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THE	
  INTERSECTION	
  OF	
  LAW,	
  RELIGION,	
  AND	
  INFECTIOUS	
  DISEASE	
  ON	
  THE	
  
HANDLING	
  AND	
  DISPOSI...
Outline:	
  	
  
THE	
  INTERSECTION	
  OF	
  LAW,	
  RELIGION,	
  AND	
  INFECTIOUS	
  DISEASE	
  
	
  ON	
  THE	
  HANDL...
Knowledge  of  Risk  from  Cadavers  Predates  Germ  Theory
Prior	
  Ebola	
  Vs	
  Current	
  outbreak	
  in	
  African	
  ConRnent	
  
Data	
  from	
  03	
  May,	
  2015;	
  Releas...
Clinical:	
  Phases	
  of	
  Ebola	
  
Aileen	
  M	
  Marty	
  MD	
   5	
  
Virus	
  can	
  be	
  isolated	
  from	
  sele...
Guinea,  June  2014
•  Pregnant	
  Guinean	
  woman	
  died	
  of	
  Ebola	
  
•  Religion/Belief:	
  
•  Mourners	
  refu...
Guinea,  June  2014
•  Pregnant	
  Guinean	
  woman	
  died	
  of	
  Ebola	
  
•  Science	
  and	
  Medicine:	
  	
  
•  W...
Find  an  acceptable  soluFon  for  both  Science  &  Beliefs
•  Anthropologist	
  knew	
  there	
  had	
  to	
  
be	
  a	...
August  2014:  Liberian  President  Ellen  Johnson  Sirleaf  
decreed  “all  bodies  of  Ebola  vicFms  to  be  cremated"
...
We	
  can’t	
  ignore	
  
their	
  fears,	
  
concerns,	
  and	
  
beliefs…for	
  
doing	
  so	
  can	
  be	
  
tragic	
  ...
Body  bags
PotenFally  Dangerous  Religious  Burial  PracFces
RIGHTS  TO  HUMAN  REMAINS
• Human	
  remains	
  not	
  deemed	
  property	
  
• Survivors’	
  “quasi-­‐property”	
  right...
COUNTERVAILING  INTERESTS—RELIGION  AND  DEAD  BODIES  
•  1st	
  Amendment	
  U.S.	
  
Cons,tu,on	
  (free	
  exercise	
 ...
Control  of  InfecFous  Human  Remains    during  Public  
Health  Emergency
Federal 	
  	
  
•  US	
  Cons,tu,on	
  	
  
...
MODEL  STATE  EMERGENCY  HEALTH  POWERS  ACT
§	
  504	
  Safe	
  disposal	
  of	
  human	
  remains.	
  	
  
To	
  the	
  ...
STATE  VERSIONS  OF  MODEL  ACT:  EXAMPLES
•  South	
  Carolina	
  &	
  Wyoming	
  
•  Adopted	
  safe	
  disposal	
  prov...
• Borrow	
  from	
  the	
  WHO	
  
q 	
  WHO’s	
  Taking	
  Stock	
  Ac,on	
  points:	
  
•  Consider	
  research	
  on	
...
q  WHO:  12  Step  Protocol:  
“No  burial  should  begin  un0l  family  agreement  has  been  obtained”
• Con,nually	
  assess	
  and	
  update	
  laws,	
  policies	
  &	
  
plans	
  
• Interdisciplinary	
  proac,ve	
  approac...
QuesRons?	
  QuesRons?	
  QuesRons?	
  	
  
22	
  
Aileen	
  M.	
  Marty,	
  M.D.	
  
Professor,	
  Infec,ous	
  Diseases	...
The  End
Aileen M. Marty, Elena M. Marty-Nelson, Eloisa C. Rodriguez-Dod, "The Intersection of Law, Religion, and Infectious Diseas...
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Aileen M. Marty, Elena M. Marty-Nelson, Eloisa C. Rodriguez-Dod, "The Intersection of Law, Religion, and Infectious Disease on the Handling and Disposition of Human Remains"

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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience.

This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

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Aileen M. Marty, Elena M. Marty-Nelson, Eloisa C. Rodriguez-Dod, "The Intersection of Law, Religion, and Infectious Disease on the Handling and Disposition of Human Remains"

