American Journal of Public Health | July 2004, Vol 94, No. 7 1096 | Government, Politics, and Law | Peer Reviewed | Wynia and Gostin GOVERNMENT, POLITICS, AND LAW GOVERNMENT, POLITICS, AND LAW causative of disease.” 13 Unlike the MSEHPA, Indiana law does not specify what due process a quarantined individual has. CONCLUSION All the states in this study con- sidered the MSEHPA, but each eventually approached concerns about bioterrorism differently. Multiple factors—including the states’ political dynamics, social characteristics, and existing legal frameworks—likely shaped these approaches. Although these states did not provide the consis- tency sought by the Center for Law and the Public’s Health, their efforts still addressed some critical needs regarding bioterror- ism detection and response. 14 Study of this issue sheds light on the interaction between law and public policy in solving a complex and contemporary na- tional, state, and local problem— bioterrorist attacks on civilian populations. Consistent and clari- fied law that minimizes time- consuming lawsuits in the event of a crisis is 1 aspect of a solution to this problem. Building on efforts to update their laws, states and lo- calities should now direct their at- tention, other aspects—including funding and personnel. 15 About the Author Requests for reprints should be sent to Wil- liam Martin, The University of Chicago Law School, 1111 E 60th St, Chicago, IL 60637 (e-mail: [email protected]). This article was accepted January 16, 2004. Acknowledgments The author thanks Elizabeth Arm- strong, assistant professor of sociology and public affairs, Princeton University, Princeton, NJ, and Rebecca Katz, PhD candidate, Woodrow Wilson School of Public and International Affairs, Prince- ton University. References 1. Rudman W, Clarke R. Drastically Underfunded, Dangerously Unprepared: Report of the Independent Task Force on Emergency Responders. New York, NY: Council on Foreign Relations; 2003. 2. Model State Health Emergency Powers Act. Available at: http://www. publichealthlaw.net/Resources/ Modellaws.htm. Accessed March 15, 2004. 3. Gillis J. States weighing laws to fight bioterrorism. Washington Post. No- vember 19, 2001:A1. 4. Gostin L, Sapsin J, Teret S, et al. The Model State Emergency Health Powers Act: planning for and response to bioterrorism and naturally occurring infectious diseases. JAMA. 2002;288: 622–628. 5. Barbera J, Macintyre A, Gostin L, et al. Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences. JAMA. 2001;286:2712–2717. 6. SARS openness “with Chinese characteristics.” Asian Economic News. June 9, 2003. Available at: http:// www.westlaw.com. Accessed May 20, 2004. 7. Kaufmann A, Meltzer M, Schmid G. The economic impact of a bioterror- ist event: are prevention and postattack intervention programs justifiable? Emerg Infect Dis. 1997;3:83–94. 8. Maine Revised Statutes Annotated, title 22, ch 1711-C, § 6-E. 9. Maine’s application for release of funding for public health preparedness and response for bioterrorism, other in- fectious diseases, and public health emergencies [press release]. Augusta: Maine Bureau of Health, Department of Health Services; April 2, 2002. 10. South Dakota Code, title 33, ch 15, § 8. 11. South Dakota Code, title 33, ch 15, § 8, paragraph 7. 12. South Dakota Code, title 34, ch 22, § 43. 13. Indiana Code, title 16, ch 19, § 3, paragraph 11. 14. Coyle M. Pushing tough state health laws: the CDC proposes a model statute. Natl Law J. 2001; 24:A1. 15. Katz R. Public health prepared- ness: the best defense against biological weapons. Washington Q. 2002;25: 69–82. Ethical Challenges in Preparing for Bioterrorism: Barriers Within the Health Care System | Matthew K. Wynia, MD, MPH, Lawrence O. Gostin, JD Preparedness for bioterror- ism poses significant ethical challenges. Although public health ethics and preparedness have received attention re- cently, health care ethics must also be considered. In epidemics, the health care system assists public health in 3 tasks: detection, containment, and treatment. Detection might fail if all patients do not have ac- cess to care, or if physicians do not understand their obligation to report infectious diseases to public health authorities. Con- tainment might fail if physicians view themselves only as advo- cates for individual patients, ig- noring their social obligations as health professionals. Treatment might fail if physicians do not accept their professional duty to treat patients during epidemics. Each of these potential ethi- cal barriers to preparedness must be addressed by physi- cians and society. (Am J Pub- lic Health. 2004;94:1096–1102) THE INTENTIONAL DISPERSAL of anthrax spores in the United States demonstrates the need for preparedness for bioterrorism, and the recent outbreak of se- vere acute respiratory syndrome (SARS) has renewed fears of un- intentional or naturally occurring infectious epidemics. In respond- ing to these threats, the public health system has rightfully gar- nered much of the attention, 1
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