10/16/2014
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In Ebola outbreak, liberty and public health may be at odds, experts say
There's no sign yet that Ebola has reached Minnesota. But experiences in Dallas highlight what government authorities can do, firmly and quickly, to try to stop more people from getting infected — at a time when the public is increasingly wary of government intrusion and authority.
The state can lock you up for weeks. It could order your kids home from school and in some cases, kick you out of your job, at least temporarily. Health officials can inspect your house, open up your health records and maybe even seize your remains if you get sick and die.
The government has to have a lot of discretion, and to treat individual health care and public health differently, Minnesota health commissioner Ed Ehlinger said.
"Sometimes, public health goals and outcomes really conflict with that individual privacy," he said. "If someone has an infectious disease and doesn't want to be quarantined or isolated, we sometimes have to do that for the protection of the general public. And that's what public health is all about. And that's where the potential struggles are going to be."
That idea dates back to the very beginnings of the U.S. health care system in the 19th century.
"We tried to quarantine people coming in from other places that had cholera or other infectious diseases," Ehlinger said. "The public health service was established to really quarantine folks coming from outside the country."
Dallas officials ordered the family of Ebola victim Eric Duncan into a quarantine after they didn't go into seclusion voluntarily. And New Jersey officials ordered NBC health correspondent Nancy Snyderman to stay in her home after she violated a voluntary quarantine request and was spotted at a restaurant. One of her colleagues contracted Ebola when they were in west Africa recently.
Minnesota offers some guarantees to people it suspects might get ill, such as ready communication with health care providers and the chance to appeal a quarantine order in court, according to attorney James Conway, of Shakopee, who studies state law and quarantine The state also requires authorities to use the least restrictive environment possible for quarantine.
Conway doesn't forsee widespread legal challenges to quarantine, but said it raises a host of issues: What does "least restrictive" mean? Who decides? And what happens while people wait to see if they'll really get sick?
Another worry: job loss. Federal workplace protection laws may help some people, Conway said. "The Americans with Disabilities Act might apply to someone in a detention situation, so that they would likely not have fear of losing their job if they were placed under a quarantine."
In Minnesota, there are laws protecting employees and even a provision to recover lost wages in the event of an outbreak, he added.
But other situations and answers aren't so clear. What about property rights, for example? In Texas, officials stripped bare the apartment where Ebola victim Eric Duncan stayed, packed everything in more than 140 barrels, and incinerated it. The cleanup cost an estimated $100,000.
Minnesota Department of Health spokesman Doug Schultz said authorities have been weighing the practicality of such measures, and the need to clean up potential hazards, versus the risk of exposing more people to infection. Officials have decided to call the Minnesota Pollution Control Agency to people's homes if any so-called "Ebola houses" turn up in the state.
Peter Sandman, a risk communication consultant in New York, said its hard to know how much authority it would take to stem an Ebola outbreak in the United States. But whatever the rules, Sandman said the key to making them work will be to apply them fairly.
"There's a real tension between protecting everybody's health and protecting everybody's liberty," he said. "But if you start diminishing some people's liberty but not other people's liberty, then that calls the whole enterprise into question."
Like everyone else, he hopes we won't have to find out if that happens.
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