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Free Content Public health measures to control tuberculosis in low-income countries: ethics and human rights considerations

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In low-income countries, tuberculosis (TB) control measures should be guided by ethical concerns and human rights obligations. Control programs should consider the principles of necessity, reasonableness and effectiveness of means, proportionality, distributive justice, and transparency. Certain measures—detention, infection control, and treatment to prevent transmission—raise particular concerns. While isolation is appropriate under certain circumstances, quarantine is never an acceptable control measure for TB, and any detention must be limited by necessity and conducted humanely. States have a duty to implement hospital infection control to the extent of their available resources and to provide treatment to health care workers (HCWs) infected on the job. HCWs, in turn, have an obligation to provide care unless conditions are unreasonably and unforeseeably unsafe. Finally, states have an obligation to provide adequate access to treatment, as a means of preventing transmission, as broadly as possible and in a non-discriminatory fashion. Along with treatment, states should provide support to increase treatment adherence and retention with respect for patient privacy and autonomy. Compulsory treatment is almost never acceptable. Governments should take care to respect human rights and ethical obligations as they execute TB control programs.
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Keywords: ethics; human rights; public health; tuberculosis

Document Type: Regular Paper

Affiliations: 1: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; Department of Health Systems Administration, Georgetown University School of Nursing and Health Studies, Washington, DC, USA; and Tiyatien Health, Cambridge, Massachusetts, USA 2: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA 3: Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, Durban, South Africa; Ethical, Social, & Cultural Issues Advisory Service, Bill & Melinda Gates Foundation's Grand Challenges in Global Health Initiative, McLaughlin-Rotman Centre for Global Health, Toronto, Ontario, Canada; and Dalla Lana School of Public Health, and Joint Centre for Bioethics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada 4: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 5: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Publication date: June 1, 2011

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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