TY - JOUR
T1 - Public health measures to control tuberculosis in low-income countries
T2 - Ethics and human rights considerations
AU - Kraemer, John D.
AU - Cabrera, O. A.
AU - Singh, J. A.
AU - Depp, T. B.
AU - Gostin, L. O.
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
KW - Ethics
KW - Human rights
KW - Public health
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=79955827767&partnerID=8YFLogxK
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U2 - 10.5588/ijtld.10.0412
DO - 10.5588/ijtld.10.0412
M3 - Review article
C2 - 21740655
AN - SCOPUS:79955827767
SN - 1027-3719
VL - 15
SP - S19-S24
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
IS - SUPPL. 2
ER -