Bioterrorism, Public Health Emergencies, and the Law
This course examines issues raised by bioterrorism and public health emergencies in the context of American culture, biomedical ethics, public policy and law. In particular, we will consider how bioterrorism and public health emergencies challenge traditional political, legal and ethical principles centering on individual autonomy and civil liberties. The course is designed to provoke thought and discussion -- legal and ethical -- concerning pressing issues involving major public health problems facing the United States.
In the past few years, the threat of bioterrorism combined with a new awareness of emerging infectious diseases, such as SARS and influenza, and other public health problems, including Mad Cow Disease and GM food, compels both the states and the federal government to reassess the strengths and weaknesses of our public health infrastructure. In addition, the impact of the global community in which we exist forces us to realize the importance of maintaining international treaties and agreements consistent with our public health policy. The new developments in this field raise myriad legal, ethical, and political issues.
The course, which will proceed in a seminar discussion format, involves critical examination of issues in their legal, ethical, cultural, economic, political and religious context. The impact of events and developments occurring in the diverse political systems worldwide will be considered. Readings will include classic expressions of ethical standards, legal cases and statutes, as well as timely books and articles dealing with recent challenges to the public health system. An important goal of the seminar is to encourage students to formulate a method of analyzing and evaluating public health problems from legal and ethical standpoints. For that purpose, the course will provide a workshop problem-solving component aimed at developing strategies for dealing with public health emergencies.
Upon completing the course, each student should be able to:
Frequent short writing assignments are anticipated. These will consist mainly of one or two page responses to the reading. In addition, students will be expected to write a substantial paper of a research and analytical nature on an appropriate public health topic of their choice. The paper should be a logically constructed paper using legal, ethical and scientific materials. The paper should include a recommendation for an action plan that addresses a major public health problem. Students will be expected to make an oral presentation of the contents of the paper and respond to questions.
During some class sessions, students will collaborate on problem-solving exercises dealing with bioterrorism and public health emergencies.
The Course texts will include the following:
Laurie Garrett, Betrayal of Trust, Hyperion, NY 2000 (Garrett)
Lawrence Gostin, Public Health Law and Ethics: A Reader, University of California Press, 2002 (Reader)
Jonathan Moreno, In the Wake of Terror: Medicine and Morality in a Time of Crisis, MIT Press, 2004 (Moreno)
Selected print and Internet articles, fiction, and other current materials will supplement text readings.
|Assignment for First Class Meeting
In preparation for the first class meeting, please have read the following:
Lawrence Gostin, PUBLIC HEALTH LAW AND ETHICS, A READER (Preface and Chapter One)
Laurie Garrett, BETRAYAL OF TRUST: THE COLLAPSE OF GLOBAL PUBLIC HEALTH (pp. 1-49)
BIOETHICS, PUBLIC HEALTH LAW, ETHICS AND HUMAN RIGHTS: INTRODUCING THE ISSUES
We begin by reviewing the basic principles and major controversies of bioethics as they pertain to public health matters. We also begin developing a definition and theory of public health law, which provides a justification of the special role of government to assure the conditions needed to keep people healthy. This justification is grounded on theories of democracy, normative ideas about the fundamental importance of health, and a historical perspective. We include an overview of major themes in public health, including the relationship between the individual and the role of government in protecting the public's health.
Readings: Reader, pp 1-19; Garrett, pp 15-49
PUBLIC HEALTH ETHICS AND HUMAN RIGHTS: POPULATION-BASED PERSPECTIVES AND THE COMMUNITARIAN TRADITION
This week we explore the field of public health, together with its ethical basis and connection to international human rights. This includes the communitarian and population-based traditions of public health. We investigate the controversies surrounding public health, especially its breadth and its connection to the political and democratic processes. We also examine the various forms of public health ethics and the increasing importance of human rights, particularly the right to health. We consider the evolution of public health concepts and institutions in the U.S.; historical relationships between religious, secular, individualistic and community-based conceptions of public health; improvements in life expectancy and quality of life in the nineteenth and twentieth centuries and reasons for those improvements; privacy and the "right to know"; tensions between individual interests (autonomy, privacy, expression, liberty) and the common good. We attempt to define the "common good".
Readings: Reader, Chapters two, three, four
PUBLIC HEALTH REASONING AND THEORY: PHILOSOPHY, RISK AND COST
We examine the various forms of reasoning in public health. In particular, we discuss the philosophical foundations (principally utilitarianism, but also the relevance of normative theories). We also address risk assessment, drawing from the field of environmental law and policy. Finally, we explore the economic issues, notably cost-effectiveness analysis. Guest speaker.
