The continuing tensions between individual rights and public health
The continuing tensions between individual rights and public health
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DOI：
10.1038/sj.embor.7401134
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发表时间：
2007-12-01
期刊：
影响因子：
7.7
通讯作者：
Bayer, Ronald
中科院分区：
文献类型：
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作者：
Bayer, Ronald
构成本月“谈话要点”的观点文章讨论了公共卫生措施的执行与由此导致的不可避免的个人权利和自由侵犯之间的老冲突。“中立评论者”的任务是困难的，因为作者之间并没有特别的分歧。George Annas认为，强制执行公共卫生措施既是对个人权利的侵犯，也是无效的，甚至是适得其反的；罗纳德·拜尔认为，必须承认公共卫生措施与人权之间不可避免的冲突，并根据情况加以处理。作为一名科学家和德国政府的顾问，我相信，在某些情况下，强制措施是唯一合理的选择，但当所有自愿措施都失败时，这些措施必须是最后的手段，这一事实进一步阻碍了中立评论员的作用。安纳斯指责政客和公共卫生官员营造了一种对健康威胁的恐惧气氛。当然，为了防止察觉到的——但实际上是轻微的甚至不存在的——危险而采取的极端措施可能会适得其反，除非对获得期望的公众曝光的个人而言。在美国，这些“威胁”主要是关于恐怖主义，以及在后9/11社会中蓬勃发展的相关恐惧。欧洲也有过类似的不相称的反应，比如疯牛病，但更多的时候，公共卫生官员不得不平息公众的歇斯底里和恐惧情绪，这些情绪是由不了解情况、往往不择手段的媒体煽动起来的。他们必须在通过提供基于事实的建议来缓解公众恐惧和确保采取措施将任何实际威胁降至最低之间走一条微妙而往往不确定的线。安纳斯将美国政府在911恐怖袭击后的下意识反应（即匆忙出台法律，允许政府机构规避人权标准）与对可能发生的流行病的反应（无论是源于恐怖主义还是自然）进行了类比。在许多方面，这是一个公平的类比：毫无疑问，他所描述的“百分之一主义”在美国和欧洲政府中都太普遍了，政客们担心在灾难发生后缺乏准备，无论是自然的还是其他的。然而，911事件后出台的严厉措施针对的是那些涉嫌恐怖主义的人，无论他们的嫌疑多么轻微。目前尚不清楚未来流行病的无辜受害者是否会受到同样严厉的对待。
The opinion pieces that constitute this month’s ‘Talking Point’address the old conflict between the enforcement of public health measures and the inevitable infringements of individual rights and liberties that are the result. The task of the ‘neutral commentator’is made difficult by the fact that the authors are not particularly at odds with each other. George Annas argues that compulsory enforcement of public health measures is both an infringement of individual rights and is ineffective or even counter-productive; Ronald Bayer believes that the inevitable conflict between public health measures and human rights must be acknowledged and dealt with according to the situation. The neutral commentator’s role is hindered further by the fact that, as a scientist and advisor to the German government, I believe that there are indeed situations when compulsory measures are the only reasonable option—but these must be the last resort when all voluntary measures fail. Annas blames politicians and public health officials for fostering a climate of fear about health threats. Certainly the extreme measures to prevent perceived—but in reality slight or even non-existent—dangers can be highly counter-productive except to the individual who gains the desired public exposure. In the USA, these ‘threats’ are primarily about terrorism, and the related fears that thrive in the post-9/11 society. Europe has had similar disproportionate reactions to perceived threats, such as mad cow disease, but more often public health officials have had to calm feelings of hysteria and fear among the public whipped up by an uninformed and often unscrupulous press. They have to walk a thin—and often uncertain—line between relieving public fear by giving fact-based advice and ensuring that steps are taken to minimize any actual threat.Annas draws a parallel between the knee-jerk reactions of the US government in the wake of the terrorist attacks of September 11—that is, hastily introduced laws allowing government agencies to circumvent standards of human rights—and the reaction to a possible pandemic, whether it originates from terrorism or nature. In many ways, this is a fair analogy: there is little doubt that the ‘one percent doctrine’he describes is all too pervasive among both the US and European governments, and that politicians fear being held responsible for a lack of preparedness following a disaster, natural or otherwise. However, the draconian measures introduced in the wake of September 11 were directed at those suspected—no matter how slight—of terrorism. It is not clear whether innocent victims of a future pandemic would be treated in the same harsh manner.