"Policies involving the use of involuntary incarceration for tuberculosis (TB) are highly ethically controversial."

Int J Tuberc Lung Dis. 2014 Feb;18(2):155-9. doi: 10.5588/ijtld.13.0609.

Attitudes towards involuntary incarceration for tuberculosis: a survey of Union members.

Denholm JT1, Amon JJ2, O'Brien R3, Narain A3, Kim SJ3, El Sony A4, Edginton ME3.

Author information

• 1Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France; Victorian Infectious Disease Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia.
• 2Health and Human Rights Division, Human Rights Watch, New York, New York, USA.
• 3Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France.
• 4Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France; The Epidemiology Laboratory (Epi-Lab), Khartoum, Sudan.

Abstract

BACKGROUND:

Policies involving the use of involuntary incarceration for tuberculosis (TB) are highly ethically controversial. To encourage ethical reflection within the International Union Against Tuberculosis and Lung Disease (The Union), the Ethics Advisory Group (EAG) surveyed members regarding their attitudes and values relating to involuntary incarceration for TB.

METHODS:

Members of the Union TB section were invited to respond to an anonymous web-based survey. The survey included both multiple choice questions describing a range of scenarios regarding involuntary incarceration, and free-text fields inviting respondents to provide general comments onethical issues.

RESULTS:

The survey was completed by 194 participants, 33 (17%) of whom were opposed to involuntary incarceration on principle. The age and sex of the respondents was not associated with likelihood of principled opposition; respondents from North America were least likely to be opposed to involuntary incarceration (P = 0.02). Respondents were most likely to consider involuntary incarceration for persons with known multidrug-resistant TB or a history of previous treatment default, and least likely where people lived alone, were university-educated or the main income provider for their families.

CONCLUSION:

This survey found a wide range of viewpoints regarding involuntary incarceration, and highlights a number of key elements in ethical engagement with the tensions surrounding involuntary incarceration. We provide commentary on approaches to ethical policy making in the light of these findings.