Ethical Principles and Legal Reform Related to Non-pharmaceutical Interventions during an Influenza Pandemic

Pandemics are the most dramatic representation of influenza. Three have occurred in the 20th century; the 1918, 1957, and 1968 influenza pandemics and have caused considerable morbidity and mortality. “History repeats itself” is a fond saying reminding us that, not always but frequently, what has happened before can, when we least expect it, happen again. Although we experience the “flu” seasonally, an influenza pandemic differs greatly in intensity and must be respected. Many methods of containment and prevention are used during times of influenza pandemics. These tactics include preventative vaccination of the public, prophylaxis and treatment with antiviral medications, and quarantine and isolation. Quarantine and isolation are effective uses of disease containment, however they must be used carefully and require the understanding of society and the time in which we live. The ethical and legal concerns become difficult if the public’s compliance is minimal. Although mandatory quarantine is a potentially powerful tool in the hands of governing bodies, will the capability exist to implement it effectively and, more importantly, should it be put into practice? A crucial foundation of public health and law is the safeguarding of individual liberty while protecting and promoting the health of its citizens. A way to remain prepared and clear headed during a time of rapid decision making and uncertainty is to establish up front an ethical and legal framework to be followed. This paper addresses ethical principles and legal reform related to non-pharmaceutical interventions during an influenza pandemic and will consider past evidence, areas of possible conflict and recommendations in relation to North Carolina’s influenza pandemic preparatory plan.Master of Public Healt