Academic journal article The Hastings Center Report

It's a Small World after All: Ethics and the Response to SARS

Academic journal article The Hastings Center Report

It's a Small World after All: Ethics and the Response to SARS

Article excerpt

As I sit writing this, I have a scratchy throat, watery eyes, a faint headache and the beginnings of congestion in my head--maybe even a slight fever. Oh, and I've been on an airplane more than a few times over the past month. So my first worry isn't that I've got a classic spring cold, but that I have something far more sinister.

The outbreak of SARS, the viral respiratory ailment, is having wide-ranging impacts on public health, public confidence, and the world economy. Responses to infectious disease outbreaks are a test of the public health infrastructure not only in individual countries and localities, but in terms of the international sharing of information and linked responses. In that sense, SARS is the first test for the post-9/11 world, and drives home the point that public health in the twenty-first century is a truly global issue requiring global responses in a world made increasingly smaller by easy and efficient travel. As I write, the World Health Organization (WHO) updates almost daily its recommendations against "nonessential" travel to infected areas.

How best to attack an illness like SARS? Identification and isolation of cases of infectious disease are the long-standing tools of public health, but they are notoriously difficult to implement effectively and raise obvious ethical concerns around coercive isolation and even quarantine. The fact that President Bush used his executive authority to add SARS to the list of illnesses for which the state can impose mandatory quarantine is evidence of the raw exercise of state power that quarantine represents.

An illness that spreads through the air is a public health nightmare, but controlling one whose symptoms parallel the common cold means that isolation outside of hospital settings is practically impossible. Efforts in cities like Toronto make the point. After the infection was apparently passed among the largely Filipino members of a church, authorities recommended that those with any SARS symptom stay home, and that those in worship settings change their practices-including restrictions on close contact like hugging, handshaking, and drinking from common cups. …

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