Tough Call?

This is pretty horrible :

Behind the county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

Now this guy softened the hard question a bit by refusing to take what I'd say were relatively unobtrusive precautionary measures. But I'm curious, what do H&R readers make of the collision of individual rights and the state's arguable (I'd say convincing) duty to protect us from highly-communicable, untreatable fatal diseases?

The idea that someone who's done nothing wrong could be condemned to an isolation cell for the remainder of his life is pretty horrifying. And certainly we should be thinking ahead, so that those who are infected with the allegedly approaching "super bugs" are as comfortable as possible. But even then, is it acceptable to lock someone up in isolation for life?  What criteria must a disease meet to merit such drastic containment measures?

And what measures should we put in place to ensure that the government doesn't abuse whatever powers it claims (or if you're idealistic, that we grant it) in the name of fighting these diseases?

I don't have answers.  Just questions.  Have at it. 

Comments

[VM]

OMG!OMG!OMG!

Highnumber blogged this!!! He's sooo cutting edge!

(got nuttin on this one. jest wanted to give the googleplex^24 some props. even though he told me to sod off. (not bitter or anything))

*opens up another Formula 409. and checks to see how the Tribe did yesterday...

[smacky]

What criteria must a disease meet to merit such drastic containment measures?

I'd say a disease that is drug-resistant, likely fatal, and air-transmittable would qualify. The guy was wrong for not wearing a mask. I don't know how many second chances someone should get in that situation. What would it take for him to be considerate of others -- a plague?

This isn't meant to be insensitive.

[Grotius]

Radley Balko,

This has some parallels with the Mary Mallon ("Typhoid Mary") case you could definately explore.

[Lost_In_Translation]

Why is this guy out in public in any case. Shouldn't he be at a hospital with doctors working round the clock to figure out wtf to do?

If nothing can be done and he's suffering, shoot the bastard and put him out of his misery.

[thoreau]

Yeah, I guess I don't have a problem with sequestering a person who carries an airborne contagion that's untreatable and often fatal, if he refuses to take steps to protect others.

As an analogy, I think we'd all agree that a person who goes around firing a gun randomly should be locked up (after due process, of course, and the an-caps can insert provisos about how it should be done in accordance with contracts that property owners sign with security companies). Well, if there's a person who goes around spewing potentially lethal particles everywhere, and he refuses to do anything to control or stop this activity and protect others, I'd say he should be tretaed the same way.

The hard question, of course, is when you start drawing lines for diseases in the gray area.

[Number 6]

In planning for pandemic emergencies, massive quarantines and lock-downs are always an option. The very idea sucks, but with certain bugs, the alternatives are too horrible to give serious consideration. I'd say this is similar. They gave the guy a chance; he didn't take basic precautions. While he is a human being with rights, it's also the case that he is a disease vector, and if the option is the spread of something as nasty as TB, there doesn't seem to be much choice.

That said, it's a terrifying power to give the government. But perhaps a necessary one.

[Kwix]

I guess the question is, who is responsible for your personal health?

Should this person, who happens to have an untreatable disease, be responsible for your health or should you wear a mask so as to prevent obtaining an infection from him?

[thoreau]

Should this person, who happens to have an untreatable disease, be responsible for your health or should you wear a mask so as to prevent obtaining an infection from him?

Should a guy with a gun refrain from firing projectiles at random, or should I be responsible for wearing body armor?

[I. Self. Divine.]

I read this early and was wondering when HnR was going to get around to blogging it.

I think thoreau and number 6 hit it on the head. A very convincing slippery slope argument could be made.

[smacky]

This is a quote from Robert Daniels:

"Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

He says that as though that is too young to know better. I wasn't aware that young adults in Russia expect to be treated like helpless children, too -- I thought that was a U.S. phenomenon.

Kwix,

Good question. I've seen photos of people in Asia wearing masks in public to protect themselves from Avian flu. Then again, this is sort of along the lines of whether you should wear a helmet when you drive a car. Maybe it's not such a silly idea.

[ktc2]

Seems to me him coming in my vicinity with an airborne untreatable fatal pathogen would qualify as an initiation of force.

Somebody said it before but it's like a guy who pathologically cannot stop firing bullets at random and never runs out of ammo. Would you stand there and let someone like that walk by and hope not to get hit or would you shoot him if he were headed your way?

[Kwix]

Dr. T,
I suppose that is an apt parallel and we empower the state to imprison people who fire willy-nilly into a crowd, but normally there is a trial involved somewhere.

[David]

If the alternative is that Daniels goes around infecting people with TB, I think that he has to be locked up. I just hope that people don't misuse that precedent as a excuse to lock away other with less contagious diseases or risk-enhancing behaviors.

I also wonder why he's in a cell rather than hospital?

[Ironchef]

Ankle bracelets.

[Grotius]

well, if they are going to lock him up for life he needs to be put into a better living situation than what he currently is in.

[Ironchef]

or anklets. Whatever they're called.

[Grotius]

Of course a lot of this depends on how quickly science figures out how to treat this particular ailment.

[smacky]

Actually, I think Daniels is American, and not Russian. Now his excuse makes more sense. Blaming complete lack of consideration for healthy people on his "youth" and ignorance.

[ed]

It isn't worth too much thought, as it's an extremely rare case. A better example would be how the U.S. locked up and isolated all the HIV cases in the 80s and 90s. Which we didn't do. Nanny states don't do that sort of thing. Police states do.

[ChrisO]

well, if they are going to lock him up for life he needs to be put into a better living situation than what he currently is in.

That's an understatement. The article does not explain why the guards took away his TV, phone, radio, and personal computer. Last I heard, you can't spread TB through radio transmissions.

