Forced quarantine for medical conditions.

[Metaphor]

This was an idea discussed on 'The Philosopopher's Zone' podcast recently. To what extent should someone have an obligation to not infect others with communicable diseases? In particular, at what point can we justify confining someone who refuses treatment and/or is highly contagious? The particular issue discussed on the podcast was Extreme Drug Resistant Tuberculosis. Tuberculosis kills about the same number of people each year as AIDS does, but is an airborne virus.

Now obviously DELIBERATELY infecting someone with a disease seems cut and dried, but what obligation do you have to wider society to take preventative steps for accidental infection? Can there be a risk to public health great enough to justify forced quarantine?

[Sabine Grant]

This was an idea discussed on 'The Philosopopher's Zone' podcast recently. To what extent should someone have an obligation to not infect others with communicable diseases? In particular, at what point can we justify confining someone who refuses treatment and/or is highly contagious? The particular issue discussed on the podcast was Extreme Drug Resistant Tuberculosis. Tuberculosis kills about the same number of people each year as AIDS does, but is an airborne virus.

Now obviously DELIBERATELY infecting someone with a disease seems cut and dried, but what obligation do you have to wider society to take preventative steps for accidental infection? Can there be a risk to public health great enough to justify forced quarantine? IMO, yes there is. Especially considering the domino effect which results from a carrier of active TB who would contaminate so many other individuals who in turn will contaminate so many others and so on.

Right there, it is enough justification IMO to isolate the identified carrier and apply treatments. Identification of carriers remains a primary tool for the CDC to prevent a pandemic.

If you look at the causes of resurgence of TB cases in some sub saharian nations such as Ivory Coast, one of them is the great difficulties for their Public Health Services to locate carriers. Because so many members of their population live in rural areas and will never consult a doctor. Another detection factor being individuals seeking health care and whose symptoms will be identified as induced by TB.

However, the alternative exists to vaccinate the population (BCG). Such as it is in country of origin.

[Loren Pechtel]

I have no problem whatsoever with locking up those who take undue risks of spreading serious disease.

Anyone who doesn't should be opposed to all DUI laws also.

[fast]

Right there, it is enough justification IMO to isolate the identified carrier and apply treatments.

Suppose you have sufficient justification to isolate the infected such that the infected could no longer infect others. Why should we leap to the other conclusion that we are justified in applying treatments, especially if they should happen to be unwanted?

It's one thing to protect others, but it's a far different thing to treat someone unwilling to be treated.

[Sabine Grant]

Right there, it is enough justification IMO to isolate the identified carrier and apply treatments.

Suppose you have sufficient justification to isolate the infected such that the infected could no longer infect others. Why should we leap to the other conclusion that we are justified in applying treatments, especially if they should happen to be unwanted?

It's one thing to protect others, but it's a far different thing to treat someone unwilling to be treated. I am not sure anyone affected with active TB would be that uneducated to refuse treatment since as long as they are active, they are also highly contagious. Under the Patient's Bill of Rights, they certainly can refuse any treatment. However, they cannot complain if kept in quarantine for an unlimited amount of time for as long as they refuse treatment.

Such person presents a hazard to public health. An unlimited time quarantine would be justified as he/she refuses treatment. You are certainly not suggesting that they be released with active TB because they refuse treatment?

[javarush]

Quarantine and treatment are separate issues. Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision. Whether or not to accept treatment generally falls in the domain of personal autonomy.

[fast]

Quarantine and treatment are separate issues.
Nicely said. I'd like to echo those comments in regards to legal rights and moral rights.

Notice that Sabine Grant said, "Under the Patient's Bill of Rights, they certainly can refuse any treatment." Clearly, an infected one has the legal right to refuse treatment. Good information!

You said, "Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision." Clearly, an infected one may be legally quarantined. Good information!

We ought not, however, draw moral conclusions from legal truths. I'm not suggesting anyone has done that. I just want to be doubly clear on that issue.

[javarush]

Another point should be made here: Personal autonomy is not absolute. There is the question of "competency" which usually is framed in terms of age and mental status. "Mental status" can be especially tricky as it invariably includes impairment caused by drugs, pain, duress from illness or situation, etc. If there is a consensus (guidelines vary but a psychiatric consultation is common) that a person is "not himself" -- e.g. wishing to forego reasonable treatment and risk death when there is no evidence that that type of thinking was ever previously expressed -- then the decision to treat can be determined by recognized kin, legal guardians, state agencies, or authorized medical personnel.

[fast]

Another point should be made here: Personal autonomy is not absolute. There is the question of "competency" which usually is framed in terms of age and mental status. "Mental status" can be especially tricky as it invariably includes impairment caused by drugs, pain, duress from illness or situation, etc. If there is a consensus (guidelines vary but a psychiatric consultation is common) that a person is "not himself" -- e.g. wishing to forego reasonable treatment and risk death when there is no evidence that that type of thinking was ever previously expressed -- then the decision to treat can be determined by recognized kin, legal guardians, state agencies, or authorized medical personnel.
Good point.

And, let's not unwittingly fall into the trap whereby we judge all who refuse treatment as therefore being incompetent (or uneducated as put by another).

[credoconsolans]

Quarantine and treatment are separate issues. Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision. Whether or not to accept treatment generally falls in the domain of personal autonomy.

Well said. I agree.

[javarush]

...
And, let's not unwittingly fall into the trap whereby we judge all who refuse treatment as therefore being incompetent (or uneducated as put by another).


Yes, pre-existing beliefs don't usually strike against competency. The standard example is Jehovah's Witnesses. As for recognized psychiatric conditions (DSM-IV), beliefs held while in compliance to prescribed treatments will typically be respected.

[fast]

Well said. I agree.

Let's review what he said and see if we can expound upon it a bit:

Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision.

