Ebola

What Is the Libertarian Response to Ebola?

How a free society should respond to a communicable disease outbreak.

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Credit: Wikimedia Commons

How should a free society respond to an Ebola outbreak? Unfortunately, that question is not hypothetical. The deadly disease continues to ravage West Africa and future Ebola cases in the United States are to be expected. To get a handle on how to strike the proper balance between public health and personal liberty, Reason.com asked four leading experts in the areas of law, health, science, and privacy to offer their recommendations for how U.S. medical and governmental officials should respond to the next domestic case of Ebola.

Don't Sacrifice Civil Liberties
George J. Annas

It is important to begin with the conclusion: trade-offs between civil rights and public health measures are not always necessary, and are almost always counterproductive. That is because we can generally rely on Americans to follow reasonable instructions of public health officials for their own medical protection.

Americans do not want to develop Ebola themselves, and have no interest in spreading it to their families or others. They will almost always demand treatment, rather than flee from it. Quarantine should only be considered for persons who are likely to have been infected with an infectious disease (like Ebola), and then only when they are a possible danger to others (in Ebola exposure, only after they have a fever).

In all cases where quarantine is deemed medically reasonable, it should be done only in the least restrictive way possible. For example, fever monitoring for those exposed should first be done by the individual, and only if this does not seem reasonable, overseen by a public health agency. The next step up in enforcement would be an agreement (like those in Dallas) to be monitored and not to travel out of the area or go to crowded places. Only if this agreement was broken should home quarantine be considered, and only if that was violated should quarantine in a state facility be considered. 

Individuals with disease are not the enemy and are not criminals; they a sick citizens and deserve to be treated with respect. That makes it most likely that government will retain the trust of the people, which is absolutely necessary to deal effectively with an epidemic. In other words, as the AIDS epidemic demonstrated, the promotion of human rights and human dignity can be essential for dealing effectively with an epidemic. We do not have to sacrifice our civil liberties for an effective public health response.

George J. Annas is the William Fairfield Warren Distinguished Professor and Chair of the Department of Health Law, Bioethics & Human Rights at Boston University School of Public Health, School of Medicine, and School of Law. He is co-author of the ACLU report "Pandemic Preparedness: The Need for a Public Health—Not a Law Enforcement/National SecurityApproach."

When Is Coercive Quarantine Justified?
Ronald Bailey

Disease microbes know no boundaries between people, countries, and continents. They treat human bodies as an open access commons that they exploit for reproduction until they kill their hosts or they are defeated by immune defenses. To prevent the invasion and destruction of the medical commons through microbial overexploitation requires germ management. The best way to prevent invasive viruses, bacteria, and fungi from wreaking havoc is to enclose the commons of human bodies by erecting immune system fences via vaccination. Good fences make good healthy neighbors.

Vaccines or antibiotics are, however, not always available. Then isolation and quarantine–the erection of literal barricades–becomes the appropriate way to keep microbes out of the commons of human bodies. Obviously there is a gradation of harm, e.g., we do not quarantine folks who are ill with cold viruses. Quarantine for airborne, easily communicable, deadly diseases is certainly justified. In such cases, protecting the majority from death and disease can and should override a person's right to freedom of movement.

Although the Ebola virus is not nearly as communicable as many airborne microbial diseases, coerced home isolation would be warranted in West Africa as way to break the chain of infections, given the lack of health care infrastructure and the large number of folks who are now ill. Unfortunately, pervasive misgovernment in the region undermines the ability to monitor and coerce people suffering from Ebola virus.

In the U.S. folks who are ill with Ebola must be isolated, but coerced Ebola quarantine of symptomless people is not warranted. Monitoring health care workers and any others who have been in close contact with actual Ebola patients is sufficient to protect the public. Given that microbes do not respect national or continental boundaries, the U.S. and other rich country governments should focus on how best to help health care workers to enclose the Ebola outbreak in the West African medical commons.

Ronald Bailey is a science correspondent at Reason and the author of Liberation Biology (Prometheus).

Expect the Government to Overreact
Declan McCullagh

I continue not to know the right thing to do with people exposed to Ebola who show no symptoms of infection. But I do know that governments make prudent and imprudent quarantine decisions.

English common law authorized quarantines to limit the spread of plague, a concept adopted by the American colonies. A Supreme Court opinion described an early New York City outbreak of yellow fever: "Never did the pestilence rage more violently than in the summer of 1798. The State was in despair. The rising hopes of the metropolis began to fade… The whole country was roused. A cordon sanitaire was thrown around the city."

Sometimes outbreaks of disease combined nastily with anti-immigrant sentiment. In 1900, San Francisco levied a quarantine preventing people from leaving without documentation of bubonic plague vaccination—but it applied only to Chinese residents. New York City over-quarantined some 1,200 Russian Jewish immigrants on an East River island in 1892.

We don't yet know enough about Ebola to decide what the right answer is. Studies have shown that 12 to 20 percent of Ebola patients who died had no fever, so a normal temperature by itself is no clean bill of health.