  1. 1. THE  INTERSECTION  OF  LAW,  RELIGION,  AND  INFECTIOUS  DISEASE  ON  THE   HANDLING  AND  DISPOSITION  OF  HUMAN  REMAINS   Aileen  M.  Marty  M.D.   Professor,  Infec,ous  Diseases   FIU  Herbert  Wertheim  College  of  Medicine   Elena  M.  Marty-­‐Nelson      Eloisa  C.  Rodriguez-­‐Dod   Professor  of  Law,  NSU  College  of  Law      Professor  of  Law,  FIU  College  of  Law     Petrie-­‐Flom  Center  for  Health  Law  Policy,  Biotechnology,  and  Bioethics  at  Harvard  Law  School   2015  Annual  Conference:  Law,  Religion,  and  Health  in  America   Panel  9,  When  Religion  Intersects  with  Mental,  Public,  and  Environmental  Health   1:30  -­‐  2:50pm  Saturday,  09  May,  2015  
  2. 2. Outline:     THE  INTERSECTION  OF  LAW,  RELIGION,  AND  INFECTIOUS  DISEASE    ON  THE  HANDLING  AND  DISPOSITION  OF  HUMAN  REMAINS       • Introduc,on     • Case  Study   •  Belief  vs  Science,   Medicine,  Public  Health   •  Burials,  Bodies,  and   Beliefs   •  Lessons  Learned   2   •  Religion,  Beliefs,  and  today’s  Science   •  The  Law   •  Recommenda,ons  
  3. 3. Knowledge  of  Risk  from  Cadavers  Predates  Germ  Theory
  4. 4. Prior  Ebola  Vs  Current  outbreak  in  African  ConRnent   Data  from  03  May,  2015;  Released    06  May,  2015   Countries  Affected:    Guinea,  Sierra  Leone,  Liberia,  Nigeria,  Senegal,  Spain,  USA,  Mali,  UK   WHO  states  that  officially  reported   figures  are  underesRmates   HCW:  507   HCW:  871   Last  month  (12  April   2015  to  05  May)  there   were  nearly  more   deaths  from  EVD  than   there  were  cases  in   largest  previous   outbreak!    
  5. 5. Clinical:  Phases  of  Ebola   Aileen  M  Marty  MD   5   Virus  can  be  isolated  from  select  fluids  for   much  longer  than  it  can  be  detected  in  blood.     E.g.  Ebola  can  be  isolated  from  semen  for     199  days  a_er  entering  convalescent  phase.  
  6. 6. Guinea,  June  2014 •  Pregnant  Guinean  woman  died  of  Ebola   •  Religion/Belief:   •  Mourners  refused  to  allow  the  “Dead  Body  Management   Team”  of  outsiders,  dressed  in  their  frightening  white  “space   suits,”  to  bury  her  Ebola-­‐infected  corpse.     •  Tradi,onal  Kissi  culture  requires  a  woman  must  not  be   buried  with  her  fetus,  because  to  do  so  disturbs  the  world’s   natural  cycles.  It  would  alter  the  beginnings  and  endings   among  humans,  animals,  and  plants.     •  Concern:  In  their  belief  system,  no  risk  from  Ebola  was  worth   the  far  greater  risk  of  altering  the  order  of  the  universe.      
  7. 7. Guinea,  June  2014 •  Pregnant  Guinean  woman  died  of  Ebola   •  Science  and  Medicine:     •  Woman’s  body  oozing  myriad  of  deadly  virus,     •  Opening  her  body  to  extract  the  fetus  would  put  everyone   involved  at  grave  risk  of  Ebola.     •  The  closer  someone  is  to  death  the  higher  the  levels  of  virus;   a  dead  body  from  someone  who  dies  of  Ebola  has  the  highest   levels  of  virus.   •  Concern:  unbelievably  high  concentra,ons  of  Ebola  virus  on   deceased  pregnant  woman  would  contaminate  their   personal  protec,ve  equipment  (PPE)  to  inordinate  levels   making  later  removal  of  PPE  extremely  hazardous.          It  could  also  aerosolize  virus  pufng  many  bystanders  at  risk  
  8. 8. Find  an  acceptable  soluFon  for  both  Science  &  Beliefs •  Anthropologist  knew  there  had  to   be  a  repara,on  ritual   •  “found  a  very  old  man  whose   grandfather  was  one  of  the   ritualists  in  charge  of  repara,ons.   He  had  inherited  the  repara,on   ritual.”     •  Elder  explained  the  ritual,  which   required  “a  goat,  12  yards  of  white   ,ssue,  salt,  oil,  and  rice”   •  Once  village  knew  of  repara,on  ritual  and  once  they   had  conducted  it,  burial  workers  were  able  to  bury   the  woman’s  body  with  the  fetus  inside   Julienne  Anoko,   Anthropologist  from   Cameroon,  hired  by  WHO   •  Could  similar  situa,on  happen  in  USA?     •  Think  now,  learn  now,  Plan  now,  be  ready  -­‐-­‐-­‐in  case!    