What we have here is an argument. There's 1) a hidden premise, 2) a premise, and 3) a conclusion:

1. Public health/safety issues justify individual freedom restrictions ....
2. Quarantine is a public health/safety issue.
Therefore, 3. Individual freedoms may be restricted ....

"may" is ambiguous as we cannot tell whether or not "may" means legally may or morally may. I have my doubts as to whether or not morally may is the intended meaning, as I am unable to find the moral connection between moral ought and legislative decision.

After giving him the benefit of the doubt, and after shopping off part of the conclusion (hence, without the “according to rules set by legislative decision” tag on), we still have the issue with the first premise—even if we suppose that it’s a moral justification and not a legal one.

For example, we may take it for granted that the townspeople’s safety remains in jeopardy even if the infected Grizzly Adams promises to remain in the secluded woods, since the risk is always present that Mr. Adams may not live up to his word; however, that we take it for granted (or even if it truly is a risk), we have not therefore provided a sufficient justification for Mr. Adams “not to complain—as another said.”

Of course, this is where (I suppose) when we start bringing in the dreaded word, “reasonable,” which often equates to “reasonable to the majority”.

[Sabine Grant]

Another point should be made here: Personal autonomy is not absolute. There is the question of "competency" which usually is framed in terms of age and mental status. "Mental status" can be especially tricky as it invariably includes impairment caused by drugs, pain, duress from illness or situation, etc. If there is a consensus (guidelines vary but a psychiatric consultation is common) that a person is "not himself" -- e.g. wishing to forego reasonable treatment and risk death when there is no evidence that that type of thinking was ever previously expressed -- then the decision to treat can be determined by recognized kin, legal guardians, state agencies, or authorized medical personnel.
Good point.

And, let's not unwittingly fall into the trap whereby we judge all who refuse treatment as therefore being incompetent (or uneducated as put by another).

My comment of "uneducated" was to point to the reality that one would have to be uninformed as to the fatal consequences of having active TB if not treated. I am wondering how many such patients you expect would in fact decline treatment for the specific active TB?

I tend to dwell on reality centered facts, meaning that the incidence of active TB patients who refuse treatment must be extremely rare. Unless they are uneducated or uninformed as to the consequences of not treating their condition.

[Sabine Grant]

Quarantine and treatment are separate issues.
Nicely said. I'd like to echo those comments in regards to legal rights and moral rights.

Notice that Sabine Grant said, "Under the Patient's Bill of Rights, they certainly can refuse any treatment." Clearly, an infected one has the legal right to refuse treatment. Good information!

You said, "Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision." Clearly, an infected one may be legally quarantined. Good information!

We ought not, however, draw moral conclusions from legal truths. I'm not suggesting anyone has done that. I just want to be doubly clear on that issue. The Patient's Bill of Rights was designed to acknowledge the person's exclusive right over his/her own bodily integrity. Medical procedures and treatments remain potentially intrusive measures to such bodily integrity. Thus such legal document places the right to exercise medical decisions with the person identified as the patient. If mental incompetency has been established, such document becomes enacted by the next of kin or court appointed medical custodian (or designated in a medical power of attorney).

IMO all precautions have been taken to preserve the bodily integrity of the patient as well as the exercise of his/her individual freedom to make decisions according to the legal definition of mental competency (meaning the capacity to formulate and communicate an informed consent or rejection of the proposed therapies/procedures).

Quarantine does not fall under the protective intent of the Patient's Bill Of Rights nor is quarantine by itself a medical procedure or treatment. It is a measure of isolation of individuals susceptible to contaminate other parties with a contagious disease. It is a preventative measure. And of course, only certain ailments qualify as necessitating such measure of quarantine. Generally airborne (though active TB does not qualify as specifically airborne, droplets resulting from sneezing, coughing, etc...present a favorable vector for contamination especially in closed in spaces. Thus the CDC alert mode which resulted from a passenger on an airplane who was an active TB carrier).

Reasonably, all the passengers on that plane could have been placed on quarantine until tests came back showing a negative for TB. The problem though with TB is that one may not develop anti bodies (which would show a positive) for several months. Resulting in "false negatives" when the person has in fact been exposed and is susceptible to become contagious with active TB a few months down the line.

IMO without going to such extremes (quarantine) for potentially exposed passengers, a mandatory X ray every 6 months for a period of two years.

[Sabine Grant]

Well said. I agree.

Let's review what he said and see if we can expound upon it a bit:

Quarantine is a public health/safety issue and therefore individual freedoms may be restricted according to rules set by legislative decision.

What we have here is an argument. There's 1) a hidden premise, 2) a premise, and 3) a conclusion:

1. Public health/safety issues justify individual freedom restrictions ....
2. Quarantine is a public health/safety issue.
Therefore, 3. Individual freedoms may be restricted ....

"may" is ambiguous as we cannot tell whether or not "may" means legally may or morally may. I have my doubts as to whether or not morally may is the intended meaning, as I am unable to find the moral connection between moral ought and legislative decision.

After giving him the benefit of the doubt, and after shopping off part of the conclusion (hence, without the “according to rules set by legislative decision” tag on), we still have the issue with the first premise—even if we suppose that it’s a moral justification and not a legal one.

For example, we may take it for granted that the townspeople’s safety remains in jeopardy even if the infected Grizzly Adams promises to remain in the secluded woods, since the risk is always present that Mr. Adams may not live up to his word; however, that we take it for granted (or even if it truly is a risk), we have not therefore provided a sufficient justification for Mr. Adams “not to complain—as another said.”

Of course, this is where (I suppose) when we start bringing in the dreaded word, “reasonable,” which often equates to “reasonable to the majority”. In your illustration, your subject Grizzly Adams is the carrier of an infectious disease. That determination would have to rely on health care professionals providing evidence that your subject presents a health hazard to any other party he would come in contact with. Which is the process that takes place to establish that fact. Meaning, it relies on existing realities and does not imply any moral deliberations from the "majority" and subjective thoughts on their part.

