Case Study on "Ethical Solutions to Implementing Quarantine"

r />

The overall issue of quarantining is a challenging one as large-scale quarantines have not been effected in the U.S., though smaller ones have (Barbera, Macintyre, Gostin, Inglesby, O'Toole, DeAtley, Tonat, Layton, 2001). Many concerns such as logistics and implementation would need to be considered and there are ethical issues here as well. The main approach to this situation that would solve the issue, as far as ethics are concerned is transparency and the duty to care. These are the big factors in deciding a utilitarian/libertarian ethical approach, which is the balance that should be attempted, as has already been put forward previously. Unintended consequences can arise from large-scale quarantines and the primary duty to care does not stop at treating those affected by the spread of influenza; it should also extend to those unintended and unforeseen consequences, as this is part of what it means to be ethically responsible for one's actions and purposeful in one's decisions to implement a plan that is oriented within an ethical framework.

Cetron and Landwirth (2005) note that the bulk of the responsibility "for public health matters within their borders rests with state and local governments" (p. 327). However, in the matter of pandemic influenza, it would be necessary for state and local governments to coordinate with federal officials and agencies in the matter, as was seen in the aftermath of Hurricane Katrina. This would mean effecting communications and efficient centers of control, with clear management in place to guide the implementation of plans.

The Model State Emergency Health Powers Act was recently passed in order to facilitate cooperation between states in case of such a pandemic as the influenza case in question. It alludes to the types of ethical, professional and legal responsibilities that public health authorities should be aware of. Likewise, the Public Health Service Act special authority to the Centers for Disease Control and Prevention, which may "detain, medically examine, or conditionally release individuals reasonably believed to be carrying a communicable disease" (Cetron, Landwirth, 2005, p. 327). It is important to be aware of Acts such as these so that the proper ethical approach can be considered when it comes time to develop an adequate solution.

In any case, it is important to keep in balance the two ethical approaches promoted in this study: the libertarian approach that supports individual rights and the utilitarian approach that supports measures that will ensure the common good. In some cases, these two approaches can be at odds with one another (as in the case of mandating vaccinations). In such cases, if it is unknown whether the outcome will be truly beneficial, it is best to adopt only the libertarian approach so as to ensure that at the very least the individual rights of persons are respected.

Regarding the question of quarantining, the issue is just as complex for, according to the Principles of the Ethical Practice of Public Health put forward by the Public Health Leadership Society, "community health shoud be achieved in a way that respects the rights of individuals and the community" (Cetron, Landwirth, 2005, p. 328).

As is noted, such a "potential dichotomy" can be problematic, but it does not necessarily have to be (Cetron, Landwirth, 2005, p. 328). One way in which a resolution or solution to this problem can be attained is by way of an educative process in which the public is educated about the benefits of quarantining and in which assurances are made regarding privacy, equity, social stigma, and care. It is important in this process to be as educative as possible because, unlike with the issue of vaccinations, there is no substantial evidence to consider quarantining as potentially hazardous to one's health, although this may be objected to by citizens who are otherwise healthy who do not want to be stuck in a quarantined zone out of fear of infection. This is an understandable fear and this where education comes into play. The public's fears will most likely be aggravated by media hysteria (which is why controlling the media can also be an issue that must be addressed). At the same time, it must be understand that quarantines cannot, by law, be effected without clear scientific cause. Therefore, if quarantine is put in place, there is good reason for it, and civilians should be made to understand this through a public education process. That is the first step towards providing an ethical solution to the issue.

A second step is coordination of communications. One of the main problems to hit New Orleans post-Katrina was the lack of coordinative communication between agencies. Ethically speaking, this was not a good policy of conduct on the part of the overall structure in place. For quarantining officials and public health authorities, communication between states and among local, state and federal agencies is essential and must come with the territory. This means that the three levels of government must be clear on which agency is in charge of what operations in which places.

Finally the banning of public outings and the ordering of employees to stay at home from work during the pandemic may become necessary for the public safety. This is, again, in the interest of the common good and follows in the guidelines of the utilitarian. Yet, at the same time, the economic impact of banning public outings and employees from going to work could be severe. This would not be good for the public good's economic health. Therefore, a balance must be sought and the risk of both types of health -- physical vs. economic -- weighed. If it is believed that the economic devastation could be worse than the physical devastation, there can be no reason, according to utilitarian grounds for promoting such a ban.

In order to solve this issue, the ethical approach to fall back on therefore becomes the libertarian principle. When the effect is uncertain or the action's consequences unclear, it must be admitted that the most ethical course of action is to allow the individual to decide what is best for him or herself. With this in mind, it should be considered that the banning of public outings and employees from going to work be avoided, as its beneficial effect is indeterminable, especially considering that quarantine zones is an alternative. The libertarian ethical approach in this case, would allow individuals to assess for themselves the risk of going out in public or of going to work. Indeed, adding extra laws to situations can sometimes lead to a level of social unrest that would be less than effective to the overall aim.

Conclusion

In conclusion, pandemic influenza is a situation that will require specific attention from various agencies on multiple levels. A proper ethical approach is needed to address these issues. As there are a number of ethical approaches, determining the right one becomes part of the solution. The best approaches are those that are utilitarian or libertarian in principle -- that is either they support the common good or they support the individual rights and liberties of persons. In some cases, the two approaches can be used to work… READ MORE