the Centers for Disease Control and Prevention (CDC) and his co-authors present a set of ethical guidelines that should be employed in pandemic preparation and response. They also identify a range of legal issues relevant to social-distancing measures. If state and local governments are to reach an acceptable level of public health preparedness, the authors say, they must give systematic attention to the ethical and legal issues, and that preparedness should be tested, along with other public health measures, in pandemic preparation exercises.

LeDuc’s fellow panelist Victoria Sutton of Texas Tech University also considered the intersection of law and ethics in public health emergencies in general and in the specific case of pandemic influenza. In particular, Sutton identified several “choke points”—particularly thorny ethical and legal issues—that present barriers to pandemic mitigation. In addition to the problem of leadership, which is addressed in the next chapter, these issues include the role of interdisciplinary and intersectoral approaches in decision-making; the tradeoffs between personal freedom and public good that are implicit in social-distancing measures; the global implications of quarantine and travel restrictions; the need for consistency among various disease-control policies; and the definition of appropriate, measurable “triggers” for when to impose each potential countermeasure.

The third paper in this chapter considers quarantine, one of the most ethically and legally complex tactics used in combating pandemic disease. In this article, Martin Cetron of CDC and Julius Landwirth of Yale University describe the modern practice of quarantine and its potential implementation as outlined in the U.S. Department of Health and Human Services (HHS) plan for containing pandemic avian influenza. Whenever the possibility of using a quarantine is discussed, they observe, decision makers confront the central dilemma arising from the contrast between public health ethics, which emphasizes collective action for the good of the community, and therapeutic medicine, with its focus on the individual. The authors identify various means to address this tension and offer examples of how ethical considerations can be incorporated into pandemic preparedness plans.

The chapter concludes with a three-part contribution by Joshua Epstein of the Brookings Institution: an informal discussion of the modeling process as it applies to infectious disease containment, followed by two publications in which such models are used to inform strategies for containing smallpox epidemics resulting from bioterrorism. Epstein and his group produce explicit models of disease, and, in the course of doing so, they examine and refine the assumptions upon which each model rests. Epstein observes that while models cannot replace human judgment, they can better inform our choices, and while they cannot eliminate uncertainty, models can identify crucial gaps in knowledge. To support these assertions, Epstein describes how his group collaborates with medical experts to produce disease scenarios and containment strategies (e.g., for smallpox) more robust than would be possible either through pure computation or through expert opinion alone.

Responding to Epstein’s presentation, workshop panelist Timothy Germann,



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