When the CDC issues a heath alert triggering an identification/tracking process of persons susceptible to be contagious, the CDC is applying a measure of emergency not a measure based on popular consensus. Once those persons have been identified, quarantine measures are ordered. I fail to see any ethical factor here as part of the overall CDC intervention. And I do not think they should concern themselves whether there is a "majority" of lay persons approving or disapproving of their intervention and resulting preventative measures to disable the dynamics we find in any potential pandemic or epidemic.

In that sense I consider it reasonable for the CDC to order such measures as their intervention relies on existing evidence that if they did not, it would greatly impair any other measures of contagious diseases control. I can provide data if necessary as to which measures have revealed themselves efficient and necessary to defeat various potential pandemics.

[fast]

Sabine Grant,

You appear knowledgeable about the subject matter. I'll give you a thumbs-up for that, and to be honest, I don't believe our views are all that dissimilar.

We look to the law for our legal justifications, and that makes sense, but if I didn't know any better, I'd think that you also look for the presence of legal justification as a signal that you have a moral justification for the things you are legally justified in doing.

Facetiously I ask, why in the world would you think it necessary to quarantine the infected from those who are not? Now, don't respond by asking me a rhetorical question about what I think. I'm sure we all think it's reasonable, but our underlying reasoning’s do not therefore match. I would do it for moral reasons whereas you seem to indicate by your writings that your reasonable actions are more so a function of legal mandate.

Of course, I don't mean to truly imply what it seems that I am. I just want you to see that belaboring on our legal duties detract from that which makes something morally obligatory.

[Sabine Grant]

Sabine Grant,

You appear knowledgeable about the subject matter. I'll give you a thumbs-up for that, and to be honest, I don't believe our views are all that dissimilar.

We look to the law for our legal justifications, and that makes sense, but if I didn't know any better, I'd think that you also look for the presence of legal justification as a signal that you have a moral justification for the things you are legally justified in doing.

Facetiously I ask, why in the world would you think it necessary to quarantine the infected from those who are not? Now, don't respond by asking me a rhetorical question about what I think. I'm sure we all think it's reasonable, but our underlying reasoning’s do not therefore match. I would do it for moral reasons whereas you seem to indicate by your writings that your reasonable actions are more so a function of legal mandate.

Of course, I don't mean to truly imply what it seems that I am. I just want you to see that belaboring on our legal duties detract from that which makes something morally obligatory. Public health hazard implies (to me at least) a matter of collective conscience and a sense of social responsibility towards our fellow human beings. Somehow it reaches back to the Golden Rule (which is my moral compass) to where I would not do anything to jeopardize the health of my fellow human beings. From a personal angle, were I infected with a contagious illness, I would willingly quarantine myself.

And I in fact do, Fast. I work in the nursing field and if I have the flu, even if capable of working, I will not expose my patients and co nurses to it. I would evaluate my dismissing the potential to infect my patients and co workers as a lack of consideration and respect for their health and welfare (especially our patients). You see what I mean?

[Illusio]

Tuberculosis kills about the same number of people each year as AIDS does, but is an airborne virus.


Although I might be pointing out the obvious... even with the elaborate infection methods of AIDS - it's pretty clear that the non-containment policy has been an utter failure, with consequences far outstripping the value of the rights of the original infected person/group, no?(I'm of course talking about the value society considers it to have that those people were allowed to wander around. The infected might possibly think otherwise.)

According to http://en.wikipedia.org/wiki/AIDS
"AIDS is now a pandemic. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it killed an estimated 2.1 million people, including 330,000 children."

Those people are the ones you should ask if early containment was appropriate.


Now obviously DELIBERATELY infecting someone with a disease seems cut and dried, but what obligation do you have to wider society to take preventative steps for accidental infection? Can there be a risk to public health great enough to justify forced quarantine?

I my view, absolutely, and I have been a strong supporter of quarantine for AIDS victims as well, although the time where that was a viable solution may have passed in some areas of the world.
For untreatable airborne diseases, the question for me isn't if quarantine is an appropriate response, but to what extent one should isolate people who don't yet show any symptoms, but may have been in contact with a bearer.

I think it's a mistake to discuss what "obligation a bearer has" to prevent the spreading of deadly diseases. To what extent is the owner of a gun obliged to not kill people? Quarantine is a self protection measure that uninfected humanity enforces to contain a deadly/severely harmful threat. The bearers won't have a choice in the matter(Except for relatively diseases, where they are free to quarantine themselves.). Quarantine is simply either decided to be required or it is not.

In the end, quarantine is grounded in the right to protect one's own life. Sometimes this involves killing/containing other people who are a threat to you.

[fast]

Now we're getting somewhere! :)

Public health hazard implies (to me at least) a matter of collective conscience and a sense of social responsibility towards our fellow human beings. You take it for granted that we have a moral duty to protect others from harm. I applaud you. But, this is where I feel compelled to argue, but don't take that as a sign that I disagree with you, for I certainly don't.

Why argue? Well, it's like this. It's not enough that we do the right thing. We need to know why it's the right thing on the off chance that what we think is right is in fact wrong.

For example, let’s suppose the trustworthy yet distrusting Grizzly Adams was like you in that he too would be willing to be quarantined if infected with a contagious illness, but unlike you, he would rather his quarantine be back in his isolated shack away from others instead of a government facility that takes him out of his element.

Although you may have the legally imposed duty to quarantine him as the CDC dictates (and under the guise of being in the best interest of the public), but although you may have a moral duty to protect others from him, you do not have a moral duty to protect other from him as prescribed by the authoritative and subjective whims of others.

I’m not suggesting that we second-guess our legal duties. I’m suggesting we think carefully before declaring an action as morally justified just because it’s reasonable.

