In pandemic, public health offsets patient autonomy
Ethical guideline clarifies quarantines, isolation
The American Medical Association (AMA) has issued new ethical guidelines to help physicians balance public health goals with the interests of individual patients during epidemics. The new guidelines came immediately following President Bush’s announcement that potentially pandemic-causing flu viruses have been added to the list of quarantinable diseases.
"The practices of quarantine and isolation have long been used to curb the spread of disease, as well as ensure that ill patients receive the critical care they need," according to AMA trustee Rebecca Patchin, MD. "In these situations, physicians must do everything they can to protect the rights and privacy of patients without compromising the health of the public."
The new AMA guideline states, in part, "Quarantine and isolation to protect the population’s health potentially conflict with the individual rights of liberty and self-determination. The medical profession, in collaboration with public health colleagues, must take an active role in ensuring that those interventions are based on science and are applied according to certain ethical considerations."1
The guidelines stress that physicians should protect patient autonomy and privacy as much as possible during quarantine or isolation. The guidelines state that physicians should collaborate with public health authorities to:
- use valid scientific methods to assess public health risks;
- avoid arbitrary application of quarantine and isolation to particular socioeconomic, racial, or ethnic groups;
- advocate for access to public health services for timely detection of risks and implementation of quarantine and isolation;
- educate patients about the importance of their compliance with public health measures;
- support mandatory quarantine and isolation for patients who fail to comply with such measures.
Physicians should also advocate for patient confidentiality and encourage patients to adhere voluntarily to quarantine measures, the guidelines state. Doctors on the front lines of a pandemic fight are particularly obliged to seek out personal protective measures, including vaccination against the disease.
Quarantine vs. isolation
The guidelines are based on an in-depth analysis by AMA’s Council on Ethical and Judicial Affairs (CEJA) on the use of quarantine and isolation as public health interventions.
Isolation refers to the separation of persons who have a specific infectious illness from those who are healthy and the restriction of their movement to stop the spread of that illness. Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious. Both isolation and quarantine are public health strategies that have proved effective in stopping the spread of infectious diseases, according to the Atlanta-based Centers for Disease Control and Prevention (CDC).
Under federal authority, the CDC has the right to detain, medically examine, or conditionally release individuals reasonably believed to be carrying a communicable disease.
In its guidelines, the AMA acknowledges that mandatory quarantine and isolation fly in the face of contemporary medical values.
"When treating individual patients, physicians are obligated to hold the best interests of the patient as paramount," the report states. "However, these individually centered concerns for personal liberties can undermine public efforts to protect the health of the population."
The CEJA guidelines adopted by the AMA’s House of Delegates stress that physicians should ensure that when quarantines are ordered they should be as least restrictive as possible and be based on valid science, and that they shouldn’t arbitrarily target population groups by economics, race, or ethnicity. Physicians should also advocate for patient confidentiality, encourage patients to adhere voluntarily to quarantine measures, and comply with mandatory reporting requirements.
The medical profession should advocate for robust public health services to "prevent undue delays" in implementing a quarantine, the AMA opinion says, and physicians should help educate their patients and the public about quarantine and its purpose.
Sources
- American Medical Association. "Report of the Council on Ethical and Judicial Affairs." Available on-line at www.ama-assn.org/ama1/pub/upload/mm/31/quarantine15726.pdf. Phone: (800) 621-8335.
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Phone: (404) 639-3311. Online at www.cdc.gov/flu/pandemic.
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