The ethics of self-isolation

[摘要] The Prime Minister has announced an end to the legal requirement for those infected with COVID-19 to self-isolate. Some think this change is premature. Whether or not this is so, the decision raises a wider issue about the isolation of those with infectious diseases. What actions should society take to avoid people with infectious diseases infecting others?It is socially responsible to avoid unnecessary social contact if you are infectious, but many of us will have been coughed-over by work colleagues or shop assistants, and wondered why they are not at home with a hot toddy instead of being out and about spreading their germs.HEALTH HAZARD There are several reasons why people may work or socialise with an infectious illness. Not all employees are paid when they are ill, and even with statutory sick pay they may not be able to afford to stay off work. Even those who would be paid may be reluctant to upset bosses, who are sometimes hostile, unbelieving, and unsympathetic when people call in sick. When I was an SHO I contracted gastroenteritis before a weekend on-call, and when I phoned my consultant to tell him I could not work his only response was ‘this is very inconvenient’!Some do not realise or believe they are a health hazard if they work with an infectious disease. Others see retiring to bed and keeping one’s germs to oneself as a sign of weakness, and refuse to ‘give in’ to illness. This is like the machismo that, during the pandemic, led Boris Johnson to continue shaking hands despite SAGE advice, and made Donald Trump disparage those who wore masks (although since masks mostly protect others rather than the wearer, not wearing them actually says ‘I don’t care about you’ rather than ‘I’m not frightened of infection’).Often this machismo is a personal characteristic; sometimes it is part of a culture that can make it difficult for even those who would like to self-isolate to protect others to do so. This culture however may change. Anne Sammon, a lawyer, said last summer: ‘Some employers have, historically, found that employees continue to come to work even when they are unwell — and potentially infectious — but this is unlikely to be acceptable to colleagues in a post-Covid work environment … We now have the precedent, from Covid-19, of employees being asked to self-isolate to prevent the further spread of illness. Employees may expect that similar steps will be taken to address all infectious disease outbreaks …’1Clearly personal responsibility and cultural expectations are important, but what role should the law play.

[学科分类] 卫生学