[whichphilosophy]

Another point should be made here: Personal autonomy is not absolute. There is the question of "competency" which usually is framed in terms of age and mental status. "Mental status" can be especially tricky as it invariably includes impairment caused by drugs, pain, duress from illness or situation, etc. If there is a consensus (guidelines vary but a psychiatric consultation is common) that a person is "not himself" -- e.g. wishing to forego reasonable treatment and risk death when there is no evidence that that type of thinking was ever previously expressed -- then the decision to treat can be determined by recognized kin, legal guardians, state agencies, or authorized medical personnel.

Mental status is tricky because there are no medical tests.

A known killer who the courts have previously convicted for more than one murder and is still a violent person, may be free once his sentence is served, unless there is definite evidence, he is very likely to kill someone else.

Yet a person who has never killed before or caused harm to themselves, may be incarcerated (but nowadays may appeal) if the practitioner deems he is a risk. The diagnosis is purely subjective, which based on behaviour is unreliable. Other than a subjective analysis from the practitioner, who sometimes takes evidence from others, rules of evidence do not apply.

As for physical illnesses, it is fair to quarantine people with a highly contagious disease. Here the individual is one issue but the rights of thousands of others prevail. Most quarantined people will accept this (especially if you pay their wages while away from work). It really depends on the severity of the illness.

[credoconsolans]

Now we're getting somewhere! :)

Public health hazard implies (to me at least) a matter of collective conscience and a sense of social responsibility towards our fellow human beings. You take it for granted that we have a moral duty to protect others from harm. I applaud you. But, this is where I feel compelled to argue, but don't take that as a sign that I disagree with you, for I certainly don't.

Why argue? Well, it's like this. It's not enough that we do the right thing. We need to know why it's the right thing on the off chance that what we think is right is in fact wrong.

For example, let’s suppose the trustworthy yet distrusting Grizzly Adams was like you in that he too would be willing to be quarantined if infected with a contagious illness, but unlike you, he would rather his quarantine be back in his isolated shack away from others instead of a government facility that takes him out of his element.

Although you may have the legally imposed duty to quarantine him as the CDC dictates (and under the guise of being in the best interest of the public), but although you may have a moral duty to protect others from him, you do not have a moral duty to protect other from him as prescribed by the authoritative and subjective whims of others.

I’m not suggesting that we second-guess our legal duties. I’m suggesting we think carefully before declaring an action as morally justified just because it’s reasonable.

So you're saying that a person with a deadly contagious disease could choose to quarantine himself in possibly the same area in which he was infected - hantavirus comes to mind - and thus can solely make the decision to stretch the resources of the medical community and possibly put at risk the safety of the medical staff by having to come to him with their quarantine equipment and protection rather than put himself in a controlled environment where he can be safely kept, treated and his health studied and monitored and needs met? Are you proposing that as a more reasonable alternative?

[1997]

Now obviously DELIBERATELY infecting someone with a disease seems cut and driedHang on. Who are we talking about?

[fast]

So you're saying that a person with a deadly contagious disease could choose to quarantine himself in possibly the same area in which he was infectedActually, that's not the scenario I had in mind.

Suppose Mr Adams is asked by a team of scientists to leave his isolated home for a short while to assist them in an area with unknown dangers. Subsequently, he is infected but instead of choosing treatment, he chooses to return to his isolated home.

Or, if you like, Suppose Mr. Adams is found in an isolated area and is uninfected. Scientists explore the area and unwittingly unearth dangers, which in turn infect Mr. Adams. They try to assist Mr. Adams but choose to do so by removing him from his home against his will.

Or, for a third idea, suppose Mr. Adams is already infected in an isolated area, but a group of unwelcome scientists who discover his infection have important business there. They take him elsewhere against his will to be quarantined for the safety of those who are unwelcome—because it’s cheaper than taking their important business elsewhere.

- hantavirus comes to mind - and thus can solely make the decision to stretch the resources of the medical community and possibly put at risk the safety of the medical staff by having to come to him with their quarantine equipment and protection rather than put himself in a controlled environment where he can be safely kept, treated and his health studied and monitored and needs met? First, let's not assume a blanket duty by the medical community to treat others in all situations. If Adams wants to be treated such that he's willing to succumb to the unalterable demands of those in authoritative power, then fine, take him away since it’s not against his will, but there's no reason for the medical community to take it upon itself a duty to help when there's undue risk due to his unwillingness to be taken to a supposedly safer and foreign controlled environment.

I'm not arguing that needless resources be spent, nor am I arguing that safety be jeopardized. I'm arguing against those in power to unjustly do as they please.

Are you proposing that as a more reasonable alternative?
I hope that which is moral trumps that which is reasonable.

[fast]

Now obviously DELIBERATELY infecting someone with a disease seems cut and driedHang on. Who are we talking about?

You so wrong for that. :D

[Sabine Grant]

Now we're getting somewhere! :)

Public health hazard implies (to me at least) a matter of collective conscience and a sense of social responsibility towards our fellow human beings. You take it for granted that we have a moral duty to protect others from harm. I applaud you. But, this is where I feel compelled to argue, but don't take that as a sign that I disagree with you, for I certainly don't.

Why argue? Well, it's like this. It's not enough that we do the right thing. We need to know why it's the right thing on the off chance that what we think is right is in fact wrong. I understand the concept. But I was speaking of the moral obligation for the infected person to avoid infecting others. It seems to me that as we exercise our individual freedoms, the choices of action we make have to take in account avoiding imposing undue harm on others. Obviously, the carrier of active TB does not have consent from the rest of the population to infect them. Realistically, I am not aware of folks who seek to get exposed and infected with active TB. Most of us experience a sense of self preservation which protects us from voluntary/involuntary exposure to contagious diseases. That all ties in with our instinct of survival so predominant in our species.

IMO you would have to demonstrate that the exercise of individual freedom, without reflecting on which harm it can impose on others, to be a moral right.