A key question is how readily the virus can be transmitted by coughing and sneezing, especially in the early stages of the disease. In a Democratic Republic of the Congo outbreak, 5 of 19 Ebola patients reported no physical contact with an infected person, implying aerosol transmission. Similarly, researchers found Ebola can be transmitted between non-human primates and from pigs to non-human primates through aerosol droplets without physical contact. What about humans?

Until we answer those questions, state and federal governments will overreact and under-react. Let's hope we learn more soon.

Declan McCullagh is the founder of Recent.io, a forthcoming news recommendation and prediction engine. He is a former CNET and CBSNews.com political correspondent. McCullagh previously wrote about SARS and quarantines for Reason.

Pandemics vs. Personal Liberty
Jeffrey A. Singer

Public health policy should not be exempt from the "non-aggression principle." Force must be prohibited from interpersonal relationships, except when used in self-defense or retaliation.

In the case of a highly contagious lethal disease, I believe that screening potential carriers, and containing them via quarantine, represents an act of self-defense.

One of the few legitimate functions of the government is to protect people from physical assault. The transmission of a disease with significant lethal potential fits that description.

Therefore, it is appropriate to screen people reasonably considered potential carriers. It is completely proper to confine people found to be a threat to the lives of others until that threat no longer exists.

That's the easy part. The hard part is the science. Who poses a threat and who does not? How long should the quarantine last?

Here, panic and emotion must not cloud rational evaluation of scientific data. It would be a tragedy to curtail liberty through quarantine without a sound, evidence-based rationale. But it is also important to remember that all knowledge is contextual. We know what we know based upon the available evidence. We must be willing to revise our conclusions as more is learned. We must rapidly adjust the criteria for quarantine as new knowledge dictates.

Jeffrey A. Singer, MD, is a practicing general surgeon and an adjunct scholar at the Cato Institute.

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  1. Guns, lots of guns… and flamethrowers

  2. If this isn’t an every man for himself situation then I don’t know what is.

    1. Shit and vomit!

      1. And bloody orifices.

  3. Similarly, researchers found Ebola can be transmitted between non-human primates and from pigs to non-human primates through aerosol droplets without physical contact.

    So, what did researchers find out about quarantine periods for non-human primates and pigs? Seems like that might be germane.

  4. Obviously the best method is to invite everyone in and let them run around without any protections for the rest of the population. I mean it worked so well for the Athenians.
    http://en.wikipedia.org/wiki/Plague_of_Athens

  5. Yawn. Wake me when it leaves the major metropolitan areas.

    1. Stop giving people from Maine superiority complexes.

  6. Let the Health Department initiate a civil commitment hearing. Encourage the judge to appoint his own experts so as not to totally rely on witnesses who work for the executive. Then hope for an accurate decision on whether the person is dangerous enough to be restricted/locked up.

    1. Who’s going to pay for the “Judge’s own experts”? Have you ever witnessed a civil commitment hearing for a psychologically troubled person? It’s a farce. All they need is a cop or doctor to say the person is a threat to himself or others and the Judge relies on that statement with little concern for civil liberties. A civil commitment does not require proof beyond a reasonable doubt, it is usually by a preponderance of the evidence. What this amounts to is that if you can’t prove you’re not a threat you’re going away.

      Civil commitment is a travesty and should be abolished.

    2. GKC, do you realize that it’d basically end up being the Salem Witch Trials: Ebola edition?

  7. Given that microbes do not respect national or continental boundaries, the U.S. and other rich country governments should focus on how best to help health care workers to enclose the Ebola outbreak in the West African medical commons.

    I keep hearing variations of this. But, I don’t necessarily see the underlying support for the claim. Of course bacteria don’t recognize continental or national boundaries. It’s a single-celled organism without the cognitive ability to recognize anything. But, isn’t that sort of beside the point? The diseases travel by means of host organisms (i.e. people with the disease). Those arguing for quarantines are basing their argument on the notion that the best way to prevent an outbreak in a particular nation or continent is to limit the contact with those who might be hosts. And they, presumably, can be persuaded to recognize said boundaries.

    Now, I’m not saying they’re right on this. And I still have some pretty significant misgivings about the inherent violation of individual liberties a quarantine would entail. But, at least intuitively, the advocates of quarantine have a more logical case than the this claim, which seems to confuse metaphor with actual fact.

    1. the U.S. and other rich country governments should focus on how best to help health care workers to enclose the Ebola outbreak in the West African medical commons.

      How this won’t require travel restrictions is a mystery to me.

  8. What Is the Libertarian Response to Ebola?

    Who is “the Libertarian”?

  9. my best friend’s half-sister makes $81 hourly on the internet . She has been out of work for nine months but last month her paycheck was $19645 just working on the internet for a few hours. this link…..

    ????? http://www.payinsider.com

  10. Cannabis can stop or ameliorate the cytokine storm. It is the cytokine storm that kills.

    1. “I’ll have what he’s having.”

  11. It’s rather amusing that the response of President Obola and his fellow Marxists appears to be more libertarian than the Libertarian response. Quarantines? We don’t need no steenking quarantines! We’ll just admit everyone from countries where the Ebola outbreak is in progress! Well, OK, we’ll screen them, just to make the simple folk think we’re doing something, but only in ways that Thomas Duncan has proven ineffective. What happens to civil liberties when the American Ebola outbreak begins will probably be somewhat less amusing.

