QUARANTINE AND ISOLATION

Quarantine and Isolation

Quarantine and Isolation

Quarantine and isolation are public health interventions designed to protect a population's health by separating from the general population individuals who are either affected by or have been exposed to communicable diseases. Because these actions may conflict with the interests of individual patients, the use of quarantine or isolation must be balanced against their potential to compromise individuals' liberty and autonomy. When treating individual patients, physicians are obligated to hold the best interests of the patient as paramount. However, these individually centered concerns for personal liberties can undermine public efforts to protect the health of the population.

Further guidance is warranted to help physicians manage their dual responsibilities to their patients and to their communities when dealing with outbreaks of communicable diseases.

Quarantine has been used to manage the outbreaks of communicable disease since the 13th century.5 The purpose of quarantine is to separate from the general population those individuals who have been exposed to and are suspected of carrying a communicable disease but have yet to display symptoms. Quarantine measures do not generally entail the forced detention of affected individuals. Rather, the measures are usually voluntary.

Those subject to quarantine are closely monitored for symptoms to detect disease at an early stage.

In contrast to quarantine, isolation is applied to individuals known or suspected to be infected by contagious agents. Isolation separates infected from uninfected individuals during the period of communicability and restricts their movement to limit exposure of unaffected individuals. Additionally, it allows for the focused delivery of specialized health care to the ill. While ill people subjected to isolation may be isolated and cared for within hospitals, public health isolation policies may also call for infected individuals to be isolated at home or to stay at other appropriate community-based facilities.

Quarantine and isolation may be either voluntary or mandatory. When mandatory, they may be effective in limiting the spread of communicable diseases, but produce tension between the public goal of disease containment and the protection of individuals' autonomy.

Standards of medical ethics place great emphasis upon respect for patients' self-determination. In contrast, public health measures can incorporate mandatory interventions if necessary, and public health statutes can authorize the restriction of individual liberties in times of public peril, thereby overriding patient autonomy.

The justified use of quarantine and isolation requires balancing individual liberties with the social goals of public health policies. As the invocation of quarantine or isolation measures may restrict citizens' exercise of fundament civil liberties, these practices will likely be subject to a high degree of legal scrutiny. To this end, the Supreme Court has declared that states must demonstrate a compelling interest that is substantially furthered by the deprivation of personal rights protected by the constitution. Moreover, legal precedents in the analogous situation of mental health civil commitment dictate that applicable public measures must contain proper protections for citizens' rights.

A review of relevant court decisions over the last few decades suggests that various legal tests may be employed to assess the acceptability of public health ...