One of the most important reformers was George Buchanan, the chief medical officer for England from 1879 to 1892. He argued that cities and towns had the authority to take necessary steps to ensure the communal “sanitary welfare.” He and other reformers based their arguments on an idea developed by the 19th-century English philosopher John Stuart Mill, who is, ironically, remembered largely as a staunch defender of individual liberty. Mill articulated what he called the “harm principle,” which asserts that while individual liberty is sacrosanct, it should be limited when it will harm others: “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty and action of any of their number, is self-protection,” Mill wrote in On Liberty in 1859. Public-health reformers argued that the harm principle gave them the authority to pursue their aims.
An essay published in The Lancet in 1883 sums up this view nicely: “We cannot see that there is any undue violation of personal liberty in the sanitary authority acting for the whole community, requiring to be informed of the existence of diseases dangerous to others. A man’s liberty is not to involve risk to others,” the author wrote. “A man with smallpox has the natural liberty to travel in a cab or an omnibus; but society has a right that overrides his natural liberty, and says he shall not.”
Backed up by these arguments, as well as the new science of microbes, the reformers carried the day. From the 1860s to the 1890s, the English government, as well as many English cities and counties, used this interpretation of freedom to pass a series of laws allowing authorities to track and report infectious diseases, isolate and hospitalize people who were sick with these diseases, and inspect and disinfect people’s homes and other buildings to ensure they were sanitary. Partly because of these interventions, rates of many infectious diseases in England dropped.
Today, however, American public-health leaders and politicians are for the most part ignoring this approach; instead, they have built their argument on numbers, and particularly on the continued rise in COVID-19 cases and deaths. This is certainly a plausible, and rational, response. But for some, the call to protect individual liberty, and to kick-start the economy in the process, is more compelling than data and statistics.
State by state, people are being asked to make a false choice between a rapid economic recovery and protecting the lives of vulnerable Americans. In a country where the idea of freedom is cherished so deeply, a compelling argument can and should be made that curtailing personal liberties is sometimes necessary to secure freedom for everyone.
Within the space of a few months, COVID-19 has joined diseases like scarlet fever, diphtheria, and cholera as a quintessential example of a threat that requires giving up one sort of liberty in order for people everywhere to enjoy their right to be healthy. Contagious and lethal, it so far cannot be cured or vaccinated against. Those who want to ignore social distancing, spurn masks, and crowd together in malls and on beaches might be making a statement in defense of personal liberty, but they are also undeniably endangering the freedoms of thousands of others.
Freedom, after all, is a flexible concept, and Americans’ freedoms surely include the opportunity to minimize the collective risk of random viral death.