title: Public health measures to control tuberculosis in low-income countries: ethics and human rights considerations.
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.
authors: 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.
authors: J D
authors: JD
authors: Kraemer
authors: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.
authors: O A
authors: OA
authors: Cabrera
authors: 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.
authors: J A
authors: JA
authors: Singh
authors: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors: T B
authors: TB
authors: Depp
authors: O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: L O
authors: LO
authors: Gostin
mesh_terms: D003140:Communicable Disease Control / Q000191:economics*; D003219:Confidentiality / Q000941:ethics; D003906:Developing Countries / Q000191:economics*; D017048:Health Care Costs / Q000941:ethics*; D006282:Health Personnel / Q000191:economics / Q000941:ethics; D006297:Health Services Accessibility / Q000191:economics / Q000941:ethics; D006806:Human Rights / Q000191:economics*; D006801:Humans; D028681:Moral Obligations; D009313:National Health Programs / Q000191:economics / Q000941:ethics; D009786:Occupational Health Services / Q000191:economics / Q000941:ethics; D026684:Personal Autonomy; D011634:Public Health / Q000191:economics / Q000941:ethics; D011790:Quarantine / Q000191:economics / Q000941:ethics; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission