This dilemma can be controversial and press the boundaries of heated debates in regards to quarantine of the exposed to reduce the spread of a communicable disease. Quarantine has been implemented using different standards and techniques all over the world; however, the question of if these practices are ethical continues to be a prominent focus for public health officials, the media and the public at large. The bottom line when it comes to quarantine; does the benefit of enforcing quarantine outweigh the consequence to public health if no quarantine was enforced? This article will discuss the ethical issues that arise from the use of quarantine to prevent the spread of a disease.
There are many ethical principles that should be considered when the use of quarantine is deemed necessary. According to Beauchamp (1989) there are four major ethical principles which are autonomy, beneficence, non-maleficence, and justice. Each of these ethical principles is equally important and can be applied in a variety of scenarios. For example, a patient who is quarantined for having a communicable and quarantinable disease must be cared for by health care workers, doctors, nurses and public health officials in a manner that is consistent with these ethical principles. This means that quarantined persons still have their right to make choices about the treatment they are to receive (autonomy). In addition, because quarantined persons are in the care of health officials and doctors, their treatment falls under the obligation that the treatment provided will not do more harm to them and rather overall be more beneficial than consequential. Although these standards of practice and care have been adopted in the united States there are still many questionable cases that have failed to live up to these basic principles.
Beneficence and Non-maleficence
Beneficence and non-maleficence both in theory help to ensure that any treatment a patient receives will not harm them. At the same time no health care provider can guarantee that any treatment given will be beneficial to their “net health”. The Center for Disease Control (CDC) has outlined four additional ethical principles specific to the use and implementation of quarantine. These principles are the harm principle, the proportionality principle, the reciprocity principle and the transparency principle (Dwyer, 2009). The harm principle and the reciprocity principle fall under the prima facie principle of beneficence and non-maleficence. The harm principle states that the “Benefits would surpass the harm” (Dwyer, 2009). In addition, the reciprocity principle states that individuals subjected to quarantine procedures receive some benefit in exchange for the loss of their liberties which include societies assistance by: providing food, shelter, care and services needed (Dwyer, 2009). These conditions are not always met as was seen in the Arizona case of Tuberculosis. This principle is important to medical and public health officials because they have an ethical obligation to provide these most basic considerations for the ill. In sum, if these conditions are not met and the lack of ethical standards becomes public perception then infected persons will in turn be less likely to seek medical treatment if they believe to have been exposed to a communicable disease. This would put the entire population at a much greater risk.
Some of the issues that may arise are legal implications, public resistance and loss of trust by the public which are all dangerous outcomes that must be avoided. If these conditions are left unchecked, the standard of care and legitimacy of the treatment of patients in quarantine would be at risk. The basic point of having these principles in place is to protect the patients and be able to provide fair, ethical and proper treatment for the sick. If the overall goal is not to do more damage than good then these standards must be upheld. This includes, as previously stated, providing services needed, as well as basic amenities. For example, if a person is held in quarantine for an extended length in time, alone, the person could develop mental illnesses and or social disorders. If these matters are not addressed then the persons net health benefit decreases.
This article has discussed some of the ethical issues that can arise from the use of quarantine to prevent the spread of a disease. The four major ethical principles: autonomy, beneficence, non-maleficence, and justice are merely focal points in the wide array of ethical issues that surrounds the topic of quarantine. Moreover, the principle of beneficence and non-maleficence is perhaps one of the most important factors. All in all, the ideas behind these ethical ideals are to do more good than harm and to provide treatment for the patient while protecting the health of the public at large.
Beauchamp T., Childress J. (1989). Principles of Biomedical Ethics. 3rd ed. New York, Oxford: Oxford University Press.
Dwyer, S. (2009). Quarantine and Ethics. CDC San Francisco Quarantine Station. Retrieved from http://www.slideserve.com/duff/quarantine-and-ethics