Public Health and Civil Liberties

Abstract

This chapter focuses on public health ethics in a particular context—a liberal, pluralistic, democratic society that embodies explicit commitments to several basic civil liberties: bodily integrity, privacy, freedom of movement, freedom of association, and freedom of religion and conscience. When civil liberties set limits on public health interventions, a presumptivist framework is more defensible and helpful than either an absolutist or a contextualist one for determining appropriate interventions. This framework recognizes several conditions for rebutting the presumption, in certain circumstances, against interventions that infringe civil liberties. Through an exploration of the metaphor of the Intervention Ladder, proposed by the Nuffield Council on Bioethics, this chapter examines several possible ways to secure individuals’ cooperation with public health measures, such as vaccinations, directly observed therapy, and quarantine, without infringing their civil liberties. It is often possible to achieve compliance through expressing rather than imposing community.