Legal Authorities for Interventions During Public Health Emergencies

Every imaginable threat from civil suits to cold-blooded murder when they got an opportunity to commit it, was made by the writhing, cursing, struggling tramps who where operated upon, and a lot of them had to be held down in their cots, one big policeman sitting on their legs, and another on their heads, while-the third held the arms,_bmed for the doctors. Account of the 1901-1903 smallpox epidemic in Boston! The public health measures used to control the 1901-1903 outbreak of smallpox in Boston, as reflected in the media account quoted above, no doubt appear draconian to a modern-day public health officer. Recently, however, public health officers, academics, and government policy makers, motivated by con-cerns about the threat of bioterrorism, have questioned whether the intentional release of a biologic agent such as smallpox would necessitate a return to s1}ch coercive public health measures as compulsory vaccinations. Such concerns have been highlighted by recent events surrounding the unprecedented terrorist attacks on the World Trade Center and Pentagon on September 11,2001. These trag-edies underscore the importance of public health officers understanding their legal authorities to ensure an effective, well-reasoned, and appropriate public health response that will safeguard civil liberties in a national emergency. This chapter descrlbeS- the legal authorities for interventions during public health emergencies. Although this chapter focuses almost exclusively on acute events, namely, bioterrorism, pandemic influenza, and emerging and infectious diseases, many of the principles covered may also apply to noninfectious or nonacute events. The second part of the chapter provides a brief historical back-ground explaining how the power of the state has traditionally been used to control infectious disease and describes the legal structure and sources of public health law in the United States. The third section discusses evolving issue