In a modern day Typhoid Mary case, Arizona has opted to quarantine a man infected with extreme drug resistant tuberculosis (XDR-TB) — in the local county hospital’s Ward 41, the section set aside for sick criminals. Robert Daniels has been locked up there since last summer, and is going to be there…indefinitely. He says that he’s being denied showers, has to clean with wet wipes, and has had his television, radio, personal phone and computer, etc, removed. He is effectively in solitary confinement, visited only by the medical personal who make sure he takes his medication. And I have to wonder — this really the least restrictive method of protecting the public? While I can understand having to remove someone who’s a serious threat to the community during treatment, is (effectively) a jail cell the appropriate place? Why do the Phoenix hospitals not have isolation rooms outside their criminal ward? What are they planning on doing during a major outbreak of any massively contagious disease — toss out the inmates and take over the cells? And why is he being denied a television, radio, personal phone and computer, and etc? It’s not like XDR-TB is going to attach itself to an email and infect the world…
There is an interesting discussion of a ruling by the European Court on Human Rights in this article by Jerome Amir Singh that suggests how to determine if forced quarantine and isolation are reasonable and justified measures (a topic Matthew Wynia wrote on in the January issue of AJOB). The courts ruled with the applicant in a Swedish case where the public health officials wanted to lock up a man who’d spread HIV after being told (basically) to knock it off, saying that “any such detention must be in compliance with both the principle of proportionality and the requirement that there be an absence of arbitrariness such that other less severe measures have been considered and found to be insufficient to safeguard the individual and the public.”
The Arizona XDR-TB case is clearly flunking some of the most basic requirements of confinement for a public health matter. Singh (et al) say that
The use of legally sanctioned restrictive measures for the control of XDR-TB should not obscure the fact that being infected is not a crime. A strong reciprocal obligation is borne by authorities so wishing to invoke these measures. Those who are isolated require humane and decent living conditions. In fact the restriction of their liberties is more for a collective good than for their own. Thus every effort must be made to ensure conditions of living that preserve dignity.
I’m pretty sure being locked up in a cell, no human contact, no mirror, no shower, no forms of entertainment, etc, for an indefinite period of time, is about the furthest you can possibly get from preserving dignity.
Originally posted on the American Journal of Bioethics Editors Blog.