Case Study: Mallon Vs. Massachusetts Case

Jessica Tice
10/10/17
Dear Dr. Concerned, In response to your questions about the rights of public health officials, I find that there are a great many details to consider. As I am sure you are aware, the United States Supreme Court decision in 1905 on the Jacobson v. Massachusetts case set a legal precedent in situations such as these. The ruling stated that the Board of Health had the right to require citizens to receive vaccinations in order to control a spreading smallpox epidemic . Legally, this supports the rights of you and your colleagues at the CDC to do what you deem necessary to protect public health, even if it may infringe upon the personal liberties of citizens. Just because there is legal precedent, however, does not mean that
these are measures you should take them. The quarantine of ‘Typhoid Mary’ Mallon and register of Tuberculosis patients provide excellent historical case studies for the decisions to be made around the current AIDS epidemic. The goal of Public Health is, first and foremost, to protect the health of the public, and it may seem that the best, most efficient way to protect the public from a disease is to track it and cut off contact with it, wherever possible. This, however, is a simplified view because, in order to do this, we must do the same to the disease’s human hosts. It can be easy to lose sight of their humanity, in fear of the disease they carry, but people are not their disease. Ensuring the protection of the public while minimizing harm to the individual can be a difficult balancing act, and Mary Mallon was an unfortunate case of public health authorities overbalancing. Detention methods can be incredibly disruptive and detrimental to the life and livelihood of those being detained—experienced in its most extreme by Mallon.
Mallon, a healthy-carrier, was held in quarantine two separate times for a total of twenty-six and a half years until her death .
Given that there were a large number of healthy carriers, besides Mallon, none of whom were taken into custody as she was, this measure seems extreme . The argument for her continued quarantine was that, when given freedom from her first quarantine, Mallon continued to transmit the infection through cooking. In Leavitt’s discussion of Mallon’s experience, however, she points out that the doctors and public health officials in charge of Mallon’s quarantine were so focused on the science that they forgot the social aspects. They searched for a cure but didn’t try to work with her or teach her . If Mallon had been educated on preventative measures and trained in a new profession without the risk of transmission that cooking had, she would no longer have been a threat to public health outside of quarantine. What should be exemplified from the case of Typhoid Mary, isn’t was done to her, but what was learned from her. “Using … their experience with Mallon, the health officials developed treatment protocols and regulatory guidelines that could be widely applied,” and these guidelines could be followed to prevent transmission without the need for quarantine . While detention methods may be helpful, they are not always necessary, and we should only implement them when they absolutely
are. Like quarantine, the idea of a mandatory patient registry is also a deeply polarized public health method.
During past tuberculosis and syphilis epidemics, this measure was hotly debated. Many felt that it would prevent the rapid spreading of the disease, to be able to know and monitor those who were infected . The other side of the debate, however, argued that “the means purposed [would] produce hardship without corresponding value, and that they are both unnecessary and insufficient.” A mandatory registration of this kind has the potential to build up stigma around the disease. By requiring people to turn over information on individuals with a disease to health officials, it creates an environment of fear. As some argued in the case of TB, such measures may even worsen transmission because the ill will hide from the registration, leading to lack of treatment or education on an individual’s preventative measures . This, coupled with the fact that AIDS is most common in some already-stigmatized groups—like homosexuals—increases the risk that a registry would do more harm to the sick than it would benefit the public. Basically, registering and monitoring every individual with AIDS would be “impractical” and has the very real potential to draw attention away from other preventative and safety measures that should be implemented by diverting focus to blaming, stigmatizing, and ostracizing victims
. The issue with public health policies epidemics pertaining to epidemics is that they are often made in the moment of crisis, during an ongoing epidemic. At that point, people feel a desperate need to do something to help the situation , so “the individual fear and community panic associated with infectious diseases often lead to rapid, emotionally driven decision making about public health policies.” In the case of both detention and registration of individuals with AIDS, however, it should be made clear that these are drastic measures with long-lasting effects on individuals’ lives that are being considered, and their implementation should not be a decision made rashly. As Fidler et al. said, “the fact that detention is a drastic measure does not mean that isolation and quarantine are inappropriate;” it simply means that, due to their drastic nature and their potential to infringe upon individual rights, they should not be the first preventative method taken . Health officials should use the “least restrictive means” to prevent a disease that is still functional, and more extreme methods like detention and registration should be used after very careful consideration “as a last resort and applied in keeping with human dignity and natural justice.”
Generally, I find that “the need for coercive measures … can be seen as evidence of a failure to provide the public health programs that could have prevented or treated disease”, so the CDC’s first step in disease prevention should be towards educational and outreach programs . Working with at-risk groups and patients who have AIDS to learn about safe prevention and to get access to resources that will help in this endeavor should be the goal. By, first, educating the public about AIDS preventions, such as safe sex, CDC can try to help the public help themselves before further measures are necessary. I hope this has helped you and your colleagues at the CDC come to a decision on what course of action you will take to combat this epidemic.
Sincerely,
Jessica Tice

Bibliography
Leavitt, Judith W. “’Typhoid Mary’ Strikes Back: Bacteriological Theory and Practice in Early Twentieth-Century Public Health.” ISIS 83, no. 4 (1992): 608-629.
“Discussion on the Advisability of the Registration of Tuberculosis.” In Transactions of the College of Physicians of Philadelphia. 16, (1894): 1-27.
Landwirth, Julius, and Martin Cetron. “Public Health and Ethical Considerations in Planning for Quarantine.” Yale Journal of Biology and Medicine 78, (2005): 325-330.
Fidler, David P., Gostin, Lawrence O., and Howard Markel. “Through the Quarantine Looking Glass: Drug-Resistant Tuberculosis and Public Health Governance, Law, and Ethics.” The Journal of Law, Medicine &Ethics 35, no. 4 (2007): 616-628.
Mariner, Wendy K. “Jacobson v Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law.” American Journal of Public Health 95, no. 4 (2005): 581-590.