Map of life expectancy at birth from Global Education Project.

Wednesday, August 17, 2005

My liberty or yours?

Competent adults in the United States have the right to refuse any medical treatment, for any reason or no reason . . . ah, err, no, they don't. In most places, people with tuberculosis can be detained and medicated against their will, as Lawrence O. Gostin discusses here.

Then there is the question of immunization. Children may not attend school without demonstrating that they have undergone a schedule of vaccinations, although most states allow exceptions for religious reasons. Not everyone is happy about this, including these folks, who describe themselves as:

Vaccination Liberation is part of a national grassroots network dedicated to providing information on vaccinations not often made available to the public so that one can make the only informed choice, complete avoidance and refusal.

Then there is the question of quarantine. This has come up in the past in the U.S., but it's gotten new life with all the hoo hah about bioterrorism. I'm not sure why we are only permitted to think about this in terms of a deliberately introduced plague, as opposed to a non-intentional epidemic, but that seems to be the fashion. David B. Fidler, writing in Clinical Infectious Diseases, says:
Neither public health law nor the law on emergency management has ever (fortunately) been implemented in a real biological weapons attack. Tabletop exercises and simulated bioterrorism incidents, such as the May 2000 TOPOFF exercise in Denver, Colorado, demonstrate that neither public health law nor emergency management law could currently support an effective response to a major biological weapons incident [2]. The ineffectiveness of existing legal frameworks in a real bioterrorism crisis would exacerbate pressure on governments to take drastic actions that might sweep away the rule of law in the midst of panic or uncertainty.

Of course, as we have seen in the run-up to the Iraq war, panic and uncertainty can be manufactured based on false information. We may indeed confront compelling reasons -- or apparent reasons -- for authorities to ban travel out of or into certain parts of the United States; to confine law abiding people to their homes or to institutions; to close businesses that are in compliance with the law; to seize private property; to enter people's homes unbidden; to vaccinate or medicate people against their will.

Should the federal government have such powers? If so, how can we trust them to use them only for the right reasons, in the right way, on the right occasions; and to stop when necessity has passed? (And keep in mind that we know the President of the United States does not always tell us the truth.) How can such powers be granted, yet constrained and made accountable? Or are such powers of government simply unacceptable?

If so, how can we protect you against people who refuse to do the right thing voluntarily? After all, we use compulsion against people who would drive while intoxicated, operate unsanitary restaurants, build unsafe houses, etc. Lately we use it in more and more places against people would expose us to their exhaled tobacco smoke. What's the difference?

I'm just asking. As usual, I reserve any opinions of my own.

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