Free at any cost?
To protect public health, individuals’ freedoms may be restricted
Health is usually a private matter. But infectious diseases also have consequences for others, who may become infected because of our actions.
People have been prosecuted for deliberately infecting others with HIV, but should we go further? Should people have to take more responsibility for ensuring they do not pass on illnesses? And how far should the state go in limiting individual freedoms to protect public health?
Bringing an outbreak under control requires public trust and cooperation. The degree to which individual liberty must be sacriﬁced in order to protect the public from harm depends on the nature of the threat. During the outbreak of SARS, for instance, thousands of people had to be forcibly quarantined. In October 2014 a US nurse faced threats of legal action when she left her house for a bike ride after returning from treating Ebola patients in Sierra Leone. Meanwhile, North Korea was reported to be quarantining anyone moving in or out of the country.
Cuba has a rate of HIV infection that is one-sixth of that of the USA, but only because of its drastic approach to dealing with the disease – until the early 1990s all HIV-positive people were placed in quarantine. Other factors such as frequent testing and the availability of free condoms contribute to Cuba’s low rate of infection.
In tuberculosis (TB) the risk to the public arises from patients who stop treatment. A ‘short course’ of treatment lasts six months. In the standard protocol (DOTS, directly observed therapy short course) someone has to watch the person being treated swallow the required pills. In many countries, therefore, non-compliant patients can be jailed until they have completed treatment.
A particularly drastic case was that of cook Mary Mallon, ‘Typhoid Mary’, the ﬁrst person to be identiﬁed as a ‘healthy carrier’ of the bacterium that causes typhoid fever. She refused to believe that she was infecting others, but is thought to have passed the disease on to 51 people. The authorities in New York eventually sent her against her will to live in isolation on an island for three years.
She was ‘freed’ in 1910 on the condition that she never again work as a cook – typhoid is very contagious and can be spread through contaminated food. But Mary, who never believed the science, soon deﬁed the court’s order. When she was caught she was sent back to the island, where she spent the last 23 years of her life in quarantine.Lead image:
David Nash/Flickr CC BY NC ND
- Health Canada: Learning from SARS
- BBC: Ebola outbreak – nurse Kaci Hickox defies quarantine
- Guardian: Stop calling me ‘the Ebola nurse’
- New York Times: North Korea said to impose Ebola quarantine on all travelers
- New York Times: A regime’s tight grip on AIDS
- Directly observed therapy (DOT) for the treatment of tuberculosis
- TIME: Refusing quarantine – why Typhoid Mary did it