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The Ethics of Disease Control

The Ethics of Disease Control
Profile photo of Logan Albright

BioSuitsAs the threat of the ebola virus looms large and the Center for Disease Control issues what are undoubtedly hyperbolic projections of over a million casualties to the disease by January, we owe it to ourselves as libertarians to ask a few questions about the ethics of disease control. Is it acceptable to use force to isolate a person with a contagious disease from society, and if so, under what circumstances? How far are we permitted to go in the invasion of another person’s personal liberty in order to secure a safe environment for the rest of us?

We start, as always, with the Non-Aggression Principle, which states that it is impermissible to use force against another except in self-defense against an actual or threatened attack on another’s life or property. The fundamental issue with disease control, then, becomes whether or not exposing others to a disease qualifies as such an attack.

Clearly, the intentional infection of another human being would qualify. Jamming a hypodermic needle into someone’s skin would be an attack even in the absence of any virus. So would mailing someone an envelope filled with anthrax. So would intentional sexual contact while knowingly carrying a sexually transmitted disease. In all these cases, the intent to cause harm is clear, as well as the actual harm caused, and self-defense to prevent this harm would be entirely justified.

But what about the murkier case where a person carries a disease, with no wish to spread it to anyone else, but with the knowledge that going about his day to day life may result in others becoming exposed?

Philosophers typically try to come to grips with these dilemmas by resorting to analogy. One might argue that going about with a dangerous disease is akin carrying a gun which may at any moment randomly fire. Clearly, if a person were to go about with such a gun (suppose it is strapped to his body and cannot be removed) this would constitute a threat to others, and he would be obligated to take precautions to minimize the risk. But this analogy fails because someone would have had to arrange the gun in the first place, and their agency would bear part of the responsibility. Viruses are, after all, simply very small animals that happen to be quite dangerous. There is no one at fault for the affliction, as there would be for the weapon contrived above.

Another analogy might concern a man forced to go about chained to a vicious dog. By entering into society, the man with the dog endangers others, and it would be justified to prevent him from doing so. But again, the analogy fails because keeping a dog or any pet involves an act of conscious choice. We are responsible for the actions of our pets, but not for those of wild animals. If the dog merely chose to follow the man wherever he went, it would hardly seem just to confine him to his house for the safety of others, for he has not violated anyone’s rights. It is not his fault that the wild dog has a particularly strong attraction to him.

This last analogy may come closest to the truth of the virus situation – an uncontrollable organism attaches itself to us against our will, and thereby poses a threat to others.

From a technical standpoint, the afflicted person is not, through any means of his agency, aggressing against anyone else by going out in public with a communicable disease. The disease consists of autonomous creatures who act on their own, and while they lack will in the sense that man has will, they are still capable of acting without being directed, unlike a gun or a knife, or any other traditional instrument of aggression. It is unclear how the mere action of going outside violates anyone else’s rights, or why he should bear responsibility for the organisms temporarily using his body as a host.

Does intent matter? I think it is clear that it does. To return to the sexually transmitted disease example from earlier, this was clearly a violation of a partner’s rights by taking deliberate action to cause an infection, even if the disease may technically operate on its own. Contrast this with the virus sufferer who merely wants to get on with his daily life without harming anyone. Yet in the latter case the necessity for forceful quarantine is taken as given.

Let us examine this topic from another angle. Suppose instead of a disease like ebola, against which most people have little in the way of defenses, we concern ourselves with a mostly benign virus, to which only 1 in 10,000 people have a fatal susceptibility. Now, for residents of large cities, it is difficult to go about one’s daily business without coming into contact with a great number of people, and the odds are high that at least one would exhibit this sensitivity. Does this mean that carriers of this mostly benign virus are in violation of the rights of others by going outside? Should they be compelled to stay in their homes or move to the country? And if so, should the wearers of perfumes and the eaters of peanuts to whom some percentage of citizens have serious allergies be subject to the same treatment? If we were to apply this rule as a broad principle, covering every circumstance, it would be the rare individual indeed who be permitted any sort of independent activity.

To the defenders of the quarantines, then, this question appears to be one of a degrees. It would be wrong to prevent someone with the common cold from getting on a train, but completely justified if the disease were instead smallpox. Both are contagious, and both are capable of killing, but the relative probability of death is what makes the difference. But if the unintentional spread of disease violates the Non-Aggression Principle, why should this not apply to all diseases, even if they are never lethal? After all, it is still assault to hit someone with a wiffle bat, even if there is no chance of killing them.

As one final point, I’d like to address the element of pre-crime inherent in any attempts at forcible quarantine. A person who goes about with a potentially deadly virus, yet who has not yet infected anyone, and who indeed may never do so, for infection is not certain, has violated no one’s rights. Nor is he making any active and explicit threat to do so. To use force on him, therefore, is to punish him for a crime he has not, and may never have, committed. This sort of preemptive strike is usually condemned by the advocates of liberty as unjust.

So where does all this leave us? It seems clear that a broad application of the Non-Aggression Principle to all communicable diseases would paralyze society’s function and result in the forcible and permanent internment of a great many otherwise innocent citizens not consistent with the ethics of liberty. On the other hand, permitting people to go about with extremely deadly diseases seems equally destructive, even if we cannot justify imprisoning them against their will.

I regret that I cannot provide a more definite resolution to these questions, but this remains one of those thorny areas of libertarian thought that, like the issue of children’s rights, requires more debate and discussion. At present I am inclined against the use of coercive force to implement quarantines, as I believe the potential for abuse and government overreach is simply too great to be tolerated.

  • wootendw

    The worry here, for me, is not that government authorities might prevent me from leaving my home, but what kind of behavior they might mandate to keep us 'safe'. For example, will there be forced vaccinations should a vaccine be developed? Will agents from CDC descend upon our homes in hazmat suits and cart us off to some isolation facility where we might be denied nutritional supplements of our own choosing? What if you get Ebola and survive it? Will you still be prevented from from venturing into society?

    Some of these things are far more worrisome to me than getting Ebola.

    • roxanne

      I believe they already have sites set up for just this kind of thing. UN trucks have been spotted being trucked into Ga. to a large FEMA facility.

  • Gilbert Berdine

    This is another problem that is only a problem due to public property.

    In a world of private property, the owners could exclude whoever they wanted to exclude from their property for whatever reasons. As applied to quarantine, most people would not invite someone with smallpox into their property, but very few people would exclude someone on the basis of the common cold. People who had family members with immune deficiencies would be more exclusive than people with normal family members. None of this exclusion or quarantine would be a violation of the non-aggression principle.

    • https://www.facebook.com/logan.albright.54 Logan Albright

      That's an excellent point, and quite true.

  • http://debtfreegen-y.com Renaud

    It is certainly one of the points statists can use to justify cohersion for "the benefits of the many".

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Profile photo of Logan Albright

Logan Albright is a writer and economist in Washington, DC.

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