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Free Content Provider perspectives on liberty and harm in the treatment of persons with tuberculosis and mental illness

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OBJECTIVES: To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle–which are often invoked in health care legislation to justify liberty restrictions–in the treatment and care of persons with TB and severe and persistent mental illness (SPMI).

DESIGN: Qualitative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis.

RESULTS: Three themes were identified: 1) the contextual nature of liberty restrictions; 2) the concept of liberty as a matter of degree; and 3) the challenges of balancing the treatment and care goals of TB and mental health for persons with both TB and SPMI.

CONCLUSION: Harm is understood by HCWs caring for persons with TB and/or SPMI in a context-dependent manner. This is compounded in the case of persons with both TB and SPMI. Liberty restrictions to advance public health goals entail reciprocal obligations from society, including social protections and additional resources, to ease the effects and range of liberty restrictions. Attention is required to ensure that treatment and care for SPMI does not impede that of TB and vice versa.
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Keywords: ethics; isolation; justice; qualitative study; reciprocity

Document Type: Research Article

Affiliations: 1: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia 2: Leslie Dan Faculty of Pharmacy & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario 3: Lunenfeld Tanenbaum Research Institute, Sinai Health System 4: Joint Centre for Bioethics & Institute of Health Policy, Management and Evaluation 5: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario

Publication date: April 1, 2019

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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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