Sound Medicine -- August 16, 2003
Special Edition: Sound Ethics

Hosts Barbara Lewis and Dr. Eric Meslin talk to physicians and researchers about:

Ethical Dilemmas Raised by Severe Acute Respiratory Syndrome (SARS)

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Ethical Dilemmas Raised by Severe Acute Respiratory Syndrome (SARS)

Severe Acute Respiratory Syndrome (SARS) is a severe form of pneumonia. This highly contagious disease originated in Guangdong Province in southern China in the fall of 2002. In February 2003, it spread to a number of countries via travelers on international flights. Experts believe the highly communicable disease is now contained, and travel advisories have been lifted. Let's look back at some decisions made when SARS first grabbed our attention.

Dr. Ross Upshur, an epidemiologist and family physician in Toronto, was a health professional treating SARS patients. He retells his experiences and explains ethical dilemmas health care providers and public health officials faced at the outbreak of SARS. Dr. David Orentlicher, a physician and Indiana state lawmaker, brings the ethical issues closer to home.

Dr. Upshur says making quarantine decisions presented major ethical dilemmas. Health care officials often didn't know who should be isolated and who shouldn't, the disease was so new. Furthermore, they didn't know if recovered patients could catch it again. Another major problem was releasing victims' names to the media, which could incur ethnic discrimination.

When highly contagious and mysterious diseases such as SARS break out, general uncertainty and fear are common. Personal liberties conflict with threats to the general public. Much is left to the discretion of the government, although recently, many decisions have been deferred to public health officials. Another question is whether health-care providers should be allowed to opt out of treating a highly contagious patient. According to Dr. Upshur, workers accept these risks when they enter the profession.

Both Dr. Upshur and Dr. Orentlicher stress that health-care professionals must be better trained to handle new communicable diseases. Overall, the decisions health-care professionals and public-health officials made during the SARS epidemic turned out well. Quarantine and isolation were usually voluntary, and Dr. Upshur is happy to say he would not have done anything differently.

Resources:

Read the working paper Ethics and SARS: Learning Lessons from the Toronto Experience, a report by a group from the University of Toronto Joint Centre for Bioethics, of which Dr. Upshur is a member.

The National Institutes of Health have compiled a list of resources, including the latest news, travel advisories, prevention, and diagnoses.

The Centers for Disease Control and Prevention also provide helpful resources about SARS, including information targeted at healthcare workers, travelers, and patients.

General information about SARS from the World Health Organization.

In general, the SARS outbreak has been contained worldwide. However, the WHO warns that the threat remains, and more research is needed.

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It was once believed that the human body was worth very little when broken down to its basic elements. But on the contrary, human body parts sell for very high prices. If every usable part of a human body were to be sold, how much would the total body be worth?

A. About $10,000,000
B. About $25,000,000
C. More than $45,000,000

Find out!

SARS appears to have been contained; however, many health officials are worried that the disease may reappear in the next flu season. What is the link between SARS and the flu season?

Find out!

The active role played by public health officials in imposing quarantines and deploying quick medical help has contributed to the containment of SARS. Here are some historical facts about quarantine:

• Quarantines first began in Venice during the 14th century during the spread of the bubonic plague.

• Periodic quarantines were common in the 19th and 20th centuries in the United States. In 1909, the Supreme Court ruled that since individuals do not have the right to harm others, quarantines do not oppose individual rights.

• In 1900, authorities in San Francisco quarantined all of Chinatown following the death of a Chinese laborer suspected of having bubonic plague.

• On April 4, 2003, President Bush signed an order to add SARS to a list of diseases for which federal health officials may quarantine U.S. citizens against their will. In 1983, the Ebola virus was the last one to be added to the list that includes tuberculosis, leprosy, smallpox and cholera.

• As of July 11, 2003 the CDC was tracking 421 patients with signs of SARS.

Resource:
Are quarantines returning in the US? Read this article from the Los Angeles Times.