Ethical Preparedness for U.S. Biocontainment Units

Biocontainment units (BCU) are purpose-built to provide medical care for patients with high consequence infectious diseases (e.g., viral haemorrhagic fevers, Middle East respiratory syndrome) and to contain the risk of disease spread. In the United States, high consequence infectious diseases (HCID) are often quarantinable diseases designated by the Centers for Disease Control and Prevention and state and local health departments, and BCU play a prominent role when public health faces an HCID threat. Patients admitted to a BCU have access to a high resource healthcare setting, but admission to the unit comes with restrictions to the rights and liberties of patients. This article begins with an introduction to BCUs and the preparedness activities that ensure the units are ready to respond. Next, it explores the significance of public health ethics for two public health interventions-quarantine and isolation care and diagnostic testing-that may place burdens on patients in a BCU. Finally, we make recommendations for integrating ethical considerations into preparedness activities to develop, formulate, and justify plans and protocols before the need to implement them in a BCU arises.