Balancing health and human rights
Efforts to contain the COVID-19 virus include the potential for enforced isolation, but are we ready for that, asks Jen Brown
IF you have considered stocking up in preparation for the chance of COVID-19 hitting the neighbourhood, then now might be a good time to stop and ask yourself if you genuinely understand and accept the concept of self or even enforced isolation.
In preparation for COVID19, the United Kingdom introduced new regulations to allow enforced isolation of individuals on reasonable suspicion of infection with COVID-19. In Australia for a long time, we have held similar powers in state and territory public health legislation; and if necessary under the Commonwealth Biosecurity Act 2015. Some states are now revisiting these laws and considering updates.
These laws have recently been labelled as draconian, invasive and interfering with human rights. This represents a long-held conundrum faced by those who deal with public health law. Certainly, interfering with rights is precisely what these laws are doing. The aim is to prevent the spread of disease. Right now isolation and quarantine of COVID-19 is important to slow the rate of infections and reduce the burden on health systems. Ultimately complete containment might be difficult but if the rate of infection can be slowed the broader impact on health services is more manageable. If an individual fails to self isolate then these laws are there to help. The aim is to restrain the individual’s right to participate as they freely choose. They isolate and restrict the movement of an individual with, or suspected of carrying an infectious disease.
Restraining the rights of one, or a few, to protect the health of the broader population is a core aim of public health laws. Western nations have been exercising soft versions of the principle in laws for a long time. Food safety, seat belt, speed limit and product safety laws are common examples. The US has compulsory vaccination laws, and Australia leads the world in highly restrictive tobacco laws. However, mandatory quarantine laws are on the harsher end of the restrictive spectrum.
The authority behind state and territory public health laws is a medical doctor. Chief Health Officers or Directors of Public Health, as they are known in some states, are statutory positions filled by medical doctors with specialist public health training. They are at the top of their professional tree and got there by years of intensive hard work and training. On becoming doctors, each of these professionals is bound by the Hippocratic oath, “do no harm”. Their role is to exercise public health law according to the underlying principles of the public health profession, to pursue the highest possible level of physical and mental health in the population while remaining consistent with the values of social justice. In some states, for example, Western Australia, this is even written into the legislative objectives with a list of guiding principles their decisions must follow.
In Australia, the right to health is often taken for granted. Not until times of personal or community crisis are we reminded how much we value it and look to our experts for guidance. Across Australia, the Directors of Public Health must consider the right to health with every decision they make and any advice they give us will be laden with many complex considerations. This triggers a set of more profound questions, well beyond the scope of this discussion. Why do, or should we value intense financial and human resources to infectious diseases control, while other health burdens such as mental illness or air pollution never garner such attention, action or resources? Both have an enormous but slowerpaced mortality rate. In dealing with a medical crisis such as COVID-19 we should continue to acknowledge the many serious health considerations confronting the community and our resourcing choices.
Quarantine as a practice has been tested repeatedly since the Spanish flu outbreak of 1918. Mathematical modelling and countless research show it does work to control and prevent the spread of disease. The control of the Ebola virus is one such example. The problem is we will never be able to design a perfect form of quarantine because, in many cases, we will need to isolate people who don’t feel very sick or worse those who have been exposed but are perfectly healthy otherwise. Consequently, there will always be people who don’t understand or find a way around quarantine. Unfortunately, sometimes protecting community health requires someone to make complex decisions that restrict
rights and disadvantage a few. Strict quarantine laws do exactly that. But ideally they should be avoided. With clear information and lots of support individuals should be capable of self-isolation. Good public health management involves planning, education, strong leadership and clear messaging, something Chief Health Officers are well trained to deliver as long as they are well supported by government and accurately represented by media in the process.