    1. He only dismissed quarantines because it’s coming from poor African nations. If it were from a rich Scandinavian nation he’d have shut it down right away.

  12. “We don’t yet know enough about Ebola to decide what the right answer is. Studies have shown that 12 to 20 percent of Ebola patients who died had no fever, so a normal temperature by itself is no clean bill of health.
    A key question is how readily the virus can be transmitted by coughing and sneezing, especially in the early stages of the disease. In a Democratic Republic of the Congo outbreak, 5 of 19 Ebola patients reported no physical contact with an infected person, implying aerosol transmission. Similarly, researchers found Ebola can be transmitted between non-human primates and from pigs to non-human primates through aerosol droplets without physical contact. What about humans?”

    Ron Bailey’s comments seem to suggest otherwise; Ron?

  13. How did the United States and the world in general survive the 1918-20 flu pandemic without collapsing into anarchy?

    1. Collapsing into anarchy wasn’t the problem. Millions of people dying very early in their lives was the problem.

      1. Thank you Homple for dealing with the sloganeers.

  14. “Quarantine for airborne, easily communicable, deadly diseases is certainly justified. In such cases, protecting the majority from death and disease can and should override a person’s right to freedom of movement.”

    So everyone who gets the flu should be quarantined, yes?

    1. So everyone who gets the flu should be quarantined, yes? False equivalence.

  15. Humans, being the most adaptable species ever, adapt to survive yet another threat to their species. News at 11.

    1. Win!

  16. “we can generally rely on Americans to follow reasonable instructions of public health officials for their own medical protection.”

    sure, we obese, booze swilling, drug taking, gun shooting and tobacco smoking americans listen very well to public health officials

  17. This did not address the issue as head on as I would have liked. If I distill what the author wrote and try to see through indirect writing:
    – Quarantine by force by an authority is occasionally necessary (or at least a more optimal solution than putting freedom first above all else and letting disease spread unabated).
    – Determining when quarantine is necessary is a cost/benefit analysis question dependent on how infectious the disease is and how deadly or debilitating the disease is versus the harm to the economy and individual freedom.

    Ebola probably doesn’t meet the threshold as it doesn’t seem to be very infectious until the very end, at which point quarantine is absolutely necessary. We only ignore the freedom implications of this end-state quarantine because people are so sick at this point they are not going anywhere anyways. However, our understanding of the disease may be wrong, or the disease may change in the future, and we shouldn’t be so arrogant to immediate write it off as trivial either.

    Infectious diseases and other similar externalities are a ‘problem’ for hard-core libertarians. It’s where theory-meets-reality and fails to offer an optimal solution (and in fact offers almost the worst solution imaginable). Ebola isn’t a strong challenge to the theory though since it is unlikely to pose a real threat. A different, more infectious and deadly virus in the future though may present a much larger conundrum.

    1. a ‘problem’ for hard-core libertarians

      By definition, hardcore libertarians are either not libertarians or not relevant.

  18. Annas and REASON need to do their basic research and stop articles based on speculation, starting by looking at what Libertarians and fans are actually doing in Africa that’s containing the Ebola problem.

    See: facebook.com/LibertarianInternationalOrganization

  19. First, let me say that we should not be engaging in wide-spread panic rather, we should exhibit rational concern. I respect those who come out and admit that either they don’t know and/or those who admit mistakes and take corrective measures immediately. Neither the Obama admin nor the CDC seems willing to do either. That’s why Obama appointed an “Ebola Czar”, Ron Klain, who has ZERO medical/scientific experience. He is a political “fixer”. They need someone to cover their asses.

  20. Bellan et al point out that 41-72% of liberians are seropositive and asymptomatic. Here is a rational libertarian response to the problem-
    http://letstalkbitcoin.com/blo…..blockchain

    1. Do you have anything even remotely relevant?

  21. This is the capitalist response 🙂
    http://www.middletownpress.com…..-sells-out

  22. From reading this article it seems the authors would agree that Ebola is at least close to the threshold for quarantine.

    I think a lot of the disagreement is caused by how we handle the unknowns: What is the exact incubation period? Can it spread through sneezes? Will you always have a fever if infected? We don’t have high certainty answers for these questions.

    Those, like me, advocate quarantine as a precautionary measure have a lower risk tolerance. We are the better safe than sorry crowd that wants more info before lifting restrictions.

    The opposite is the better free than restricted position.

    I think we should focus on this area for discussion rather than the macro view which most libertarians seem to agree on. I wish this article addressed this risk tolerance better. This is not an disagreement that will disappear anytime soon.

  23. Your buckyballs has infinite solutions that you can create. A sense of achievement comes with inventing anything of artistry and fascination . With buckyballs you can mold infinite arrangements of shapes that you will love to flaunt, and create plenty of patterns that are unique, and have never even been seen before!

  24. Ooops, Bailey has committed heresy to those who memorize slogans like “the free market is always better” … but have no clue how to explain why.

    “We don’t have to explain why. The freaking progs control their minds” and they others know better already.”

    “Never mind”

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