16

Is there a law or a judgment from a Court in the United States wherein it is established that a government (at any level) in the US, during an officially declared public health crisis, can enforce administration of a drug/medical treatment onto a US citizen who has been declared by a public health authority (PHA) to be medically ill/sick?

I've come to know that a State government can make vaccination mandatory1. That said, I've also learned that in cases concerning mandatory vaccination4 of persons of certain age groups, some state governments provide exemptions on certain grounds, such as medical, religious and philosophical2.

However, in my proposed example case, the drug in question, let us call it DRUG, is not a vaccine at all. Instead, DRUG is a drug which has induced swift recovery in some of the sick patients. Assume that information is not available in public domain as to whether the aforesaid recovered patients were able to give informed consent with regard to the treatment they received or not. Neither can a Jack or Joe contact those patients for the lack of their contact details available on account of protecting their privacy.

Points to be noted:

  1. The available data from hospitals and PHA suggests that no known medical treatment or DRUG is so far universally effective on patients -- varied age-groups (some having co-morbidity too).

    Varying amount of information on other treatments/drugs already tested on patients or been researched/explored is available in the public domain, therefore, a citizen can attempt to make an opinion based on the available data.

  2. There may be a dearth of data released from PHA (whether deliberately done or not is not proven yet) on the number of patients administered with the DRUG who either fell more sick or died, but PHA is providing the statistics on those who did recover.

    Some probable reasons behind the data release could be:

    • PHA might be biased in the favor of DRUG (for whatsoever reason - genuine or otherwise).
    • Another reason could be: PHA's accountability is sought by political leaders, and the latter - under public pressure - might be pushing PHA to push forward with the DRUG. Like many political issues, this is subjective and open to speculation.

      Suggestion: consider historical data and analyses of earlier epidemics with similar medical treatment related issues, so as to make a reasonable assumption on why PHA is doing what it is doing.

      Note: to be clear here, I'm not trying to establish that PHA is a bad actor. But during crises, a lot of folks, whether acting as or for the authorities, want the crises to end as quickly as possible, sometimes by sidelining or deliberately encroaching the fundamental rights of the citizens. Hence, skepticism towards PHA's actions is justified from a citizen's point of view.

  3. There is emerging evidence, in the form of patient/medical staff testimonies and/or medical literature, that DRUG cause some serious side effects. Whether this happens with every patient or not is not clear yet.

  4. Armed with the information (as given in points 1,2,and 3), some veteran medical professionals using medical literature and statistical data available from PHA and hospitals have called into question the efficacy of DRUG.

  5. Despite the evidences (from points 3 and 4) already at the disposal of PHA, it has argued to their respective government that further delay in administering the DRUG upon the sick patients can severely harm the community's health and prosperity, and that the whole of the community should not be held as a hostage by those who are resisting the administration of DRUG, irrespective of them being patients.

  6. Information tsunami from hundreds of print media and electronic media outlets, and from dozens of social media sites has made it near impossible for a lot of citizens to accept as well as discard information, especially when "sponsored content as news" has become the norm for many such outlets and sites.

    The citizens concerned are capable of informed decision making. I'm not concerned with the process and information a citizen would use to reach a decision.

Intertwined questions I'm looking to be answered:

  1. What hard legal facts (such as a law or the effects of its application discussed in a judgment) are available to a US citizen so as to make a reasonable assumption on whether their own elected government can forcefully (against their will) administer a drug/medical treatment onto them if they are declared sick and are deemed a threat to public health?
  2. If step1 is positive, it would mean informed consent to medical treatment3 is no longer sought. However, does the law/judgment allows information about the treatment be made available to the patient, whether voluntarily or mandatory?

Please note:

  • I'm only interested in a law (Act, Rules, Regulations, etc.) or a judgment from a Court of the US. Everything else, no matter how obvious it is, is a personal opinion which I'm not looking for.

  • the question is not specifically about the ongoing health crisis in the US as of May 2020.