For example, let’s suppose the trustworthy yet distrusting Grizzly Adams was like you in that he too would be willing to be quarantined if infected with a contagious illness, but unlike you, he would rather his quarantine be back in his isolated shack away from others instead of a government facility that takes him out of his element. Again based on my relying on realistic facts, such scenario is highly improbable because Adams is bound to need human interaction at some point of time. Unless he volunteered to be shipped on a deserted island somewhere in the South Pacific, with ample resources to last him for several months. In such condition, Adams would present not even any minimal risk to infect any other human being. There would be no risk at all due to the void of any human beings in his environment.

But in your scenario, there is still a risk or potential for human interaction. Now, IMO, it would be an unreasonable expectation from such person to demand that tax payers support his being shipped to a deserted island in the South Pacific with the necessary resources to survive for several months. He/she would have to use his/her own financial resources to isolate himself/herself on such island and be self supportive. I also have to wonder about his/her vision of a plane crew having to wear full protective gear while flying him/her there. And the resulting disinfecting process of the entire plane.

And that entire very involved process would be somehow justified by someone complaining that it is morally wrong to place him/her under quarantine?

Although you may have the legally imposed duty to quarantine him as the CDC dictates (and under the guise of being in the best interest of the public), but although you may have a moral duty to protect others from him, you do not have a moral duty to protect other from him as prescribed by the authoritative and subjective whims of others. How is a medical diagnosis establishing that an individual is the carrier of a highly contagious disease which will undeniably infect other innocent and unwilling to be infected persons an authoritative and subject to the whims of others REALITY?

How would the refusal from other members of society to be exposed and contaminated by the carrier of active TB be a "whim" on their part? Is the will of other members of our society to pursue happiness to be considered a "whim" by anyone? Keeping in mind that their pursuit of happiness would be greatly jeopardized and impaired by the anti social response of any person who insists on exercising his/her freedom while neglecting to reflect on the undue harm he/she will cause and impose on his/her fellow human beings.

I’m not suggesting that we second-guess our legal duties. I’m suggesting we think carefully before declaring an action as morally justified just because it’s reasonable. When I use the word "reasonable" I mean that it was reflected upon, weighing pros and cons and the resulting choice of action was in fact not the product of a subjective whim.:) Which I hope I was able to demonstrate to you.

Of course one may attempt to find ethical positives in arguing that that we have no moral obligation to exercise our individual freedoms while reflecting on the potential for undue harm we may impose on others through our decisions. Which IMO, persons in our human societies who have detached themselves (emotionally) from the welfare of others have prompted some of the most horrific crimes against humanity. We, in fact, have identified them as sociopaths and further as psychopaths.

[Trout]

I've got not problem with walling off an infected area and letting people die if it's ultra serious and no treatment possible.'

Of course, if I were on the wrong side of the wall I'd also consider jumping it.

[premjan]

That's the story of Doomsday (http://www.imdb.com/title/tt0483607/).

[Sabine Grant]

I've got not problem with walling off an infected area and letting people die if it's ultra serious and no treatment possible.'

Of course, if I were on the wrong side of the wall I'd also consider jumping it. Such situation did occur during an Ebola outbreak on the African continent. The villagers were placed in total isolation and all died. Not because they were "left to die" but because there is no possible treatment and survival to Ebola. The medical staff attending (you can imagine, in full protective gear) the victims could only provide some degree of relief as to the experienced symptoms until death occurred. Needless to say that if they had not been placed under quarantine, there would have been devastating effects which could not have been controlled.

I have no doubt that such medical staff experienced grief as to not being able to remedy to such situation and save some of the victims. Ebola progresses so fast that it adds one more complication to attempting finding treatments which can delay its acute onset causing internal hemorrhaging.

To add the emotionally draining aspect for other people that the bodies of their loved ones could not "benefit" of a proper burial.

The "silver lining" of rapidly progressing with observable symptoms highly contagious diseases such as Ebola is that the possibility of an Ebola carrier getting on a plane and infecting so many other individuals is very low. That is why the CDC is not constantly monitoring possible Ebola outbreaks in the US. The virus would have to be imported by an infected person who somehow exhibits no signs of illness while boarding the plane. Considering that such symptoms develop within a couple of days and international airlines would not allow such passenger to board the plane. Which is not the case for TB to where it can remain asymptomatic for several weeks.

Florida is currently at higher risks for a TB outbreak because of the medically unsupervised inflow of immigrants from Haiti.(and also US residents visiting Haiti without a mandatory BCG vaccination). Which IMO should be required for any US resident bound to a destination where TB is rampant.

When we traveled with my family inbound to Africa from Europe we always had to have vaccinations against various tropical diseases and infectious diseases. It was part of the documents we had to provide before boarding a plane. Basically, were there a TB epidemic in the US, I would be spared from quarantine and be part of the active and immunized health care intervention teams because I was vaccinated. A simple measure which would spare this nation from a devastating pandemic.

I have often questioned why when it comes to TB, the US has yet to realize that vaccinations have contributed to defeating the expansion of various highly contagious diseases, which TB is. Is the American public aware that such pandemic is a realistic threat to their welfare?

Should not the government have a moral obligation to educate the people and promote BCG vaccination rather than resorting to quarantine which is only a damage control measure?

[Trout]

Is the American public aware that such pandemic is a realistic threat to their welfare?

I'd guess no.

Another good question is why are we not undertaking a vast immunization program globally to erradicate everything we can which has the potential to reach us once again in the future? It had been started in the past but barriers of various sorts stopped a full effort.

Should not the government have a moral obligation to educate the people and promote BCG vaccination rather than resorting to quarantine which is only a damage control measure?

Should perhaps but that's an ideal they don't truly care much about in and of itself. If we're talking death potential then that would be a lot smarter than investing in aircraft carriers.

Of course, that's not what the priorities are

[Sabine Grant]

Is the American public aware that such pandemic is a realistic threat to their welfare?

I'd guess no.

