Are there Characteristics of Infectious Diseases that Raise Special Ethical Issues?¹

Abstract

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.

Nordihydroguaiaretic acid (NDGA) and α-mangostin inhibit the growth of Mycobacterium tuberculosis by inducing autophagy

“…It is estimated that 9.0 million people developed this infection and 1.5 million died from TB in 2013 (WHO, 2014). The prevalence of TB is related to neglect treatment and the misuse of drugs as well as patient complications from other diseases, such as diabetes mellitus and HIV [1].…”

Pre‐pandemic planning survey of healthcare workers at a tertiary care children’s hospital: ethical and workforce issues

“…Ethical challenges are intrinsic to the treatment and control of communicable diseases. Caring for infected individuals juxtaposes the medical ethics principles of patient autonomy, non‐maleficence, beneficence, and justice 2 with healthcare worker responsibility and duty (to work, to not become infected, and to not infect others) 3 . Public health measures of surveillance, contact tracing, immunizations, forced therapy, isolation, and quarantine are critical to the control of communicable diseases, especially during an epidemic or pandemic; these measures are founded in the ethical principles of utilitarianism 4 and social justice 5 and focus on public good rather than on each individual.…”

Testing for Neisseria gonorrhoeae by nucleic acid amplification testing of chlamydia samples using Roche Cobas Amplicor in a rural area in the north of England does not find more gonorrhoea in primary care

“…Public health policies needed to protect the community may be in conflict with current bioethical principles regarding the care of individual patients. 7 The additional laboratory costs of the N gonorrhoeae NAAT testing materials for this number of samples was approximately £1500, without taking into account the costs of laboratory or clinician time. We think that screening for N gonorrhoeae by NAAT with this method is neither cost effective nor appropriate in this low prevalence population.…”