  9. 9. August  2014:  Liberian  President  Ellen  Johnson  Sirleaf   decreed  “all  bodies  of  Ebola  vicFms  to  be  cremated" •  Public  Health   PerspecRve  –  great   idea!   •  Reality,  based  on   social,  cultural,  and   religious  norms  –  a   disaster!    
  10. 10. We  can’t  ignore   their  fears,   concerns,  and   beliefs…for   doing  so  can  be   tragic  at   mul,ple  levels    
  11. 11. Body  bags
  12. 12. PotenFally  Dangerous  Religious  Burial  PracFces
  13. 13. RIGHTS  TO  HUMAN  REMAINS • Human  remains  not  deemed  property   • Survivors’  “quasi-­‐property”  rights  to   possession  of  remains  for  purposes  of  burial   or  other  disposi,on   • Religious  Rights   • Qualified  by  government  interest  in  protec,ng   public  health  
  14. 14. COUNTERVAILING  INTERESTS—RELIGION  AND  DEAD  BODIES   •  1st  Amendment  U.S.   Cons,tu,on  (free  exercise   of  religion)   •  Federal  RFRA  (Restora,on   of  Freedom  of  Religion   Act)   •  State  RFRAs   •  Religious  provisions  in   State  cons,tu,ons   •  Other  laws   • Restric,ng  religious   death  rituals   •  Burden  on  religion?   •  Government’s   compelling  reason?   •  Least  restric,ve   alterna,ve?  
  15. 15. Control  of  InfecFous  Human  Remains    during  Public   Health  Emergency Federal     •  US  Cons,tu,on     •  Commerce  Clause   •  Necessary  and  Proper  Clause   •  General  Welfare  Clause   •  Federal  Codes  &  Regula,ons   •   264-­‐265  of  Title  42  of  the  U.S.C.   •  Part  70  of  C.F.R.     •  Agencies,  par'cularly   •  DHHS   •  Centers  for  Disease  Control  and   Preven,on  (CDC),     •  U.S.  Public  Health  Service  (PHS)   •  DHS   States   •  10th  Amendment     •  Police  Powers   Front  Line:   Local  Public   Officials  
  16. 16. MODEL  STATE  EMERGENCY  HEALTH  POWERS  ACT §  504  Safe  disposal  of  human  remains.     To  the  extent  possible,  religious,  cultural,  family,  &   individual  beliefs  of  deceased  person  or  family  shall  be   considered  when  disposing  of  human  remains     §  Sec,on  606  CollecRon  of  laboratory  specimens;   performance  of  tests.     Collect  specimens  &  perform  tests  upon  deceased   persons  &  acquire  previously  collected  specimens  or  test   results   -­‐  Autopsy?   -­‐  Unlike  §  504,  no  religious  sensi,vity  language    
  17. 17. STATE  VERSIONS  OF  MODEL  ACT:  EXAMPLES •  South  Carolina  &  Wyoming   •  Adopted  safe  disposal  provision,  with  No  religious  clause     •  New  Jersey   •  Adopted  safe  disposal  provision,  including  religious  clause   •  Added  temporary  mass  burials   •  Adopted  postmortem  tes,ng  provision,  expressly  using  term   “autopsy”     •  Iowa   •  Adopted  safe  disposal  provision,  including  religious  clause   •  Adopted  postmortem  tes,ng  provision,  adding  religious   clause  
  18. 18. • Borrow  from  the  WHO   q   WHO’s  Taking  Stock  Ac,on  points:   •  Consider  research  on  local  customs  and  funeral  rites  and   •  Consider  anthropological  studies  recommended  to   understand  local  culture.     •  Disseminate  exis,ng  guidelines  or  ar,cles.     •  Train  and  equip  Na,onal  teams  to  perform  safe  burials   ac,vi,es   RecommendaFons During  an  Emergency  is  too  late   We  need  to  do  this  research  NOW  and  consider  the   various  religions  and  beliefs  in  the  USA  
  19. 19. q  WHO:  12  Step  Protocol:   “No  burial  should  begin  un0l  family  agreement  has  been  obtained”
  20. 20. • Con,nually  assess  and  update  laws,  policies  &   plans   • Interdisciplinary  proac,ve  approach  –  integrate   science  &  community   • Preparedness  is  KEY!    The  USA  is  NOT  Immune!     RecommendaFons  (ConFnued)
  21. 21. QuesRons?  QuesRons?  QuesRons?     22   Aileen  M.  Marty,  M.D.   Professor,  Infec,ous  Diseases     FIU  Herbert  Wertheim  College  of  Medicine   Aileen.Marty@FIU.edu       Elena  M.  Marty-­‐Nelson   Professor  of  Law     NSU  College  of  Law     nelsone@nsu.law.nova.edu       Eloisa  C.  Rodriguez-­‐Dod   Professor  of  Law   FIU  College  of  Law   elrodrig@fiu.edu    
  22. 22. The  End

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