Readings: Reader, chapter 5, Garrett, pp 50-121
PUBLIC HEALTH AND THE CONSTITUTION
This week and next, we examine the "building blocks" or constitutive parts of the field of public health law, including the constitution, law and economics, and the tort system. This week, we concentrate on the constitutional foundations of the public health system. First, we consider what obligations the government has to assure the conditions for the public's health. Next we explore government powers in the realm of public health, notably the "police powers." Finally, we explore the limitations on government power. This inquiry takes place within the context of American federalism (and what is called the "new federalism" doctrines being developed by the Supreme Court), focusing on the question of whether federal or state government has the power to act in a given situation. We study the complex relationships between federal, state, and local agencies with public health missions and the concept and application of the police power to protect public health. We consider the constitutional and statutory limits on the exercise of police power to protect public health.
Readings: Reader, chapters 6 and 7
TORT LITIGATION FOR THE PUBLIC'S HEALTH
Government regulates indirectly through the tort system, as well as directly through regulatory agencies. This week we investigate tort litigation as a strategy for protecting and improving the public's health. This involves an examination of science, epidemiology and the concept of causation. It also involves an exploration of the major tort theories of public health litigation. We will look at case studies in fields that may include smoking litigation and firearm litigation, and food litigation. Possible guest speaker.
In-class case study workshop: We will explore and analyze a case study in a field of litigation.
Readings: Reader, chapter 9; Garrett, pp 268-338
SURVEILLANCE AND PUBLIC HEALTH RESEARCH: PRIVACY AND THE "RIGHT TO KNOW"
We begin an exploration of major public health activities and their effects on law, ethics, and policy. With each activity, we examine the tensions between individual interests (e.g. autonomy, privacy, expression, liberty) and the common good. This week we discuss the public health activities of surveillance and research. We explore the importance of these activities for population health and the burdens they place on personal interests, notably privacy.
Readings: Reader, chapter 10; Garrett, pp 338-408
PUBLIC HEALTH EMERGENCIES
We explore the origin, nature and development of public health emergencies, including profiles of disease, emerging infectious diseases, infectious agents, symptoms, biological toxins and emerging diseases, and environmental signs. We consider the impact of HIV-AIDS on the public health philosophy. We consider the responsibility and liability of public health agencies during an emergency, disease reporting and other tools for determining emergency preparedness. In the course of our inquiry, we consider public health emergencies including SARS, Mad Cow disease in all their social, economic, and political dimensions. Guest speaker.
Readings: Garrett, pp 408-485
BIOLOGICAL INTERVENTIONS TO CONTROL INFECTIOUS DISEASE: IMMUNIZATION, SCREENING AND TREATMENT
The public health activities discussed this week involve personal restraints to control infectious diseases. We discuss immunization, screening and treatment. These interventions affect autonomy and bodily integrity. They are traditionally exercised in the face of serious infectious disease threats. We discuss the legal, ethical and policy implications of these powers. We also discuss the public health powers of civil confinement (e.g. isolation, quarantine, mandatory vaccination, and civil commitment) and criminal punishment. We inquire whether these powers are effective and in what circumstances. We also consider the tradeoffs between control of infectious diseases and liberty interests. We discuss the legal, ethical and policy implications of the exercise of these powers. To illustrate these issues, students will participate in a class exercise involving a major health threat.
Readings: Reader, chapter 12; Garrett, pp 486-550
FRONTIERS AND CHALLENGES: CASE STUDIES ON EMERGING INFECTIONS, BIOTERRORISM, AND GENETICS
This week we examine visions and challenges for the future of public health and safety. In particular, we consider three paradigmatic areas of public health in current times. They include emerging infectious diseases (including the concern about antibiotic resistance) bioterrorism (including the anthrax incidents following September 11, 2001 and the threat of smallpox), and public health genetics (including current efforts to reduce the burdens of genetically-related diseases). In the course of our inquiry, we consider the extent to which bioterrorism is a real threat. We evaluate the historical background of bioterrorism and biowarfare and the current applications.
Readings: Reader, chapter 14; Moreno, pp 1-70
Bioterrorism (continued); in-class case study workshop. We will explore and analyze a case study in the field; oral presentations
Readings: Moreno, pp 71-140
PUBLIC SAFETY AFTER SEPTEMBER 11: THE MODEL EMERGENCY HEALTH POWERS ACT
Following September 11, 2001, the CDC asked the Center for Law and Public's Health to draft a Model State Emergency Health Powers Act. Approximately one-third of the states now have adopted the Act or a version of the Act. An in-class workshop provides an opportunity for students to examine the tensions and controversies surrounding the exercise of emergency health powers to combat bioterrorism or a naturally occurring outbreak with a potential for catastrophic health consequences; oral presentations
Readings: Moreno, pp 141-210
THE FUTURE OF PUBLIC HEALTH
We consider the future of public health, including genetic engineering and species-endangering experiments, the potential for emerging infectious diseases and bioterrorism, the implications for human experimentation, and the restriction of scientific research; oral presentations