Medical Ethics and Moral Dilemmas
Posted by Jerry on December 19, 2007
A story came up on Yahoo! News today about 49 highly infectious tuberculosis patients in South Africa who escaped from their hospital isolation units where they were being forcibly confined for treatment.
The last paragraph of the story evoked some interesting thoughts on the moral nature of this situation:
Although forced confinement of patients violates most medical ethics, authorities say they have no choice but to put the wider public good above individual rights. Confinement for XDR-TB is at least six months.
I can reasonably assume that the South African authorities are functioning on a utilitarian ethical system in their decision-making: individual rights are dispensable in the name of “public good” as defined by authority.
Is having an infectious disease grounds for limiting–or even denying–the right to liberty? Is it a crime to live in a society with a highly infectious disease?
I am not entirely confident of the answers I am about to offer and of all their implications. My aim, however, in writing this post is to clarify the moral and legal dilemmas that arise from health-related conflicts of interest. More importantly, I wanted to examine these apparent conflicts from an Objectivist perspective because, largely, the field of medical ethics has been dominated by utilitarian, altruist, and religious moralities–often proposing grotesque solutions that makes one wonder if the situation hasn’t been worsened further.
I believe that the Objectivist theory of rights offers by far the most robust framework of principles against which such moral dilemmas can be analyzed and successfully resolved. Having said that, what follows is my own application of the Objectivist ethics to the situation being discussed; this does not mean that my application is accurate or that this is what Objectivism prescribes.
The Yahoo! news report only states that the individuals have highly infectious tuberculosis. There are several kinds of tuberculosis and it should be clear that to have a highly infectious disease is not necessarily to have a contagious or communicable disease. Tuberculosis of some kinds are highly communicable, but not all of them are.
Individuals with fatal, life-threatening, and communicable diseases pose a real and direct threat to the lives of healthy individuals in their normal surroundings. In this sense, the existence of such a disease in a general environment can be thought of as the existence of force or threat to individual rights in society. To illustrate:
A person who walks on a busy street with a knife in his pocket has not committed any crime and is well within his rights. However, the moment he draws his knife menacingly at another unsuspecting and innocent individual and stands poised to attack, he has created a context of force, introduced a threat to life, and has abandoned the context of freedom that makes rights possible. Therefore, at this moment, even if physical contact between the attacker’s knife and the other individual has not occurred, and even if he has not lunged forward with his knife to attack, the man has committed a punishable crime.
Likewise, an individual with a highly infectious but non-communicable disease existing in a public environment has committed no crime and remains well within his rights: he is like a man walking with a knife in his pocket. However, if the individual is aware that his infectious disease is communicable and life-threatening, then he properly should choose to or be forced to separate from healthy individuals in his environment.
Further, despite his knowledge that his disease is life-threatening and communicable, if the man makes a deliberate, careless, or negligent act of transmitting the life-threatening disease to another unsuspecting or unwilling person, he has introduced the threat to life and relinquished his right to live freely among healthy individuals in a non-threatening environment in society.
Yet, this does not mean that the person with the disease should be imprisoned as a criminal; it certainly does mean, however, that such a person with a life-threatening and communicable disease must be isolated and quarantined. And then, it is up to the victim of this person’s actions whether or not to pursue criminal or civil charges against the infected individual for his negligent or deliberate endangerment.
Going by the above framework, a communicable disease that is not life-threatening does not meet the criteria for isolation from society or legal charges, because there is no actual threat to life, which is necessary to invalidate the existence of rights. Likewise, a highly infectious individual with a non-communicable disease poses no threat to the lives and rights of other individuals and therefore cannot be denied any of his own legitimate legal rights.
Thus, it is not matter of public good versus individual rights but an issue of force (or threat to life) versus rights.