[de stijl]

Camus already blogged this.

[Sam B]

Kwix,
We do detain people, especially those considered dangerous, before a trial.

I like ktc2's point about this person's actions being an initiation of force. It is certainly a stretch but the argument can be made.

[I. Self. Divine.]

David: The cell he is in is within a hospital. He is confined in an area usually reserved from criminal patients.

[Choy]

Oooh! Time for a non-initiation of force analogy.

So there's this guy who walks around the city carrying a gun and every 5 seconds he fires it in a random horizontal direction. He can't stop himself and he won't put a deflector on his gun that forces the bullet to the ground. Do you have the right to defend yourself from him? Of course you do; he is initiating force that will result in your death or the death of another innocent.

This guy won't put on a mask and his initiation of force is not obvious like the gun firing. I'd say you have every right to just shoot him in self defense.

His right to life and liberty stops immediately at the point that he actively interferes with my right to life and liberty. Going around spreading a deadly disease is definitely actively interfering.

[Grotius]

ChrisO,

Yes, dangerous or not he ought to be afforded a far better living situation than he has now.

[steveintheknow]

Operation human biological weapon?

Cross fingers and hope the singularity is right around the corner?

Send to Australia?

Other then that, sounds like we got a leper-camp on our hands.

[Jennifer]

I read the article this morning; I can see why the guy needs to be locked up, but why isn't he allowed to have a phone, computer, TV or radio? There are no public-health benefits to keeping such things away from him.

[MP]

How 'bout a nice, unpopulated desert island.

[Jennifer]

Oops, Chris already asked my question.

[John]

I swear the government and the police in particular could fuck up a cup of coffee. As numerous posters rightly point out, no question the state has and should have the authority to lock this guy up if he refuses to take reasonable measures not to infect people. But that doesn't mean they should lock the guy up and take away his TV and computer and the like. He is sick man who due to his own actions and sickness needs to be separated from society. He is not, however, a violent criminal in need of punishment. Put the guy up in a nice hospital room with a good TV and some recreation and give him good medical treatment. For God sakes keep the door locked, but to put him under these conditions is just wrong.

[Gimme Back My Dog]

somebody should draw an analogy between this guy and someone with a gun who fires it at random. that would be cool.

[vache folle]

Slippery slope, thin end of the wedge, etc. I wonder what process he was afforded and what the standard of proof was. He should at least have his case subject to periodic review, and a petition for a writ of hc might help to ensure a fair procedure.

What if the hypothetical shooter is firing bbs at random and can only cause relatively minor discomfort except in some fatal freak accident? Should he be locked up? I say he is analogous to a flu carrier.

[John]

I would place him under house arrest if he refuses to take the appropriate precautions against spreading the disease. This leaves him with some liberty, if only in his home, and is a much better alternative to prison. While I can't think of another situation where just setting foot outside puts others in harm's way, restrictions on one's liberty to protect people in public is fine. People with poor vision who refuse to wear glasses shouldn't be allowed to drive. But such a restriction should only apply to truly dangerous diseases, not colds or second hand smoke. Such decisions should only be made upon the recommendation of medical professionals, not public opinion.

[Cambion]

I agree with the analogies. He was told to wear a mask because he was contagious and didn't. That seems pretty negligent to me. Or at the very least criminally stupid. He had to be stopped and this seems like the most effective way, he can get the treatment he needs but not be a dnager to everyone else.

[Number 6]

Ed-You're missing a crucial difference. AIDS is not an airborne contagion. TB is. A person with AIDS cannot infect others simply by breathing. A person with TB can. Look-aerosol transmissable diseases are different because the risk of spread is so much higher.

A better example would be smallpox or ebola. Or TB; the US has an extensive history of quarantining people with TB.*

*It should be noted that the quarantine power was sometimes abused. As I said, it's a scary power, but probably a necessary one.

[pigwiggle]

He sounds like a dick. Maybe that's why they took his toys.

[smacky]

Why don't some of the religious leaders talk to God and have Him cure them? Problem solved.

I read the article this morning; I can see why the guy needs to be locked up, but why isn't he allowed to have a phone, computer, TV or radio? There are no public-health benefits to keeping such things away from him.

Jennifer,

Maybe, as highnumber already suggested elsewhere, he is just a dick. He does come across as mildly belligerent, if not completely ignorant. Perhaps this is just a temporary petty punishment by the wardens. But I agree, long-term something more humane should be agreed upon.

[John]

Smacky,

If you have a drug resistant form of TB and you refuse to wear a mask to keep from infecting other people, "dick" doesn't even begin to describe who you are. Even still, being a loathsome piece of crap shouldn't give the government the right to take away any more rights from you than necessary to protect public health.

[Grotius]

smacky,

Mary Mallon was in denial about the disease that she carried. Now maybe you don't find any sympathy with her plight, her way of dealing with it, etc. but it is an all too human response that I can at least empathize with though not condone.

[smacky]

John,

I agree...but maybe he was being a dick in prison, too...like turning his TV and radio up really loud, or something like that.

[Walking Anthrax]

Shouldn't this guy be out walking amonsgt the populace so we can all adapt and build immunities to the disease? What's so wrong with a few million of the weakest dying off?

You people don't know shit about science.

[MikeP]

Don't the dangerously insane get this sort of treatment all the time? Granted, they aren't quite as aware of their predicament, but the legal mechanisms are there.

[Grotius]

smacky,

Or maybe not. Whatever the case, it is up to the authorities to justify their action, correct?

[joe]

"I swear the government and the police in particular could fuck up a cup of coffee."

John's right.

City Hall coffee can eat through the quarter panel of a Crown Vic.

