Your Liberty or Your Life: Reciprocity in the Use of Restrictive Measures in Contexts of Contagion

The distinction between quarantine and isolation is important to observe: Quarantine refers to the compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas. That is, these individuals do not manifest any signs and symptoms of disease, but are at risk of developing active disease and contributing to further spread due to exposure to a case. Isolation refers to the separation and confinement of individuals with signs, symptoms, or laboratory evidence of infection to prevent them from transmitting disease to others.

While it is claimed that reciprocity is one of the conditions of legitimacy of public health action, we shall remain neutral on the question of what processes or features confer legitimacy on public health action. Accepting our argument about reciprocity as a condition moral legitimacy leaves it open that moral legitimacy may be conferred on public health measures by democratic processes, legal authority, reasonable endorsement/rejection, etcetera. For instance, Trotter (2007, 30–7) maintains that we need to distinguish between two senses of legitimacy. On the one hand, there is good reasons legitimacy, which is “satisfied by well-formed arguments that show how a proposed intervention makes ethical, political and scientific sense” (Trotter 2007, 30). On the other hand, there is public justification legitimacy, which “results from a process in which proposed interventions and their rationale are properly discussed, articulated, marketed, explained, or otherwise brought to life before the general public” (ibid). Our focus shall be firmly with the former, though we do not discount the importance of the latter. Indeed, part of the robustness of our account of reciprocity is that it can accommodate both senses of legitimacy.

As Koller (2007, 203) has so aptly put the point: “The motivating force of moral norms, however, has its limits too. In general, its strength depends on the extent of reciprocity of human interaction. Therefore, a public morality needs a social world in which individuals feel bound together by ties of social solidarity, a shared interest in mastering their problems of existence cooperatively, based upon an effective social practice. Without such an idea, we shall hardly succeed in establishing a widely acknowledged political and legal order, since the voice of morality will not be strong enough to gain attention against the parties’ selfish interest in their struggle for power and benefit. It is, therefore, an important task to create and preserve a climate of social solidarity in order to bring forth the moral virtues without which a well-functional legal order cannot exist.”