Public Health Measures to Control Tuberculosis in Low-Income Countries: Ethics and Human Rights Considerations

International Journal of Tuberculosis and Lung Disease 15 (2011): 19-24

6 Pages Posted: 27 Jul 2012

See all articles by John Kraemer

John Kraemer

Georgetown University Law Center; Georgetown University - School of Nursing & Health Studies

Oscar A. Cabrera

Georgetown University - Law Center; Georgetown University - O'Neill Institute for National and Global Health Law

Jerome Singh

University of KwaZulu-Natal

Timothy Depp

affiliation not provided to SSRN

Lawrence O. Gostin

Georgetown University - Law Center - O'Neill Institute for National and Global Health Law

Date Written: July 26, 2012

Abstract

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.

Keywords: ethics, tuberculosis, TB, public health, low-income countries, LICs

Suggested Citation

Kraemer, John and Cabrera, Oscar A. and Singh, Jerome and Depp, Timothy and Gostin, Lawrence O., Public Health Measures to Control Tuberculosis in Low-Income Countries: Ethics and Human Rights Considerations (July 26, 2012). International Journal of Tuberculosis and Lung Disease 15 (2011): 19-24, Available at SSRN: https://ssrn.com/abstract=2118150

John Kraemer (Contact Author)

Georgetown University Law Center ( email )

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Georgetown University - School of Nursing & Health Studies ( email )

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Oscar A. Cabrera

Georgetown University - Law Center ( email )

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Georgetown University - O'Neill Institute for National and Global Health Law ( email )

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Jerome Singh

University of KwaZulu-Natal ( email )

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South Africa

Timothy Depp

affiliation not provided to SSRN ( email )

Lawrence O. Gostin

Georgetown University - Law Center - O'Neill Institute for National and Global Health Law ( email )

600 New Jersey Avenue, NW
Washington, DC 20001
United States
202-662-9038 (Phone)
202-662-9055 (Fax)

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