[Number 6]

Walking Anthrax- I understand that you're trying to be a smartass, but I'd recommend that you do a bit of research before picking a handle. Anthrax is not, except in very rare circumstances, person-to-person transmissible.

[thoreau]

To be clear, I'm all in favor of (1) due process and (2) better living conditions for the guy.

My point was about the more general issue of whether it's OK to confine somebody with a deadly disease. It seemed like Radley was opening that up for discussion, not just the specifics of the case.

[thoreau]

On a different note, what's so special about Arthur Caplan? Whenever there's a bioethics news story, he shows up to say that "Yeah, it's complicated, there's a lot to consider here."

Now, I know just barely enough about ethics (as a formal field of study) to realize that ethicists don't always just pronounce absolute verdicts, but rather they study the complexity of the issue. So I'm not suggesting that he should just start tossing out his opinions on stone tables with "Thou shalt..." at the beginning of the sentence. But, you know, I have yet to figure out what's so special about this guy.

He's in every friggin story involving bioethics!

[highnumber]

VM,

Not only did I blog it this AM, but I immediately sent this

from [e-mail] hide details 9:30 am (5 hours ago)
to [e-mail]
date Apr 3, 2007 9:30 AM
subject How have you guys missed this story?
mailed-by gmail.com

http://www.reason.com/blog/show/119343.html#671087

I've been robbed of my hat tip!

[Grotius]

thoreau,

I thought that Balko was more interested in what the procedures for, etc. such a process should be. BTW, there is some federal law on this subject. See the Public Health Service Act and the Interstate Quarantine Act. Sec. 70.6 of the latter (as of a few years ago at least) mentioned TB as one of the diseases which the Act applies to.

[ChrisO]

I agree...but maybe he was being a dick in prison, too...like turning his TV and radio up really loud, or something like that.

Problem is, he's not a criminal and this is supposed to be an iso ward, not imprisonment. Even as a libertarian with a low tolerance for govt. power, I think he's extremely dangerous and should not be out and about. But the guards' actions have only given his lawyers more firepower to argue for his release.

[VM]

HAT TIP TO HIGHNUMBER

[thoreau]

I think he's extremely dangerous and should not be out and about. But the guards' actions have only given his lawyers more firepower to argue for his release.

Yep. The more dangerous a person is, the more importance it is that we get it right.

[Grotius]

Er, the Interstate Quarantine regulation. Its the regulation created in light of the organic act (Public Health Service Act) giving the HHS power over this issue.

Anyway, a lot of the pertinent language can be found here: 42 USC secs. 201-202aaa-13 and 42 CFR part 70. Or that was the case a couple of years ago.

[Pro Libertate]

For a blog obsessed with everything Heston, it's hard to believe that no one has referred to The Omega Man. Tsk, tsk.

[someone in AZ]

Ok - the no TV thing: "During the first six months of his confinement, Daniels was allowed to have a TV, clock radio and other amenities. However, in mid-February sheriff's employees seized his belongings and declared they were a security threat on the hospital's jail ward."

http://www.azcentral.com/news/articles/0329tb0329.html

I don't see how a clock radio is a security threat, but whatever...

[Grotius]

Pro Libertate,

Yeah, but his blood in that film was a curative agent, right?

[Fluffy]

One could say that what's actually being quarantined here is the germs. The germs just happen to be inside a person right now.

[Bobster]

So where did this guy pick up this disease?

[Grotius]

someone in AZ,

So is the argument that they were a security threat because other individuals there might use them for nefarious purposes?

[highnumber]

Bobster,

Russia

[MP]

For a blog obsessed with everything Heston, it's hard to believe that no one has referred to The Omega Man. Tsk, tsk.

Especially considering that the remake (of sorts) is due to be released this winter. Starring none other than Will Smith.

[thoreau]

In Soviet Russia, TB evolves resistance to YOU!

[ChicagoTom]

Since most people seem to agree that the state should in fact have the right to quarantine him, would the next logical question be:

Who foots the bill for the quarantine? And who pays for all those other living conditions he should be entitled to? ( Internet, phone, tv)

[Grotius]

At the very least they need to find a locale for him where he isn't surrounded by actual criminals if his items are so dangerous.

[Nybbles]

This has already been dealt with in the pages of Marvel Comics. A little event called "Civil War".

[Grotius]

thoreau,

It seemed like Radley was opening that up for discussion, not just the specifics of the case.

The specifics of this case are a way of discussing the general issue itself. Indeed, that's probably the only way to figure out some of the consequences of any particular policy.

[Number 6]

On a different note, what's so special about Arthur Caplan?

Dr. T- Let me give you a reporter's answer. I would guess that he answers the phone or returns calls, and is known to be ready with a quote. On quick turnaround stories, reporters tend to call the people they know will be available and have something to say.

[Bobster]

If he got it in Russia shouldn't we quarantine everybody who has visited the place?

[someone in AZ]

Grotius - I have absolutely no idea. That's just what the sheriff's people said. In AZ, "security" and "terrorism" get thrown about in really strange ways. E.g., violent teen kidnapping gets turned into "terrorism": http://www.azcentral.com/news/articles/0403evterrorism0403.html

[Bobster]

Until they can be tested that is.

[de stijl]

Re: Remake of The Omega Man

Who plays the Anthony Zerbe role? (Love him! He's the male version of Kay Lenz - i.e., in every movie released during the '70s.)

Will Will Smith sport the ascot / scarf thingie?

[JasonL]

He should be locked up, but somewhere nice.

[de stijl]

In AZ, "security" and "terrorism" get thrown about in really strange ways.

