Quarantines and Distributive Justice

Abstract

Medical quarantines threaten the civil rights of the persons whom they confine. This libertarian concern, moreover, is anything but fantastic. Infectious diseases, particularly in epidemic forms, commonly trigger retributive and discriminatory instincts, so that actual quarantines often impose inhumane, stigmatizing, or even penal treatment upon persons who are confined based on caprice or even prejudice. But well-run quarantines confine only those whose continued integration in the general population has been reasonably adjudged to expose others to infection and, moreover, impose no burdens beyond those necessary for protecting against this harm. And even the staunchest civil libertarian must accept that one person's liberty may be restricted in this way when necessary for preventing harm to another. The civil libertarian objection therefore identifies abuses in quarantine administration. It does not apply to quarantines per se.

Libertarian concerns do not, however, exhaust the ethics of quarantines. In particular, quarantines also generate an egalitarian anxiety, which addresses the distribution of the burdens that quarantines impose and worries that this pattern of burden and benefit may be in itself unfair. The egalitarian anxiety, moreover, emphasizes genetic features of quarantines - burdens and benefits associated with the patterns of confinement that quarantines inevitably involve - and so casts a wider net than the more common libertarian objection and, in particular, applies even to well-run quarantines. This egalitarian concern about quarantines has nevertheless been overlooked in discussions of quarantines, and the ethics of quarantine are in this respect not well understood.

These pages take up the connection between quarantines and distributive justice and elaborate this connection in a way that tends to sow doubt about quarantines. In particular, the argument compares quarantines to vaccinations - an alternative method of combating infectious disease. It suggests that vaccinations, even if they are less efficient than quarantines, are more fair and should perhaps be preferred over quarantines, all-things-considered. Moreover, and more strikingly, the argument asks whether, when vaccinations are available but are not administered, and an outbreak of disease arises, fairness may require allowing the outbreak to spread unchecked rather than employing quarantines to contain it.

Keywords: medical ethics, quarantines, distributive justice