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Should Kaci Hickox, the nurse who treated Ebola patients in Sierra Leone with Doctors Without Borders, be free to move about as she pleases, or is it right that restrictions be placed upon her until it is beyond a doubt that she doesn’t have the disease?
Yes, from a legal point of view. No, from a moral perspective. Here’s why:
Upon returning to the United States, Hickox was placed in quarantine after she exhibited an elevated temperature when tested at the New Jersey airport. She threatened to sue when the quarantine wasn’t lifted even after she tested negative for Ebola. Gov. Christie was unsympathetic and practically dared her to sue. “Whatever,” he said. “I’ve been sued lots of times before. Get in line. I’m happy to take it on.”
A few days later Hickcox was driven to Maine, where the governor there ordered her to be quarantined. Once again she challenged the decision to isolate her when the state filed a court order requiring her to observe a 21-day quarantine, citing “concerns about the lack of reliability and lack of trustworthiness of the information that has been received.” Maine’s health commissioner considered the isolation commonsense. “This is a reasonable request to ensure, out of an abundance of caution, that we are protecting the people of this state.”
The judge hearing the case sided with the nurse, overturning the order saying that the state was violating her rights and that she did not have to remain confined to her home until the incubation period was over. District Court Judge Charles LaVerdiere said that “people are acting out of fear and this fear is not entirely rational.”
Gov. Paul LePage said the court decision was unfortunate and that Hickox was being unreasonable in her refusal to isolate herself.
For her part, Hickox said, "I know that Ebola is a scary disease. I have seen it face-to-face. I know we are nowhere near winning this battle. We'll only win this battle as we continue this discussion, as we gain a better collective understanding about Ebola and public health, as we overcome the fear and, most importantly, as we end the outbreak that is still ongoing in West Africa today."
Science seems to favor Hickox. As the judge noted, “According to the information presented by the court, Respondent currently does not show any symptoms of Ebola and is therefore not infectious.” The CDC, WHO, Doctors Without Borders, and all other medical professionals familiar with the disease agree: Without symptoms, a person isn’t contagious.
The law also seems to agree with Hickox: Without a very good reason, the right to be free trumps everything. Restrictions can be imposed for considerations of public health, but according to the best of anyone’s knowledge, Hickox doesn’t pose a public health threat. A quarantine is disproportionate to the risk she poses.
Isolating Hickox for no compelling medical reason also risks discouraging others from volunteering to fight the disease in Africa. As she said, “It scares me to think how they're going to be treated and how they're going to feel." If Ebola isn’t contained in Africa, it certainly will reach our shores.
So on the one side there is the constitution and science, and on the other there is public perception and politics. The choice should be clear but it isn’t, for politics cannot be ruled out of public policy, and irrationality cannot always be dismissed with better reasoning.
Kaci Hickox is a hero for volunteering to fight Ebola in West Africa, but she also threatens to undermine confidence in the health profession by not being more sensitive to public opinion. Whatever her motives, it does strike many as cavalier for her to be about when the incubation period hasn’t passed.
The judge was correct in ruling the Hickox’s rights need to be protected, but the governor was also right in stating that Hickox was unreasonable in not isolating herself.
People are frightened by the unknown, and there is still much that isn’t known about Ebola. Hickox would do more for public education by self-isolating and continuing to provide accurate information about the disease. As it is, she is undermining the credibility of the medical community. Rather than promoting good science and reason, she may be contributing to fear and irrationanlity.
