Conclusion: The Debate Continues
Given the ethical and logistical complexities surrounding quarantine—of which this presentation has explored only a few—when and how should it be used? The answer to this question lies at the intersection of medicine, public-health policy, and law. Good science is the first requirement in determining the course of treatment for a contagious disease; quarantine oftentimes may not be the best method to contain an outbreak. However, if it is determined that quarantine is the best course of action to take, it is essential that civil liberties are not limited unnecessarily.
The implementation of quarantine must be informed by the social and political context. In the United States the cultural emphasis on civil liberties may make implementing quarantine more difficult than in China. As Roy M. Anderson, an epidemiologist at Imperial College London, points out in reference to China's quarantine during the SARS epidemic:
It would have been very difficult to do the same in North America or Europe. You have to convince people that death is right around the corner before you limit their civil liberties. Otherwise, you end up with court cases.
Although the federal government does have the power to quarantine, that action is usually left up to local and state authorities. State laws are inconsistent and often obsolete due to the varying conditions of their historical development. These shortcomings could be crippling in the event of an epidemic, whether naturally occurring or resulting from a bioterrorist attack.
To address this issue, the Centers for Disease Control and Prevention (CDC) asked the Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities to prepare model legislation on public-health emergencies to be adapted and adopted by states. The result, the Model State Emergency Health Powers Act, puts five public-health functions into law:
- preparedness, comprehensive planning for a public health emergency;
- surveillance, measures to detect and track public health emergencies;
- management of property, ensuring adequate availability of vaccines, pharmaceuticals, and hospitals, as well as providing power to abate hazards to the public's health;
- protection of persons, powers to compel vaccination, testing, treatment, isolation, and quarantine when clearly necessary; and
- communication, providing clear and authoritative information to the public.
The act addresses the protection of civil liberties in several ways. It provides legal safeguards for the quarantined as well as requiring provisions for their physical and cultural needs. According to one article defending the act:
Officials must follow specified legal standards before using isolation or quarantine, which are authorized only to prevent the transmission of contagious disease to others and must be by the least restrictive means possible. . . . Orders for isolation or quarantine are subject to judicial review, under strict time guidelines, and with appointed counsel.
However, the act has also drawn fire from civil liberties advocates who assert that it gives officials too much power.
Poll
After considering the ethical and legal complications of quarantine, would you change your mind about whether to implement quarantine?