So does this whole thing boil down to Sheriff Joe had another embolism thing? That fucker is insane - and scary.

[lunchstealer]

On a different note, what's so special about Arthur Caplan?

Isn't he that guy that killed that UN Ambassador and then claimed his name was Roger Thornhill or some such foolishness? I think he eventually ended up getting shot by some crazy chick at the lodge at Mt. Rushmore.

[SmartGuy Peter McHollis]

Question: is their anything in the Constitution that states that if you have certain illnesses somehow this means you don't have rights?

[VM]

"JasonL | April 3, 2007, 4:22pm | #
He should be locked up, but somewhere nice."

[tongue in cheek]

Like on a Caribbean Island? It'd be like summer camp! And they'll do cheerleader-style gymnastic tricks! And harmless fratboy hazing stuff

[/TiC]

(your comment did make me lol! was just having fun with the rest - not poking at you at all)

[Doc]

Well since TB is my speciality, this guy is hardly the only one in confiment like this. The confinement laws have been around a long time and we use them on a number of occassions for those patients with TB that are considered infectious (drug suscept. or resistant, doesn't matter). Don't want to take your drugs? Fine. Since you're sick you have a 50% chance of dying or getting over the disease. We'll wait you out.

If you're a healthy person, if MR. XDR TB infects you, you have a 10% chance (lifetime) of coming down with the disease. And if it's a true XDR, there may be no drugs to treat you. Maybe some surgical intervention can improve your odds but it'll run 50% mortality.

We've had one highly infectious MDR TB case in NYC under house confinement for 10 years now. He can leave with a mask but otherwise he has to stay inside.

1 MDR or XDR case can run from $250k on up to treat so money rears it's ugly head in this equation for *sure*.

[Eric the .5b]

Yeah, I guess I don't have a problem with sequestering a person who carries an airborne contagion that's untreatable and often fatal, if he refuses to take steps to protect others.

As an analogy, I think we'd all agree that a person who goes around firing a gun randomly should be locked up (after due process, of course, and the an-caps can insert provisos about how it should be done in accordance with contracts that property owners sign with security companies)

Emphasis added.

Uh, where's the due process? Is lifetime imprisonment on the basis of a court order acceptable, then?

How can he go about appealing this?

We do detain people, especially those considered dangerous, before a trial.

What trial?

I'm not utterly against the idea of quarantining people with dangerous diseases, but can we at least try not to pretend doing so fits reasonably and comfortably in the framework of a liberal society? He's not being punished for breaking a law, he's being imprisoned indefinitely because he's considered a threat. It may be necessary, but I don't we we're right to shrug and say "Yeah, no-brainer."

[Willy]

Its worth noting on the whole mask thing that regular surgical masks are only effective in preventing TB spread if worn by the patient, and don't help a bystander. A bystander would have to wear a respirator (a different kind of mask that all the air actually passes through) which has to be fitted, and can restrict breathing (esp. if you have a heart condition). So, asking everyone else to wear one, doesn't really work.

Its also interesting that in many countries (esp. in Asia) its considered socially unacceptable to not wear a mask if you are out in public with even just the cold or flu. When someone with the flu sneezes all over you on the subway, it doesn't seem hard to make the leap to seeing that as an assault. Not that they should be throw in jail, but they could put you out of commission (or if you're old, even kill you) just as easily as if they had punched you in the face. Petty biowarfare, if you will. Its a the very least a more solid basis for state action than second hand smoke.

[highnumber]

JasonL, VM,

Like this?
It worked for some other sickies.

[Brian24]

Who foots the bill for the quarantine? And who pays for all those other living conditions he should be entitled to? ( Internet, phone, tv)

I'd say that, since he is being imprisoned against his will to protect the welfare of the general public, the general public should pay. And just as the government is the conduit by which he is imprisoned, the money should be spent through the government.

It's not like we're talking about a huge expense in context here.

[hanmeng]

Of course they took away his computer. He could transmit viruses through the internet tubes! And radios can have tubes, too, even in a vaccuum!

[swillfredo pareto]

AIDS is not an airborne contagion. TB is. A person with AIDS cannot infect others simply by breathing. A person with TB can. Look-aerosol transmissable diseases are different because the risk of spread is so much higher.

An HIV+ person can certainly infect someone without that person knowing they are at risk. Aren't there various laws that can be used to prosecute an individual for knowingly exposing an individual to HIV without telling his/her partner?

[mike]

I just wanted to respond to Choy's comment

This guy won't put on a mask and his initiation of force is not obvious like the gun firing. I'd say you have every right to just shoot him in self defense.

His right to life and liberty stops immediately at the point that he actively interferes with my right to life and liberty. Going around spreading a deadly disease is definitely actively interfering.

It troubles me to hear someone take aphilisophical point of view, and not take pause regardless of the conclusion it points to. Ovbiously it is logically sound to say: if you threaten my life, I get the right to end yours. But holy shit, doesn't that give you pause

Obviously you are only talking, and will never be in a place to put forth policy (I hope). Still, no one has absolute truth at their disposal -fundamental christians/muslims/jews, or democratically elected representatives or libertarian theorists. We can have our views and put them forward, and if it is well thought out we can put forth radical ideas. Still, let's keep in mind the fact that we are all faillable. That is a big part of what I like about libertarian ideas -no government will be 100% correct, so let's limit them. But we should be wary of the other extreme of absolute personal liberty, or at least circumscribe it when it leads to a right to kill.

[Aresen]

The evolution of drug-resistant and highly-communicable diseases will be a greater and greater problem in the future. We may be faced with the necessity of isolating hundreds of thousands of people.

