being a reasonable restriction on civil liberties. They address a genuine threat to public safety, and if done right, they are an effective means of addressing the danger. So what's the problem?
As with any government power, this is one which can be easily abused - a real problem when we are talking about the power to limit people's freedoms. There are a wide variety of public health laws that give government sweeping powers to impose quarantines on populations exposed to deadly diseases and to isolate people thought to be infected. There are also powers to impose vaccinations and treatment on people, regardless of any religious or other objections they might have.
In these circumstances, the powers are administered by flawed humans - and these humans can be misled by misperception, prejudice, personal opinions, and personal gain. Those who have suffered the most, quite naturally, tend to come from the poorest groups and various minorities. In the early 1900s, Chinese immigrants were quarantined en masse during plague scares. Mary Mallon, an Irishwoman better known as Typhoid Mary, was isolated for decades in New York because she carried typhoid. Patients in tuberculosis sanitariums have been put in isolation not simply for reasons of public health but also as a means of enforcing discipline.
Quarantines have a tendency to stigmatize those with the disease as being dirty or immoral in some fashion, especially when they are not used fairly because the government targets poor groups over the middle or upper classes. As a result, many may not seek treatment for symptoms, whether out of a desire to escape isolation or out of a desire not to be stigmatized as well. Even people in the targeted populations may become stigmatized, despite being disease-free.
Consider the relationship this issue has with AIDS. That disease is communicable and deadly, so should all of those who have it be quarantined? Should all of those who are at risk of getting it be required to report for regular blood tests, to reveal their personal activities, and to give the names of those they have been in contact with if that contact might result in the transmission of the AIDS virus? That is exactly what many members of the Religious Right have wanted to see happen - and overly broad public health laws that allow for draconian quarantine measures to battle biological terrorism could end up being used as a weapon against AIDS and gays, just as such laws were used against minorities in other eras.
This leads us to the important question of just how the authority and power to enact coercive quarantines be should delegated. Should the executive branch be given broad powers to enforce directives for the purpose of quarantining citizens without legislative or judicial overview? Under what circumstances might doctors be permitted to refuse to break patient-doctor confidentiality? What minimum standards should be in place before a quarantine can be required - how many infections and how serious of a disease? These and other issues absolutely have to be spelled out in any proposed laws, otherwise we run the risk of handing over dictatorial powers to the government.
The dangers of quarantines are clear: not only do they create a massive infringement upon people's civil liberties, but they have a strong tendency to be applied unfairly and to cause suspicion and prejudice among those outside the quarantine. Although quarantines do have significant possible benefits, those benefits are only likely to occur if the quarantines are created quickly, encompass many individuals, and have a very, very low rate of failure (i.e., people who should be included but, for whatever reason, are not).
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