Another good question is why are we not undertaking a vast immunization program globally to erradicate everything we can which has the potential to reach us once again in the future? It had been started in the past but barriers of various sorts stopped a full effort. Do you know why and how such barriers came up? I realize that there are opponents to vaccination based on health concerns. (side effects mostly). But vaccinations have proven to be the ultimate effective tool to defeat the potential for various infectious diseases. Do you think it is a matter of people feeling that their freedom of choice is being intruded upon by the state?

Should not the government have a moral obligation to educate the people and promote BCG vaccination rather than resorting to quarantine which is only a damage control measure?

Should perhaps but that's an ideal they don't truly care much about in and of itself. If we're talking death potential then that would be a lot smarter than investing in aircraft carriers.

Of course, that's not what the priorities are Trout, when I saw that the US government had only allocated so much budget to provision SARS vaccination for only 10% of the US population, I freaked out. Do they not realize that such pandemic would affect the entire economy as it would disable millions of working Americans? And present a fatality factor for seniors, young children and persons with immune deficiencies.

[s-o-i-d-p]

This was an idea discussed on 'The Philosopopher's Zone' podcast recently. To what extent should someone have an obligation to not infect others with communicable diseases? In particular, at what point can we justify confining someone who refuses treatment and/or is highly contagious? The particular issue discussed on the podcast was Extreme Drug Resistant Tuberculosis. Tuberculosis kills about the same number of people each year as AIDS does, but is an airborne virus.

Now obviously DELIBERATELY infecting someone with a disease seems cut and dried, but what obligation do you have to wider society to take preventative steps for accidental infection? Can there be a risk to public health great enough to justify forced quarantine?

Isn't this like passive smoking? Often there is no intent to affect others' health, but it's still opposed nonetheless.

[fast]

I understand the concept. But I was speaking of the moral obligation for the infected person to avoid infecting others.I support the notion that an infected person has the moral obligation to do what's necessary to avoid infecting others; however, I do not support the notion that an infected person necessarily has a moral obligation to do as those reasonable's in authority dictate.

It seems to me that as we exercise our individual freedoms, the choices of action we make have to take in account avoiding imposing undue harm on others. But, must it always be in total submission to those in authority, especially when moral alternatives exist?

It’s okay to tell me (for example) that I ought not harm another, and though following the demands of another may lead to a state of affairs that ensures that I will not harm another, the reasonableness of the demands do not go to show (however) that I am morally obligated to the demands of others.

Obviously, the carrier of active TB does not have consent from the rest of the population to infect them. It's amazing how the needs of the many always seems to outweigh the needs of the few, and no one would dare imposition the majority to the benefit of the few (apparently), but just in case anyone would like a comical rendition of the alternative, then behold:

Although all you peons are ordinarily granted the gift to leave your cubicles, today I, The Great Fast, (and shithead boss and owner of this magnificent yet community minded place) has a cold, so although you may ordinarily roam freely, for the next couple of days, you shall remain quarantined to your little safe havens so as to allow for my freedom to omnipotently roam this magnificent place.

Either way, I agree with your statement. The carrier of active TB does not have consent from the rest of the population to infect them.

Realistically, I am not aware of folks who seek to get exposed and infected with active TB. Neither am I. I'm not sure why you mention that.

Most of us experience a sense of self preservation which protects us from voluntary/involuntary exposure to contagious diseases. Makes sense. Again, I'm not sure why you mention it.

That all ties in with our instinct of survival so predominant in our species. Okay.

IMO you would have to demonstrate that the exercise of individual freedom, without reflecting on which harm it can impose on others, to be a moral right.You sound like you have a good question in the making, but I'm not sure what you're asking. Are you asking me to morally justify my right to individual freedoms? Wow, I don't know if I have the necessary skill set to accomplish that. First, I recognize that the exercise of our individual freedoms is generally framed as legal rights. It's been said that the rights we have are a creature of law. Hence, if we were in a lawless society, we would have no legal rights.

But, what you are asking me to do (I think) is to speak of the legal rights we have as moral rights and justify them from a moral stance, and that’s a hefty task, so before venturing down that long and windy road, please elaborate on what kind of response you'd be expecting from me.

Again based on my relying on realistic facts, such scenario is highly improbable because Adams is bound to need human interaction at some point of time. Then you get to say as Kevin Spacey did in the movie Negotiator, "You want something? You want something from me?"

This reminds me of mandatory evacuations. Thank you for the warning, and I understand that if I make my bed (by staying), then I ought to lie in it (by not expecting help) should I decide to stay, but how dare you mandate my evacuation (under the guise of having a duty to protect me) when I have elected to stay. See, any present obligation is mitigated by my refusal to leave, and my beef would of course be the lack of choice in the mandate itself.

Unless he volunteered to be shipped on a deserted island somewhere in the South Pacific, with ample resources to last him for several months. In such condition, Adams would present not even any minimal risk to infect any other human being. There would be no risk at all due to the void of any human beings in his environment.

In philosophy, issues are often abstract, and it's often a good thing to give examples to help convey the things we have in mind so as to lessen the complexity and vagueness of situations that usually have too much of both, but unfortunately, arguing the intricacies that examples bring can often times get in the way of the underlying issues that are of greater importance.

You are bringing in extraneous factors in potentially real world situations to help support your case, but you undermine the very principles under discussion in doing so. Safety is important, and liberty is important, and although there are plenty of real world cases where the importance of safety may trump the importance of liberty, I'd like to keep the fight fair by not bringing in the burden of the people to provide ample resources to a person who is infected refusing treatment. You are skewing the situation such that a reasonable person might never disagree with you.

What I find disheartening is that the person without authority has no power in the struggle over those who tout the curtailing of liberties like it's nothing to infringe upon the autonomy of another so long as others find it reasonable.

But in your scenario, there is still a risk or potential for human interaction. Now, IMO, it would be an unreasonable expectation from such person to demand that tax payers support his being shipped to a deserted island in the South Pacific with the necessary resources to survive for several months.