Walking Anthrax's comment at 3:47 may be sarcastic, but it has a bit of truth. The number of infected persons may get so large that we cannot contain the disease.

That's when nature will begin culling us. Drug-resistant tuberculosis is already endemic in Russia and parts of Asia. Ebola and the Marburg virus have both come within hairbreadths of escaping containment several times in the last 15 years. The flu virus is constantly mutating.

Sooner or later, something is going to get loose.

[Thomas Paine\'s Goiter]

The hard question, of course, is when you start drawing lines for diseases in the gray area.

Today, once again on H&R, Thoreau as Cathy Young.

[John Travolta]

Can't we get a plastic bubble for this guy?

[thoreau]

On the one hand, TPG's comment is quite funny.

On the other hand, it could be construed as an insult.

And on yet another hand, the routine that I'm doing right now is getting kind of tedious.

🙂

[Tom Accuosti]

Problem is, he's not a criminal and this is supposed to be an iso ward, not imprisonment.

But the children! Doesn't anybody care about the children?

We do have some history of locking people up who are a potential danger to themselves and to the community; but are people carrying certain pathogens ethically equivalent to the insane?

[thoreau]

In regards to the specifics of the case, from what Doc is saying in his 4:33 pm post it sounds like this guy isn't actually contagious yet? If that's the case then it's pretty messed up.

If this guy isn't actually spewing spores of death every time he exhales then I don't see the justification for keeping him locked up.

Can anybody else explain more about the science and risks here?

[Thomas Paine\'s Goiter]

Sooner or later, something is going to get loose.

Let's hope it's the nymphomania virus.

[Pro Libertate]

Charleston Heston's solution in The Omega Man was to shoot everyone who was infected.

[Thomas Paine\'s Goiter]

And on yet another hand, the routine that I'm doing right now is getting kind of tedious.

Tell us about it.

[Pro Libertate]

Sorry, Chuck, I meant "Charlton Heston". My brother is going to Charleston on vacation.

[Doc]

No, the guy is considered 'infectious' if they can detect the bacilli in his sputum (so coughing, sneezing, etc.). You need it in the sputum to make the aerosols that are so effective at transmission.

TB is a disease you can have but is latent and may never proceed to the 'active' (and potentially infectious by the presentation) deadly form.

This dude is highly infectious with a bacterium that, if he succesfully infected you by sneezing, talking, coughing, you would run a 5% chance of dying, a 5% chance of being under similar isolate and requiring a year or two (or more) of nasty antibiotic therapy.

[D.A. Ridgely]

Should a guy with a gun refrain from firing projectiles at random, or should I be responsible for wearing body armor?

Depends on the neighborhood.

[Paul]

I believe that the history of Tyhpoid Mary should provide some guidance. Here was a woman who was somewhat mentally unstable and went 'underground' preferring the food industry as her primary mode of employment. Look, it is a tough call. Individual rights, freedom, fourth amendment, ninth amendment, blah blah. But man, when someone is a walking biological weapon, what the hell are you going to do? Sorry, I haven't RTFA'd yet.

[Thomas Paine\'s Goiter]

This dude is highly infectious with a bacterium that, if he succesfully infected you by sneezing, talking, coughing, you would run a 5% chance of dying, a 5% chance of being under similar isolate and requiring a year or two (or more) of nasty antibiotic therapy.

Can't we send them to Gukanjima?

Drop all of those bastards onto the island and airdrop supplies every couple of months. Give them satellites and such for intarwebnet communications and take care of this issue.

[Rex Rhino]

There are literally hundreds of thousands of sizeable uninhabited islands. If this becomes a real problem (i.e. more than just one in a country of 300 million people), than it seems reasonable to build colonies. With telecommunications, those colonies could even have working economies...

[Thomas Paine\'s Goiter]

With telecommunications, those colonies could even have working economies...

Are you thinking what I'm thinking?

Leper Porn!

[thoreau]

Just make sure the island doesn't have any polar bears, crazy French women, creepy cults, or computers that activate giant magnets if a code isn't entered.

[Pro Libertate]

Fools! Why do you think we're going to build a massive moonbase?

[Matt]

Should a guy with a gun refrain from firing projectiles at random, or should I be responsible for wearing body armor?

The former. The inherently dangerous, and therefore agressive, act should be curtailed. This is pretty clear to me.

It's similar to carrying a holstered gun vs brandishing. The gun has the same potential for damage, but holstered is not an inherently agressive position. Unholstered and pointing at someone is. Wearing a mask, the bugs are still dangerous and untreatable, but it's not a dangerous presentation.

It's not unreasonable to restrict random firing of a gun in another's direction without cause, similar to a bat, fists, etc, and spraying germs in their general direction.

[jw]

What if the guy had rabies? That's even more contagious (though not air transmisable, I think), virtualy untreatable, and definitely fatal. If it were a dog that was infected, would anyone hesitate to shoot it?

On another note, instead of locking him away - how about shunning him somehow?

[Eric the .5b]

OK, I'm seriously asking whether we can lose the "guy waving around and shooting a gun" metaphor, because it stinks.

Someone waving around and shooting a gun could be prosecuted for his intentional act under a number of laws and, via due process, convicted and imprisoned. If he wasn't mentally competent, he could be confined for his protection and the public's.

We're not talking about intentional acts or crazy people, here. We're talking about people who, unwillingly, pose a threat to everyone else and about voiding their civil liberties and human rights in order to remove that threat.

It may be necessary, but conflating that with completely different things doesn't advance the discussion any.

[NotThatDavid]

Not wearing a mask after being told to by a doctor is an intentional act. That's the crux of the situation.

[jw]

"We're not talking about intentional acts or crazy people, here. We're talking about people who, unwillingly, pose a threat to everyone else..."

