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Public Policy and the Role of Experts c h a p t e r f o u r Feelings of self-importance blossom in many settings, but disaster seems to beget an exceptional profusion. Consider the Muncie, Indiana, smallpox epidemic of 1893, in which twenty citizens died, a public health official was shot, and vainglorious experts caused more harm than good. Almost from the beginning, in August of that year, there was dispute over both the source of the epidemic and how best to manage it. Several out-of-towners, dissenting physicians, and “highly experienced” observers confidently proclaimed that the offending illness was not smallpox at all, but rather, the more benign “waterpox.” This mistaken claim was trumpeted by the media. Some people believed it and died as a result. Some failed to take necessary precautions. And some stubbornly resisted coercive isolation—a conflict that led inevitably, as it must, to violence. Most of the local physicians got the diagnosis right. Yet their egos prevented them from contributing as much as they could. At the height of the epidemic, local physicians met with a few politicians and favored community members to produce a set of rules that they expected public officials to enforce. Most of the rules were sensible, if debatable. Others were unrealistic —as, for instance, Rule 14: “We recommend that no person except nurse and physician be permitted to visit any sick person until it is certainly ascertained that they are not suffering from small-pox.”1 When some of their recommendations were not enforced, the physicians reconvened to issue a joint resolution absolving themselves of all responsibility for the impending catastrophe. Subsequent to this washingof -hands, the epidemic quickly petered out. As with San Francisco’s response to the influenza epidemic of 1918, officials and experts in Muncie appealed to their own moral and practical intuition as justifica- tion for using force. From the standpoint of modus vivendi theory, this approach is problematic, since the legitimization of coercive public health interventions such as isolation and quarantine requires public consultation and some form of advance public affirmation. Specifying the precise mechanism for this public affirmation becomes the central problem for modus vivendi theory and practice. Individual citizens are the most obvious and recognizable bearers of the right to give permission. But if individuals are the proper locus for permission, then coercion is fully legitimate only when each individual has voluntarily accepted, in advance, that under certain circumstances he or she should be coerced. There are unfortunately two very obvious and very important practical barriers to identifying individual persons as the sole legitimate permission givers, each discussed briefly in the preceding chapter. First, universal individual advance veto rights would preclude many sensible and widely popular cooperative ventures (such as building highways and ratifying constitutions). Second, the objective of getting everybody’s input often proves to be unworkable—especially in exigent circumstances such as mass casualty events in which there is not time for it. The first problem, then, for those who would enact government by modus vivendi , is the question of agency. Which are the appropriate individual, community, and organizational roles in deliberation, decision ratification, leadership, and enforcement ? In this chapter, we examine the roles of experts and news media in public deliberation about coercion in mass casualty medicine. Then, in subsequent chapters, we will examine related agency issues including: (1) stakeholders’ role in public deliberation, (2) leadership authority in strategic and tactical decisions about coercion, and (3) the authority to make and enact decisions for particular coercive actions. experts’ role in public deliberation The Muncie epidemic wasn’t unique in precipitating a coalescence of genuine and fanciful experts. Illness, disaster, violence, and other sudden, unexpected, and fearful disruptions elicit cries for help. There will always be well-wishers, opportunists , sages, and savants—clothed in erudition and poised to heed the summons. This dynamic is as natural as the impulse to understand. And it is a crucial matter for deliberation. The first requirement of good deliberation seems to be that it is based on an accurate assessment of the facts. Relevant factual input includes medical/scientific information , demographic information, political/legal information, and sometimes integrative judgments about probabilities (as in surveying the most likely results of an 54 t h e e t h i c s o f c o e r c i o n i n m a s s c a s u...

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