The Ethical Landscape of TB control
In a special issue, the International Journal of Tuberculosis and Lung Disease recently released a series of articles addressing the grave ethical and human rights issues uniquely faced in the fight against TB.
Two articles authored by TB-CRE investigator and affiliate A/Prof Justin Denholm and Dr Diego Silva highlight the ethical burden of TB care in the control of latent infection and in the involuntary isolation of patients during active disease.
A/Prof Denholm explores the curly question of ethical LTBI management - a state that can impose burdensome treatments upon an asymptomatic individual who may progress to active disease... or may not. LTBI management has added complexities given the ubiquity of cases, affecting up to a quarter of the global population, but also the fact that risk factors for progression to active disease are not well understood.
An ethical consideration of LTBI management requires the balancing of the risk of progression, latent infection in health care workers and multidrug-resistant LTBI issues against the expense, breadth, and individual burden of LTBI treatment on a community and individual level. In the article entitled "Latent tuberculosis infection and the EndTB Strategy: ethical tensions and imperatives", A/Prof Denholm reviews various new tools, policies, diagnoses and management techniques in order to pinpoint the most effective, least burdensome program of LTBI management. He concludes that community engagement is an essential element in developing strategies that satisfy the ethical imperative and health management requirements involves in latent TB control.
In an article bearing incredible relevance to the age of COVID-19, Dr Diego Silva investigates the ethical justifications behind the involuntary isolation of people with TB in his article "Ethics and human rights considerations regarding involuntary isolation of people with TB".
While isolation for patients who have active TB disease is a rare occurrence, and a last resort, the impingement of human rights involved in involuntary isolation is held to be justified in circumstances where the isolation is proportionate to the serious threat of disease spread. Furthermore, Dr Silva argues that the isolation serves and archives its clearest intended objective; the treatment of the patient, and the safeguarding the health of a population.
Dr Silva further delineates the circumstances and prerequisites that must be met in order to achieve ethical justification for involuntary isolation.