Seems to me that if he did not wear a mask in public, he IS willfully posing a threat. I don't think I care too much about his "intentions" - hell being paved with them, etc. etc.

[jw]

Crap! NTD beat me to it.

[Eric the .5b]

Not wearing a mask after being told to by a doctor is an intentional act. That's the crux of the situation.

No, that's not the crux of the situation. He hasn't been tried and convicted of refusing to wear a mask, nor is quarantine inherently limited to some guy who refuses to wear a mask.

He's being confined because he's contagious.

[thoreau]

To expand on what NotThatDavid said, it's not just that the doctor is an authority figure. It's that he is knowledgeable of the likely consequences of his actions, the likelihood that at some point he's going to give a number of people an illness that (at least according to figures offered in this thread) will kill 5% of the people he gives it to and subject another 5% to a long and serious illness.

Knowing the consequences of acting without protection, he does so anyway.

Now, one could ask whether similar logic would apply to STDs. I would say that STDs are transmitted via an act that should be consensual. Informed and consenting adults engaging in a deliberate act with someone are very different from people who happen to sit at the adjacent table in a restaurant.

[thoreau]

BTW, I should have added the proviso that he should still have the right to contest the allegations made against him in a fair and speedy trial. I am defending the concept of locking up a person who knowingly endangers innocent strangers on the street without their knowledge and consent. I am not defending the concept of locking him up without due process.

[Sandy]

The guy has a court hearing coming up, and is being held in detention prior to that hearing. I really don't see the constitutional issue some people are trying to make it.

We also have laws against him intentionally having sex with someone and not informing them he has HIV, and I think this would be similar. He was caught intentionally going out in a way that he had been told would transmit the disease, whether docs in Russia wear masks or not.

That being said, give him his freaking radio, but tune it to a channel that says, "Next time wear your goddamn mask, you pseudoscientific Russki-wannabe prick," on a loop.

[Eric the .5b]

Knowing the consequences of acting without protection, he does so anyway.

As you've put it in Gitmo discussions, we have government mechanisms for dealing with dangerous people who choose to do harmful things. If he's negligent, let's put charge him and put on trial.

Except, um, nobody's interested in charging this guy. He's just being kept in a cell on a court order.

[Eric the .5b]

We've crossed posts, Thoreau...

But let's tweak one thing. What if there wasn't even the question of the doctors being willing having him out and about with a mask on? What if they thought that was too risky?

We've lost even the illusion of negligence and crime and due process at that point.

[Jon H]

I'm betting he doesn't have the radio/computer/etc simply because those are the rules for the usual occupants of his residence.

In other words, slavish dedication to rule-following is at fault.

[thoreau]

What if there wasn't even the question of the doctors being willing having him out and about with a mask on? What if they thought that was too risky?

Then that's a hard question. I know it's been pointed out earlier in this thread that there are already laws and traditions addressing this sort of thing, but I take your question to be of an ethical nature, not a historical nature. i.e. If we could make the decision and perhaps change those laws, what decision would we make?

If his contagious stage is of finite duration it's perhaps less problematic. There are still some issues, it's never good to lock away a person who isn't trying to hurt anybody, but if it was finite, well, we could be pragmatic and console ourselves that it's only temporary. (Might not be much consolation to him, however.)

If he's likely to die, then the problem also sort of solves itself, at least at some point: He won't even want to be out on the street, he'll be too weak for that, so he'll need (and presumably want, at that point) to be in a hospital getting pain relief and whatever else the doctors can do to ease his suffering. Then again, he might be the sort who wants to die doing something he loves doing, or in a place that he loves being. An understandable and common concern, and hopefully one that can be at least partially addressed with appropriate quarantine procedures, i.e. send him to the family farm or whatever emotionally significant place but keep him in a bubble and give him pain relief.

But this hardly covers all of the plausible cases.

[s.m. koppelman]

What a bunch of anti-freedom statists you all are, favoring government-backed lockup of this guy. In what way does his mere contagiousness constitute an assault?

If and only if he infects someone and that person can prove beyond doubt that he was the person responsible for transmitting the disease, then the aggrieved should be able to seek financial redress through an independent court selected by mutual agreement by both parties.

And you call yourselves libertarians!

[NoStar]

I know how this guy could get released immediately. Get infected with AIDS.

AIDS: The only disease with its own civil rights!

[Fluffy]

Since we're handing out uninhabited islands, where do I sign up?

I'll pay for the construction of my living quarters and my transportation there. I'll also telecommute [I already do] and pay my living expenses / supplies / taxes, etc.

Where's my island?

[Sandy]

And you call yourselves libertarians!

Everybody drink. It'll ward off what ails ya.

[Fluffy]

BTW, I was only partially being facetious above when I asserted that it was the germs and not the person being confined.

So in some respects it's not a due process issue.

The individual is somewhat in the position of a person caught in a shootout between the police and a gang of robbers. The police are entitled to use force to apprehend the robbers, and in some unfortunate situations that will mean that an innocent bystander catches a bullet. In this case, the public health authorities [the police] are trying to apprehend and incapacitate some germs [the robbers] and this guy happened to catch a bullet.

[highnumber]

Troll and/or Sarcasm of the Day Award goes to...

...s.m. koppelman!!!

I give you the benefit of the doubt, of course, but the award has already been named.
Funny. Very funny.
You forgot though that the victim also has to prove that the infection wasn't consensual at the time.

[brotherben]

Seems like I saw a scare piece on tv a few months ago about Mexican and other Central American people having a similarly untreatable strain of TB.
I suppose now I oughtta look into it before I hitchhike to Cancun for spring break. Crabs the size of grasshoppers is one thing.....