He/she would have to use his/her own financial resources to isolate himself/herself on such island and be self supportive. I also have to wonder about his/her vision of a plane crew having to wear full protective gear while flying him/her there. And the resulting disinfecting process of the entire plane.


I still think the introduction of these variables undermine the underlying issue, but since we're arguing the scenario, I do agree that it's unreasonable to expect other members of society to foot the bill, unless of course certain authoritative members of society were perhaps the one's responsible for the predicament in the first place.

As to the crew wearing full protective gear, my first thought was to wonder of how much more danger they would be in compared to the dangers that they would nevertheless be exposed to by doing what they would otherwise do. However, let's not forget that if Mr. Adams doesn't have the means to escape the one's wanting to quarantine him according to their demands, then he still has the moral duty to avoid infecting others, and if he can't accomplish that, then perhaps he does need to concede the fight to be free of intervening others, but you're the one introducing the complexities in the scenario that make it such that no autonomy is possible without unduly jeopardizing the possible safety of others.

Hopefully, and not to sound too awfully ignorant, but it's like the authoritative one's are saying this: "do as we tell you to do, as it's the only right way for it to be done, and if there does so happen to be another (and better) way, then it really doesn't matter anyhow, for as of this time, this is what we think we know to be best, so deal with it, especially since we have the authority to do what we want anyway, and so long as we can exclaim that in our reasonable judgment that what we do is in the best interest of society, then we are as justified as we need it to be, even if our justifications are just that-mere-justifications. PS: You may write your grievances on the back of any napkin of your desire. We'll properly file it where it belongs."

By the way, in regards to my "whims" comment. I believe you misinterpreted me on that one. Or, I miscommunicated. Yeah, I probably did that. My bad. Anyhow, by whim, I only meant to convey a sense of something I sometimes feel when I come across particular passages of law. I don’t have a source at the moment, but it usually says something to the effect that some commission or another may from time to time require this or that—and that we’re required to conform to those (I should have said demands) as well.

[arkirk]

I wish to make it clear that tuberculosis is caused not by a virus but a bacterium. It is a bacterial infection that is characterized in the lungs by the formation of tubercles. There are calcium deposits the body forms around the offending organisms. It also affects the kidneys. Tuberculosis has always been somewhat resistant to antibiotics. In the past it was treated with heavy doses of auromycin. This drug can in heavy doses cause hearing loss, so TB patients on this regimen were tested all the time for hearing.

It is in the realm of public health that one must comply with the best interests of society at large. We live in a throw away society. The real problem with having a communicable disease is the type of treatment one might expect in a quarantine situation. Are you a criminal or a patient? The same issue seems in effect for petty criminals that are locked up and punished.

I think every society has the right to quarantine contagious people. It does not have the right (though some seem to think so) to throw them away. People with TB (my father was one) always have it, though it can be in brought into remission with good health care. My father had inactive TB most of his life. He would not tell a soul.

We need to not just quarantine these individuals. They need expert care. TB is largely a 3rd world phenomenon and a disease of the POOR. It is endemic in many countries. Our American society (ask Michael Moore) denies as much health care as it delivers. That makes us a potential trouble spot for contagious disease. We do not treat. We just imprison. The real crime is being black or brown and poor.

Universal health care would go a long way toward eliminating many of the threats of communicable disease. But we have to take it seriously and not just shine each other on and spout platitudes. I know why my father kept his secret.

[whichphilosophy]

I wish to make it clear that tuberculosis is caused not by a virus but a bacterium. It is a bacterial infection that is characterized in the lungs by the formation of tubercles. There are calcium deposits the body forms around the offending organisms. It also affects the kidneys. Tuberculosis has always been somewhat resistant to antibiotics. In the past it was treated with heavy doses of auromycin. This drug can in heavy doses cause hearing loss, so TB patients on this regimen were tested all the time for hearing.

It is in the realm of public health that one must comply with the best interests of society at large. We live in a throw away society. The real problem with having a communicable disease is the type of treatment one might expect in a quarantine situation. Are you a criminal or a patient? The same issue seems in effect for petty criminals that are locked up and punished.

I think every society has the right to quarantine contagious people. It does not have the right (though some seem to think so) to throw them away. People with TB (my father was one) always have it, though it can be in brought into remission with good health care. My father had inactive TB most of his life. He would not tell a soul.

We need to not just quarantine these individuals. They need expert care. TB is largely a 3rd world phenomenon and a disease of the POOR. It is endemic in many countries. Our American society (ask Michael Moore) denies as much health care as it delivers. That makes us a potential trouble spot for contagious disease. We do not treat. We just imprison. The real crime is being black or brown and poor.

Universal health care would go a long way toward eliminating many of the threats of communicable disease. But we have to take it seriously and not just shine each other on and spout platitudes. I know why my father kept his secret.


It depends on the severity of the disease (E.g Ebola, SARS) China and other countries managed to eliminate SARS in a comparitively short time. Here the people in Asia were quite happy to go to hospital. The only fear was that someone who was not infected, but suspect, feared they may be infected by someonw who was due to close proximity.

[Trout]

Do you know why and how such barriers came up? I realize that there are opponents to vaccination based on health concerns. (side effects mostly). But vaccinations have proven to be the ultimate effective tool to defeat the potential for various infectious diseases. Do you think it is a matter of people feeling that their freedom of choice is being intruded upon by the state?

In global terms some geographical areas have been very challenging due to religious crapthink, gender power issues and basically superstition but in the end, the developed world stopped short of a major vaccination mandate because we made it to the borders of the "civilized world" and priorities dropped. It's the same sort of reason why babies still die from diarrhea when they can be fed salt/clean water mixtures that cost pennies.

Do they not realize that such pandemic would affect the entire economy as it would disable millions of working Americans? And present a fatality factor for seniors, young children and persons with immune deficiencies

Yes I do if it happened but you have to look at these things from the perspective of policy makers/politicians and their goals. We could put many more resources into things like this certainly but like I said, #1 people don't care that much and #2 they likely figure that if a big "plague" hit then the shite is already hitting the fan regardless and cannot be stopped.

