Tuberculosis, non-compliance and detention for the public health

Journal of Medical Ethics 26 (3):157-159 (2000)
Coercion, the act of compelling someone to do something by the use of power, intimidation, or threats, has been deemed a necessary weapon in the public health armamentarium since before public health fell under the remit of physicians and out of the grip of “sanitarians” and civil engineers. This article examines the ethics of detention in the pursuit of public health and uses a contemporary example, detention of poorly compliant individuals with tuberculosis, to highlight the moral dilemmas posed, and examine whether recently proposed approaches are just. In particular I focus upon the public health response to non-infectious individuals who fail to comply with treatment . Our response to them helps clarify contemporary attitudes to recalcitrant, often marginalised, individuals who pose an uncertain threat.Globally tuberculosis control is failing. The World Health Organisation recently called this public health threat a global emergency.1 Transmission occurs through often casual contact from individuals who have pulmonary disease. Although there is much that is uncertain regarding the infectiousness of this ancient disease, we do know that those who are smear-positive, that is who have organisms of Mycobacterium tuberculosis visible in stained respiratory secretions, are considerably more infectious than those who do not.2, 3 Compliance with effective treatment rapidly makes previously infectious patients non-infectious. Standard treatment for fully drug-sensitive tuberculosis usually lasts for six months. Erratic adherence to chemotherapy, however, may result in relapse and the development of drug-resistant disease which is considerably more difficult to treat.In the 1980s and early 1990s New York City witnessed an epidemic of tuberculosis and, of particular concern, a marked increase in drug-resistant and multidrug-resistant strains. In the early 1990s the threat of a virtually untreatable, casually communicable, …
Keywords No keywords specified (fix it)
Categories (categorize this paper)
DOI 10.1136/jme.26.3.157
 Save to my reading list
Follow the author(s)
My bibliography
Export citation
Find it on Scholar
Edit this record
Mark as duplicate
Revision history Request removal from index
Download options
PhilPapers Archive

Upload a copy of this paper     Check publisher's policy on self-archival     Papers currently archived: 24,470
External links
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library
References found in this work BETA

No references found.

Add more references

Citations of this work BETA
Yann Joly & Gillian Nycum (2007). Currents in Contemporary Ethics. Journal of Law, Medicine & Ethics 35 (4):734-738.
Yann Joly & Gillian Nycum (2007). Currents in Contemporary Ethics. Journal of Law, Medicine and Ethics 35 (4):734-738.

Add more citations

Similar books and articles
Jonny Anomaly (2011). Public Health and Public Goods. Public Health Ethics 4 (3):251-259.

Monthly downloads

Added to index


Total downloads

11 ( #381,719 of 1,925,582 )

Recent downloads (6 months)

1 ( #418,223 of 1,925,582 )

How can I increase my downloads?

My notes
Sign in to use this feature

Start a new thread
There  are no threads in this forum
Nothing in this forum yet.