[Eric the .5b]

I take your question to be of an ethical nature, not a historical nature

More of a human-beings-and-government matter.

Let me put it this way: the latching onto the matter of his failing to wear a mask is our way of trying to rationalize what's being done with a discussion of negligence and continuously-firing guns. But this isn't why or how the government is doing this, any more than some person rotting in Gitmo is a convicted criminal because we could rationalize that he'd be convicted of whatever crimes in a fair trial.

Call it sensible, call it utilitarian, call it expedient, call it but-what-else-can-you-do?, but acknowledge that the idea of involuntary quarantine is not about what we'd want it to be about (and probably never will be). The whole practice is about preventing innocent people from dying at the cost of being willing to void someone else's human rights. Our government may or may not choose to be as humane as possible about it, but that doesn't change the situation.

[Eric the .5b]

The individual is somewhat in the position of a person caught in a shootout between the police and a gang of robbers. The police are entitled to use force to apprehend the robbers, and in some unfortunate situations that will mean that an innocent bystander catches a bullet. In this case, the public health authorities [the police] are trying to apprehend and incapacitate some germs [the robbers] and this guy happened to catch a bullet.

So, Radley Balk is the perfect guy to cover the issue, then.

[Eric the .5b]

Balko, beg pardon.

[Eric the .5b]

And I don't mean my last post to lecture anyone...I just get this palpable feeling that we're all squirming to find a comfortable way to look at this situation, because it's just not right, but unlike, say, Jose Padilla, we can't bring ourselves to say, "Let him out!"

[Aresen]

s.m. kopperman

I salute you, sir.

Why don't you visit this poor man personally and assure him of your support. Shake his hand. Give him a kiss.

[jw]

"being willing to void someone else's human rights."

He doesn't have the right to infect others nor does he have the right to attempt to infect others. I don't think he has a right to even chance infecting others. If this guy's "externality" that he is emitting were secondhand smoke or smog, or greenhouse gases - what then?

[mediageek]

"I don't see how a clock radio is a security threat, but whatever..."

On an episode of Mythbusters, they used chunky salsa and a clock radio to cut through jail bars.

/watches too much teevee for a guy without cable.

[jw]

hey, mediageek! How was that done, anyway? Seriously. (the info might come in handy some time.)

[highnumber]

Does it have to be chunky salsa?
Would tomato soup with some haba?ero sauce work as well?

[Your Good Buddy Johnny Clarke]

I notice everyone keeps side-stepping the Typhoid Mary implications. Let's say, for whatever reason, he should be released. Fine.

Let's say he decides to take a job in a restaurant, or working at a day-care center, or assisting the elderly...In a sense, aren't we now morally responsible for the ensuing infections and deaths because we did not stop him?

[Eric the .5b]

He doesn't have the right to infect others nor does he have the right to attempt to infect others. I don't think he has a right to even chance infecting others.

By that logic, since he's risking infecting the medical personnel caring for him if anything goes awry, he should be killed and his corpse carefully disposed of.

If this guy's "externality" that he is emitting were secondhand smoke or smog, or greenhouse gases - what then?

See, this is the other reason we shouldn't be struggling to work out some nice, comforting excuse for why it's ethically benign to quarantine him - you flush, and the justification ends up rushing back up the pipe at you.

Potentially lethal infectious disease, offensive smell of smoke...what's the difference, after all? Externalities, man!

[Eric the .5b]

I notice everyone keeps side-stepping the Typhoid Mary implications. Let's say, for whatever reason, he should be released.

Nobody's said that, quite the contrary.

[brotherben]

I think we are all overreacting a bit. The cured nun what had parkinsons needs to get the pope JP2 to intercede for this unfortunate soul and prove hisself saint-worthy material.

[Your Good Buddy Johnny Clarke]

I guess I was trying to separate individual liberty from work/career...I'll come back when I have some sort of lucid argument. Nothing to see here, move along.

[jw]

"By that logic, since he's risking infecting the medical personnel caring for him if anything goes awry, he should be killed and his corpse carefully disposed of."

Not neccessarily. The medical personnel are not caring for him against their will; they are doing the jobs they were hired to do and that they freely chose even though they know the risks involved.

"Potentially lethal infectious disease, offensive smell of smoke...what's the difference, after all? Externalities, man!"

The last I heard the offensive smell is not the main objection to secondhand smoke, but even if it were, there is certainly a substantial difference between offensiveness and lethality. In any event, if someone insists on blowing it in my face or otherwise forcing it upon me, should I have no recourse?

[The Real Bill]

Good thread. I'm a little more radical. If he was told that by not wearing a mask he would infect others, and 5% of those would die, then when he failed to wear the mask, he commited the crime of attempted murder.

But I'm a wacko. I think that running a red light is attempted murder.*

*I'm no lawyer, so I'm sure there is a better and more accurate term.

[J Golden Rockwell]

Matt wrote: "It's similar to carrying a holstered gun vs brandishing. The gun has the same potential for damage . . ."

Matt, you need a better gunsmith. Or don't put the thing in the holster with your finger in the trigger guard.

As far as the disease issue, the answer is simple, and only the latest generation has any trouble understanding it. You MUST isolate anyone whose simple existence is a significant danger to innocent bystanders. If he won't do it voluntarily, he has himself broken the "initiation of force" bubble. Nothing in the rule of self-defense requires that the attack be intentional before we can respond.

I'll bet that the Philippines or Micronesia would happily sell (or lease) the US an island or three for an isolation colony. Each can provide the basis for infrastructure that would be needed, and each could benefit from the boost to the local economy.