Look, if we, as a species, wanted to provide good basic health care to all children, immunize the entire population against 2-5 major diseases and so on, we probably could if we had 20-30 years to implement it. But when we can't even reach a consensus on if all American children should receive basic developed world level care when they live in the richest nation in history then I have little hope.

[Sabine Grant]

I wish to make it clear that tuberculosis is caused not by a virus but a bacterium. It is a bacterial infection that is characterized in the lungs by the formation of tubercles. There are calcium deposits the body forms around the offending organisms. It also affects the kidneys. Tuberculosis has always been somewhat resistant to antibiotics. In the past it was treated with heavy doses of auromycin. This drug can in heavy doses cause hearing loss, so TB patients on this regimen were tested all the time for hearing.

It is in the realm of public health that one must comply with the best interests of society at large. We live in a throw away society. The real problem with having a communicable disease is the type of treatment one might expect in a quarantine situation. Are you a criminal or a patient? The same issue seems in effect for petty criminals that are locked up and punished.

I think every society has the right to quarantine contagious people. It does not have the right (though some seem to think so) to throw them away. People with TB (my father was one) always have it, though it can be in brought into remission with good health care. My father had inactive TB most of his life. He would not tell a soul.

We need to not just quarantine these individuals. They need expert care. TB is largely a 3rd world phenomenon and a disease of the POOR. It is endemic in many countries. Our American society (ask Michael Moore) denies as much health care as it delivers. That makes us a potential trouble spot for contagious disease. We do not treat. We just imprison. The real crime is being black or brown and poor.

Universal health care would go a long way toward eliminating many of the threats of communicable disease. But we have to take it seriously and not just shine each other on and spout platitudes. I know why my father kept his secret. As I mentioned earlier, Arkirk, BCG vaccination would reduce the potential for a pandemic of active TB. The problem as I see it is that too many people in this country are not aware of that potential to happen.There seems to be a climate of insouciance, once in a while disrupted by the media echoing fears about the Nile Virus or SARS. To add "Monleypox" now in Congo which is reaching epidemic proportions.

Maybe ( a big maybe) the tables are turning a bit . When I went for my mammogram today, I was asked for the first time to fill out a form inquiring about the following symptoms :
- have you had any persistent fever in the last three months?
- have you had any persistent coughing?
- have you been coughing up any blood?
- have you had any abnormal fatigue?
- any night sweats?

Arkik, none of those symptoms are related to the type of illnesses a mammogram is designed to detect. Every single patient awaiting for an MRI or a Pet in the waiting room was given a similar questionnaire to fill out.

Those symptoms above as you probably have recognized are typical of TB. Meaning that at least in Fla., the CDC has launched a tracking campaign to dig up potential TB carriers. Meaning they are on alert in Fla. Unbeknown by the media. There must be several TB cases that popped up.It is worrisome.

You see Arkirk, it is all done "underground" instead of informing the public and educating the same public about TB. Heck... I even have a nurse who works with me and had never heard of the BCG.

[Sabine Grant]

Do you know why and how such barriers came up? I realize that there are opponents to vaccination based on health concerns. (side effects mostly). But vaccinations have proven to be the ultimate effective tool to defeat the potential for various infectious diseases. Do you think it is a matter of people feeling that their freedom of choice is being intruded upon by the state?

In global terms some geographical areas have been very challenging due to religious crapthink, gender power issues and basically superstition but in the end, the developed world stopped short of a major vaccination mandate because we made it to the borders of the "civilized world" and priorities dropped. It's the same sort of reason why babies still die from diarrhea when they can be fed salt/clean water mixtures that cost pennies.

Do they not realize that such pandemic would affect the entire economy as it would disable millions of working Americans? And present a fatality factor for seniors, young children and persons with immune deficiencies

Yes I do if it happened but you have to look at these things from the perspective of policy makers/politicians and their goals. We could put many more resources into things like this certainly but like I said, #1 people don't care that much and #2 they likely figure that if a big "plague" hit then the shite is already hitting the fan regardless and cannot be stopped.

Look, if we, as a species, wanted to provide good basic health care to all children, immunize the entire population against 2-5 major diseases and so on, we probably could if we had 20-30 years to implement it. But when we can't even reach a consensus on if all American children should receive basic developed world level care when they live in the richest nation in history then I have little hope. You have got a 100% seal of approval on my part on your comments. Read my last reply to Arkirk. It relates to what you explained.

It is inconceivable and morally reprehensible that this government "downplays" such public health hazards. At a time when we have been bombarded with mantras about "National Security" while a mycobacterium can contaminate millions and disable this nation.

[fast]

It is inconceivable and morally reprehensible that this government "downplays" such public health hazards.
I disagree. It isn't inconceivable. :(

But, it is probably morally reprehensible. I'll give you that one.

[Monkey Wrench]

I once worked with a guy that said if he got AIDS. He would go out of his way to infect as many people as possible. According to his reasoning the more people that had the disease the harder the government and science would try to find a cure.

[Sabine Grant]

I once worked with a guy that said if he got AIDS. He would go out of his way to infect as many people as possible. According to his reasoning the more people that had the disease the harder the government and science would try to find a cure.There is more attention given to HIV at this point than other fatal ailments such as lupus. The assumption on your co worker's part that "science" is somehow not working hard enough on "finding a cure" is based on a lack of understanding of which obstacles researchers are dealing with.HIV is IMO the most complex viral contagious disease of our modern times and of global proportions. Keeping in mind that the virus disables T cells, rendering the human immune system vulnerable to secondary infections.

Areas with a high ratio of HIV sero positive persons also present a high increase of non treatable TB cases.( doubling the infectious disease vectors).

His proposal, if enacted by anyone, would result in an attempt to murder so many persons. Certainly not an ethical application of "the end justifies the means".