Back in 2014 Kaci Hickox, a nurse from my home state of Maine, returned to the United States after serving as a health care worker in an Ebola outbreak. Rather than being greeted as a hero, she was confined to an unheated tent with a box for a toilet and no shower. She did not have any symptoms and tested negative for Ebola. After threatening a lawsuit, she was released and allowed to return to Maine. After arriving home, she refused to be quarantined again. She did, however, state that she would be following the CDC protocols. Her situation put a face on a general moral concern, namely the ethics of balancing rights with safety. As Ebola has once again made it into the American news cycle, it is worth revisiting this situation.
While past outbreaks of Ebola in Africa were met largely with indifference from the West (aside from those who went to help), the 2014 outbreak infected the United States with a severe case of fear. Some in the media fed the fear, presumably in the hopes of increasing views. Politicians also contributed to the fear. Some tried to make Ebola into a political game piece to bash their opponents and score points by appeasing fears they helped create. Because of this fear, most Americans supported a travel ban for Ebola infected countries and some states imposed mandatory quarantines. While politicians will exploit the fears of the public, the ethics of the matter should be considered rationally. My view has not changed much from 2014 but is worth reconsidering.
While Ebola and other deadly diseases are scary, I address them with the same approach I use for all situations in which rights (or liberties) conflict with safety. The first step is sorting out the level of risk. This includes determining the probability that the harm will occur as well as the severity of the harm (in quantity and quality). In the case of Ebola, the probability that someone will be infected in the United States is low. As experts have pointed out, infection requires direct contact with bodily fluids while a person is infectious. Even then, the infection rate has seemed relatively low, at least for past cases in the United States. In terms of the harm, Ebola can be fatal. However, timely treatment in a well-equipped facility can be effective. In terms of the things that are likely to harm or kill someone in the United States, Ebola is near the bottom of the list. As such, a rational assessment of the threat is that it is usually a small one in the United States. Naturally, if the chances of infection increased, then a reassessment of the threat would be in order. While overreacting from fear is bad, not responding to a disease can be worse.
The second step is determining key facts about safety proposals. One obvious concern is the effectiveness of the proposed method. As an example, the 21-day mandatory quarantine would be effective at containing Ebola. If someone shows no symptoms during that time, then she is almost certainly Ebola free and can be released. If a person shows symptoms, then she can be treated immediately. An alternative, namely tracking and monitoring people rather than locking them up would also be effective—at least it has worked in the past. However, this method could fail—bureaucratic failures might happen or people might refuse to cooperate. A second concern is the cost of the method. In the case of the 21-day quarantine, there are the obvious economic and psychological costs to the person being quarantined. After all, some people will not be able to work from quarantine, and the person will be isolated from others. There is also the cost of the quarantine itself. In terms of other consequences, it was argued that imposing this quarantine would discourage volunteers from going to help and this will be worse for the United States. This is because it is best for the rest of the world if Ebola is stopped before it spreads and this will require volunteers from around the world. In the case of the tracking and monitoring approach, there would be a cost—but less than a mandatory quarantine.
From a practical standpoint, assessing a proposal is a utilitarian calculation: does the risk warrant the cost? To use some non-Ebola examples, every aircraft could be made as safe as Air-Force One, every car could be made as safe as a NASCAR vehicle, and all guns could be taken away to prevent gun accidents and homicides. However, we have decided that the cost of such safety is too high and hence we are willing to allow people to die. In the case of Ebola, the calculation is a question of considering the risk against the effectiveness and cost of the proposed method. Since I am not a medical expert, I will defer to the medical experts who claimed that the quarantine approach was not warranted for people who lack symptoms and test negative.
The third concern is the moral concern. Sorting out the moral aspect involves weighing the practical concerns (risk, effectiveness and cost) against the right (or liberty) in question. Some also include the legal aspects of the matter here as well, although law and morality are distinct (except for those who are legalists and see the law as determining morality). Since I am not a lawyer, I will leave the legal aspects to others and focus on the ethics.
When working through the moral aspect, the challenge is determining whether the practical concerns morally justify restricting or even eliminating rights (or liberties) in the name of safety. This should be based on consistent principles in when balancing safety and rights. Unfortunately, people tend to be wildly inconsistent. In the case of Ebola, some people expressed the “better safe than sorry” view and imposed or supported mandatory quarantines at the expense of the rights and liberties of those quarantined. In the case of gun rights, these are often taken as trumping concerns about safety. The same holds true of the “right” or liberty to operate automobiles: tens of thousands of people die each year on the roads, yet any proposal to deny people this right would be rejected. In general, people assess based on feelings, prejudices, biases, ideology and other non-rational factors, which helps explain the lack of consistency. So, people are willing to impose on basic rights for little or no gain to safety, while also being content to refuse even modest infringements in matters that result in great harm (as the COVID-19 pandemic illustrated). However, there are also legitimate grounds for differences: people can, after due consideration, assess the weight of rights against safety differently.
Turning back to Ebola, the main moral question is whether the safety gained by imposing a quarantine (or travel ban) would justify denying people their rights. In the case of someone who is infectious, the answer would seem to be “yes.” After all, the harm done to the person (being quarantined) is greatly exceeded by the harm that would be inflicted on others by his putting them at risk of infection. In the case of people who are showing no symptoms, who test negative and who are relatively low risk (no known specific exposure to infection), then a mandatory quarantine would not be justified. Naturally, some would argue that “it is better to be safe than sorry” and hence the mandatory quarantine should be imposed. However, if it was justified in the case of Ebola, it would also be justified in other cases in which imposing on rights has even a slight chance of preventing harm. This would seem to justify taking away private vehicles and guns: these kill more people in the United States than Ebola. It might also justify imposing mandatory diets and exercise on people to protect them from harm. After all, poor health habits are major causes of health issues and premature deaths. To be consistent, if imposing a mandatory quarantine is warranted on the grounds that rights can be set aside even when the risk is incredibly slight, then this same principle must be applied across the board. This seems rather unreasonable and hence the mandatory quarantine of people who are not infectious would also be unreasonable and not morally acceptable.
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