At the same time, both the RP and Micronesia are beautiful places, and it would be a lot cheaper to make the isolation colonies pleasant than to pay the costs for imprisonment of a growing number of the ultra-contagious over the next couple of decades.

[matt]

OK, i haven't read the entire thread, but on the "man who fires off rounds randomly all the time." We all seem to agree is chill to detain him, but one person said that he would at least get a trial...well no, if he was firing off the bullets..the cops would stop him from firing his gun, disarm him THEN arrest and try him. Now this guy with TB is like that same dude randomly firing bullets...except his hands are guns, and the only way to stop him from firing is to a. lock him in a bullet proof room or b. cut off his hands

[Thomas Paine\'s Goiter]

Where's my island?

What disease ya got?

[Adam]

Quarantine him, but make it a humane quarantine. TV, internet, TiVo, library card, etc. As comfy as possible

[LoneSnark]

And we should pay for it. The least we can do, if we are going to quantine someone against their will, the least we can do is make them comfortable AND compensate them and their family.

[Mike Espinoza]

I agree with Adam. If anybody ever quarantines me, they damn well better ship my computer, entertainment system, books, magazines, and every bit of analog and digital media that I own.

The question is a compelling one, though. The AIDS scare in the 80s brought up many of these issues, but education and activism helped to quell the hysteria. In this age of the Patriot Act and biological WMD, hysteria may be all that is necessary to start putting people away. I hope that last sentence proves to be hyperbole. Hysterical hyperbole.

[The Wine Commonsewer]

Think: Leper Colonies, like on Molokai.

Hired an old lady eons ago as a secretary. As a child, she had lived through the flu epidemic of the late nineteens in San Fran. She had the flu. Her house was under quarantine, she was not permitted outside. Her mother was required by law to wear a mask in public and was not allowed to ride on the inside of the street car. Outside only.

I'm like Radley. No real answers.

[Throw the Jew Down the Well]

Since we're handing out uninhabited islands, where do I sign up?

http://www.reason.com/

[Throw]

That is, on site.

[welfare queen]

This reminds me of that time Wilford Brimley got locked in a shack for the greater good.

[Cracker\'s Boy]

Send him to France.

CB

[tros]

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/04/MNG2EOF84U1.DTL&type=health

The government is on track to approve a new antibiotic to treat a pneumonia-like disease in cattle, despite warnings from health groups and a majority of the agency's own expert advisers that the decision will be dangerous -- for people.

The drug, called cefquinome, belongs to a class of highly potent antibiotics that are among medicine's last defense against several serious human infections. No drug from that class has ever been approved in the United States for use in animals.

The American Medical Association and about a dozen other health groups warned the Food and Drug Administration that giving cefquinome to animals would probably speed the emergence of microbes resistant to that important class of antibiotic, as has happened with other drugs. Those super-microbes could then spread to people.

Echoing those concerns, the FDA's advisory board voted last fall to reject the request by InterVet Inc. of Millsboro, Del., to market the drug for cattle.

Yet by all indications, the FDA will approve cefquinome this spring. That outcome is all but required, officials said, by a recently implemented "guidance document" that codifies how to weigh threats to human health posed by proposed new animal drugs.

The wording of "Guidance for Industry 152" was crafted within the FDA after a long struggle. In the end, the agency adopted language that, for drugs such as cefquinome, is more deferential to pharmaceutical companies than is recommended by the World Health Organization.

Industry representatives say they trust Guidance 152's calculation that cefquinome should be approved. "There is reasonable certainty of no harm to public health," Carl Johnson, InterVet's director of product development, told the FDA last fall.

But others say Guidance 152 makes it too difficult for the FDA to say "no" to some drugs.

"The industry says that 'Until you show us a direct link to human mortality from the use of these drugs in animals, we don't think you should preclude their use,' " said Edward Belongia, an epidemiologist at the Clinic Research Foundation in Marshfield, Wis. "But do we really want to drive more resistance genes into the human population? It's easy to open the barn door, but it's hard to close the door once it's open."

[eb]

Several people have brought up AIDS and it does point to an example of the government putting civil rights first in a public health issue. We chose to not impose quarantines or shut down the most obvious avenues for widespread infection, choosing civil liberties as more important. Now it is evidently killing millions around the world.

Would anybody had done anything differently if they knew where we would be 20 years later?

[andy]

This guy is worse than criminal. He knowingly and willingly put people at risk for a fatal disease. They're treating him WAY too good.

[Mikeyes]

Under the laws of every state, he will have due process. But not under the criminal system, rather in the civil courts in which the time lines and burdens of proof are different.

He is not a criminal. He is a public health menace.

[tbone]

All stations this net, this is Viper 6.
The Commander in Chief has issued final authorization . . .we are ordered to proceed.
Some of us have doubts about what we are about to do. It's human.
But the fate of the nation, perhaps the world is in our hands.
We are the last line of defense. .and we can not, we dare not refuse this burden.
I am confident that each of us . . that each of you, will do his duty.
Viper 6 out.

[Joshua]

How's this for an alternative to quarantine?

1) Give him a fake military uniform (any Coalition country will do) and a bunch of documents containing fake military secrets.
2) Instruct him not to resist if captured, and to cooperate fully with his captors.
3) Fly him out to the Persian Gulf, put him on a raft set him adrift, slowly, toward Iranian waters.
4) Sit back, wait for the Iranians to pick him up, and watch the fun begin.

At least that way, if he dies, he can die a hero, and maybe even take a few bad guys with him. Maybe even ol' I'madinnerjacket himself.

[Singeq]

It's not appropriate to say he didn't do anything wrong. He is guilty of reckless endangerment.