Public Health Law Map - Beta 5 - Medical and Public Health Law Site

fallen into disuse since antibiotics and the use of specific behavioral restrictions has
made it possible to allow infected individuals more personal freedom without
endangering others. However, quarantine is still used on some patients, such as
tuberculosis carriers whose disease is resistant to all the antituberculosis drugs
available. Mandatory immunization or incarceration for treatment is still used by
public health officials.
a) Involuntary Testing
The least intrusive coercive public health measure is the involuntary testing of
populations at risk for communicable disease. The most common example is testing
for tuberculosis in high- risk populations. Involuntary testing has three benefits.
First, it allows public health officials to learn the prevalence of a disease in the
community. This is difficult to accomplish with voluntary testing because of the
statistical problems associated with self-selected data sets. Second, it identifies
infected individuals who may benefit from treatment. Third, it identifies individuals
who may need to be restricted to protect the public health.
Involuntary testing for communicable diseases is legally different from testing for
personal behavior such as drug use or the propensity to steal from an employer. The
presence or absence of a communicable disease may be objectively determined, and
the risk it poses is easily quantified. There are no criminal law consequences to the
diagnosis of a communicable disease, so there is no need for protection against self-
incrimination in disease screening. In many cases, treatment will eradicate the
condition. Even when treatment is impossible, only rare circumstances demand
more than minimal workplace restrictions to prevent the spread of the disease.
When these restrictions are required, they are solely to protect others, not to punish
the affected individual.
b) Contact Tracing
This is a method that has been used in the control of endemic contagious disease
for decades. [Hethcote HW, Yorke JA. Gonorrhea Transmission Dynamics and
Control. New York: Springer-Verlag; 1984.] A disease investigation begins when
an individual is identified as having a communicable disease. An investigator
interviews the patient, family members, physicians, nurses, and anyone else who
may have knowledge of the primary patient’s contacts, anyone who might have
been exposed, and anyone who might have been the source of the disease. Then the
contacts are screened to see if they have or have ever had the disease. The type of
contact screened depends on the nature of the disease. A sexually transmitted
disease will require interviewing only infected patients and screening only their sex
partners. A disease that is spread by respiratory contact, such as tuberculosis, may
require screening tens to hundreds of persons, such as other inmates in a prison.
Many persons object to contact tracing as an invasion of privacy. Since contact
tracing is constitutionally permissible, these objections are often disguised as
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