Sources:

  1. Is Mandatory Vaccination Legal in Time of Epidemic?

  2. Vaccination Law 101: A Guide for Children’s Lawyers

  3. Informed Consent: An Ethical Obligation or Legal Compulsion?

  4. State Law & Vaccine Requirements

  • 1
    Do you mean if they can physically force it, or if they can throw you in jail if you don't comply? – pipe Apr 30 at 17:35
  • What do you mean by "no alternative patient recovery strategies"? Do you mean that DRUG is the only known cure, but cases will resolve by themselves if not cured? Do you mean that the disease is invariably fatal unless DRUG is administered? Note that if the disease is always fatal without DRUG but administering DRUG cases a swift recovery, then it's really impossible for the efficacy of DRUG to be called into question. – Tanner Swett May 1 at 15:14
  • Are we assuming the patient is an adult cognitively capable of making informed decisions? – Kat May 1 at 17:39
  • @TannerSwett I'm sorry for causing confusion. I've made an edit so as to remove that confusion. Please review my question and let me know if there is still something I shall provide clarification for. – Firelord May 1 at 20:31
18

The government cannot force people to get vaccinated, without passing a law to that effect. When they do, they can. This was sorted out in Jacobson v. Massachusetts, 197 U.S. 11, when the Supreme Court, in 1905, ruled:

The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint, nor is it an element in such liberty that one person, or a minority of persons residing in any community and enjoying the benefits of its local government, should have power to dominate the majority when supported in their action by the authority of the State.

It is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health.

Nothing in that ruling is specific to vaccinations as opposed to other medical treatments. If a law mandating a certain vaccination exists in a state, the citizen's beliefs about the efficacy of the vaccination are irrelevant to the legal issue -- get the vaccination, or the punishment.

If a state were to pass a law mandating snake-oil innoculations to prevent smallpox infections, the law could be challenged in court. In general, people have the right to go about their business without the government interfering in their fundamental rights, but fundamental rights are not absolute, they are attenuated in case of a "compelling government interest": which leads to a particular kind of judicial review, strict scrutiny. While preventing a virulent deadly disease is arguably a compelling government interest, snake-oil is not necessary to reach that end (it does not reach that end, so it is certainly not necessary to reach that end).

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  • 2
    "The state legislature [...] recognized vaccination as at least an effective, if not the best, known way in which to meet and suppress the evils of a smallpox epidemic"—as this predates the adoption of strict scrutiny, it is an open question whether such a law without appropriate exceptions or alternatives would stand today. – chrylis -cautiouslyoptimistic- Apr 30 at 15:35
  • "Nothing in that ruling is specific to vaccinations as opposed to other medical treatments" Indeed, Jacobson was relied on in the current public health crisis to shut down abortion clinics in TX. – Hasse1987 Apr 30 at 23:33
4

Where DRUG exists, a law can be passed to that effect.

It's worth noting as a corollary that where DRUG does not yet exist, the government is allowed to quarantine people indefinitely where they present a risk. This was perfectly demonstrated in the case of Typhoid Mary - she was initially quarantined for several years, then allowed out on the condition that she did not work as a cook, and when she did start work as a cook again she was quarantined for the rest of her life.

The laws relating to this will be specific to each jurisdiction. Mary Mallon was held in quarantine under laws in New York State, but each US state can set up their own laws, or the federal government can set a law across the states to harmonise this.

Relating to refusal of certain groups to vaccinate, then, it would be completely legal under the older laws to control typhoid for states or the federal government to give them a choice of either accepting vaccination or accepting living in permanent quarantine until they die.

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1

Generally speaking, US courts have come down on the side of patients' rights to self-determination, in this case, acceptance or refusal of medical treatment, provided that patient is of sufficient mental competence.

These judgments often come when a hospital or physician, for their own reasons, deem a patient's survival to be of such importance that it overrides that patient's right to choose between their mores or survival.

There is a good downloadable .pdf here, which outlines some history in US courts on this topic: http://www.rbs2.com/rrmt.pdf

Legal Right to Refuse Medical Treatment in the USA
Copyright 2012 by Ronald B. Standler

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  • 1
    This question is about whether the US government (state/federal) can enforce that residents receive a medication/vaccination. Your linked article is aimed at whether an adult can refuse treatment. So its relevant but coming at the question from whether the citizen is able to refuse after such a law is enacted. page 46 point 6 is probably the more relevant point. – Criggie Apr 30 at 21:16
  • @Criggie By definition, the government forcing you to do it means that you're not allowed to refuse. If you're allowed to refuse, that means that the government can't force you to do it. – EJoshuaS - Reinstate Monica May 1 at 15:51

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