Ethical and Legal Challenges Posed by Severe Acute Respiratory Syndrome: Implications for the Control of Severe Infectious Disease Threats
Abstract
The appearance and spread of severe acute respiratory syndrome (SARS) on a global level raised vital legal and ethical issues. National and international responses to SARS have profound implications for 3 important ethical values: privacy, liberty, and the duty to protect the public's health. This article examines, through legal and ethical lenses, various methods that countries used in reaction to the SARS outbreak: surveillance and contact tracing, isolation and quarantine, and travel restrictions. These responses, at least in some combination, succeeded in bringing the outbreak to an end. The article articulates a set of legal and ethical recommendations for responding to infectious disease threats, seeking to reconcile the tension between the public's health and individual rights to privacy, liberty, and freedom of movement. The ethical values that inform the recommendations include the precautionary principle, the least restrictive/intrusive alternative, justice, and transparency. Development of a set of legal and ethical recommendations becomes even more essential when, as was true with SARS and will undoubtedly be the case with future epidemics, scientific uncertainty is pervasive and urgent public health action is required.
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Nine studies stressed how mass quarantine aggravated inequalities in individuals' access to, understanding of, and actions on prevention and control of infections.
“Nine studies stressed how mass quarantine aggravated inequalities in individuals’ access to, understanding of, and actions on prevention and control of infections.21,23–26,31–34”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [26]
Gostin et al. argued that people in poverty could not afford space for physical distancing in their households during SARS outbreaks; similar challenges were found among the First Nations population in subarctic Canada.
“Gostin et al.26 argued that people in poverty could not afford space for physical distancing in their households during SARS outbreaks; similar challenges were found among the First Nations population in subarctic Canada.24”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [26]
Gostin et al. expressed that travel restrictions caused enormous damage to businesses relying on mobility and individuals having economic interests in tourism.
“Gostin et al.26 expressed that travel restrictions caused enormous damage to businesses relying on mobility and individuals having economic interests in tourism.”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [26]
Three studies reported that travel bans during mass quarantine might impact agricultural production, leisure business and tourism.
“Three studies reported that travel bans during mass quarantine might impact agricultural production, leisure business and tourism.22,26,29”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [26]
Two included studies were based on ethical scenarios rather than lived experiences of people in quarantine.
“Two studies were based on ethical scenarios rather than lived experiences of people in quarantine.26,28”
From Social consequences of mass quarantine during epidemics: a systematic review with implications for the COVID-19 response (2020) · cites this paper as [26]
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References 19 · Cited by 240
- Authors
- Gostin, L. O., Bayer, R., & Fairchild, A. L.
- Affiliations
- Georgetown University (US)
- Columbia University (US)
- The Ohio State University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-12-24
- Volume
- 290
- Issue
- 24
- Pages
- 3229
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1994182043
- Cited by
- 240
- References
- 19
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 13 · 2020: 52 · 2019: 3 · 2018: 1 · 2017: 5 · 2016: 7 · 2015: 10 · 2014: 3 · 2013: 4 · 2012: 7
- FWCI
- 13.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Legal, Health, Environmental and COVID-19 Challenges
- Social Sciences › Sociology and Political Science › Global Security and Public Health
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- SARS, public health ethics, public health law, privacy, freedom, freedom of movement, quarantine and isolation, travel restrictions, precautionary principle, least restrictive alternative, justice, transparency, infectious disease outbreaks, individual rights
- MeSH terms
- Civil Rights, Communicable Disease Control, Disease Outbreaks, Humans, Patient Isolation, Population Surveillance, Quarantine, Travel, Global Health, Public Health Practice, Contact Tracing, Privacy, Severe Acute Respiratory Syndrome
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