Ethical Considerations for use of Public Health Travel Restrictions

Individuals diagnosed with specific contagious diseases of public health interest are advised by local public health authorities not to travel. However, some of these persons still elect to travel or are perceived by local public health as at high risk for noncompliance and subsequent travel. There are a variety of public health tools to protect the public from potential risk of infection posed by such persons. These tools include isolation and quarantine orders, placement on a public health “Do Not Board” list, and other restrictive actions. CDC's Division of Global Migration and Quarantine (DGMQ), which has authority to use restrictive actions to protect the public's health, has developed a standard operating procedure (SOP) for use of travel restrictions. DGMQ worked with the CDC Ethics Subcommittee of the Advisory Committee to the Director to identify potential ethical issues raised by the procedures and to develop guidance on addressing these issues. In addition, a mechanism for retrospective case review of ethical issues raised by the actual use of the travel restriction procedures was developed. This presentation will describe the collaborative process used to develop ethics input and will illustrate the challenges and opportunities of translational, multidisciplinary work. The ethicists involved had much to learn about the context, concerns, and “vocabulary” of tools and practice conditions utilized in restricting travel. The central concepts and tensions involved in balancing public health and community interests while protecting individual rights will be discussed.