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03/05/2015

Using the Least Restrictive Limits in Public Health Emergencies

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) recently released Ethics and Ebola: Public Health Planning and Response. In this brief, the Bioethics Commission examined U.S. engagement in the global response to the Ebola epidemic with the goals of 1) determining what lessons might be learned from the U.S. response and 2) creating recommendations to support proactive response to public health epidemics.

The Bioethics Commission considered in detail the U.S. public health emergency response with regard to the ethical use of liberty-restricting public health measures that involve monitoring or restricting movement and association, such as quarantine, and the impact of such measures on western African and U.S. health care workers. The Commission’s analysis of the use of restrictive measures highlighted the importance of the principle of least infringement, which holds that the least restrictive measures—grounded in the best available scientific evidence—should be taken to protect the public health and health care workers. Specifically, the Bioethics Commission recommended that:

Governments and public health organizations should employ the least restrictive means necessary—on the basis of the best available scientific evidence—in implementing restrictive public health measures, such as quarantines and travel restrictions, intended to control infectious disease spread. In addition, governments and public health organizations should be prepared to communicate clearly the rationale for such measures and provide ongoing updates to the public about their implementation, with particular attention to the needs of those most directly affected.

The Bioethics Commission stressed the importance of ethical preparedness and planning, with an emphasis on transparency and consensus in decision making through democratic deliberation, a process that fosters public engagement. The Commission emphasized using deliberative democratic processes to provide citizens with sound scientific and ethical justifications for public health policies. Drawing on the principles of least infringement, beneficence and non-maleficence, reciprocity, justice and fairness, and the harm principle—in addition to lessons from the current Ebola epidemic and other public health crises, including HIV/AIDS, SARS, and tuberculosis—the Bioethics Commission concluded that public health officials should implement the least restrictive measures that are effective in controlling disease transmission during a public health emergency.

The brief and all other Bioethics Commission reports are available at Bioethics.gov.

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