Murdoch Childrens Research Institute, Parkville, Victoria, Australia
School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
J Med Ethics. 2021 Aug;47(8):553-562. doi: 10.1136/medethics-2020-107104. Epub 2021 May 31.
Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation-that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option-fails to adequately accommodate the complexity of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options.
几个世纪以来，为了限制传染病的传播，人们实施了限制自由的措施。本文探讨了在何种情况下，为了减轻大流行对特别脆弱群体的负面影响，通过防止这些群体感染疾病，对其实施有选择性的限制自由的措施在伦理上是否可以接受。我们认为，人们普遍接受的解释——当限制自由是防止对他人造成伤害的最具限制性的选择时，限制自由是合理的——未能充分考虑到问题的复杂性或必须做出的艰难选择，而新冠疫情就说明了这一点。我们引入了一种二元后果主义方法，在人口和个人层面上权衡效用，这可能为考虑限制自由的理由提供一个更好的框架。虽然限制自由的措施可能基于对人口的重大利益和对个人整体效用的小成本而被证明是合理的，但是否可以接受歧视的问题应该分开考虑。这是因为后果主义方法没有充分考虑平等的价值。这种价值可以通过适用附加的相称性检验来保护。提出了一种用于决策的算法。最终是否实施有选择性的限制自由的措施将取决于一系列因素，包括社区中感染的广泛程度、社会愿意接受的风险和危害程度，以及其他缓解措施的效果和成本。
