Communicable Disease Control in the New Millenium: A Qualitative Inquiry on the Legitimate Use of Restrictive Measures in an Era of Rights Consciousness

Background: When Canadian public health officials issued thousands of quarantine orders during the SARS outbreak in 2003, it raised difficult questions about the legitimacy and acceptability of restrictive measures to achieve public health goals. While public health interventions have traditionally been justified on utilitarian grounds, this project aims to establish an empirical basis to justify public health action. The objectives are: 1) Descriptive: To describe the views of members of society on the justifiability of using restrictive measures to achieve public health goals; 2) Analytic: To analyze the use of restrictive measures at the intersection of public health policy, human rights norms, and ethics; and 3) Normative: To situate public health ethics within a Habermasian model of communicative ethics that can serve as the basis of justification for the legitimate use of restrictive measures based on the intersubjective recognition of public health and human rights. Methods: Individual interviews were conducted with 62 participants, including 23 health care providers, 16 members of the public, 13 community and/or spiritual leaders from the Greater Toronto Area, as well as six public health officials and four health care regulators at the local, provincial, and federal levels of jurisdiction. Findings: Participant views were analyzed and organized into themes that revolve around the following concepts: 1) common good; 2) types of quarantine; 3) compliance; 4) reciprocity; 5) uncertainty; and 6) communication. Conclusions: Combining empirical research with conceptual scholarship, it is argued that the recognition of and commitment to the common good by participants, which emerged as an overarching theme, provide justificatory power for the use of quarantine during communicable disease outbreaks. But to respect rights, while being committed to the common good, it is argued that we must move beyond the see-sawing between ostensibly competing requirements toward a conception that gives equal weight to public health and human rights; that is, both imperatives – the community and the individual – refer to one another without dissolving into one another. Following a Habermasian account of opening processes of decision-making to a moral-practical discourse, it is argued that public health ethics offers an important site for integrating his model of discourse ethics within public health deliberations to expand the scope of moral argumentation on--and ultimately to ground the justification of--the use of restrictive measures.Ph