The intervention at the Lemuel Shattuck Hospital aimed at the control of the spread of Tuberculosis targets mainly individuals that are homeless and may not be able to complete the treatment. Among the factors identified as the leading causes for drug-resistant Tuberculosis is the deviation from the strict 6 to 12-month antibiotic regimen required to treat the disease (Annas, 1993). The intervention policy requires that patients in these high-risk groups already testing positive with the disease are committed to treatment at a health facility until treatment is completed.
It had been argued that the stringent controls were the reasons behind the 70 years sustained decline of the disease in the state. However, in the period from 1988 to 1990, there was a marked 15% increase in the incidence of TB in the state. It is reported that this rise in the incidence of TB was largely due to crowding in prisons, drug abuse, and HIV. Some officials have argued that the emphasis on ill patients has shifted focus from other possible causes and means of propagating the disease (Annas, 1993).
The health policy is considered inclusive based on several factors. First, it has been reported that among the causes of the increase in the spread of TB from1988 from 1990 was a result of several factors. One of these factors was an increase in drug-related cases in courts that saw an increase in the number of people incarcerated. This in turn led to overcrowding in prison populations thus making it easier for the disease to spread. It has been suggested that instead of incarceration a more suitable alternative could be to provide treatment for drug addiction to the offenders (Annas, 1993).
Second, another reason cited for the increase in the prevalence of the disease during the period was attributed to an increase in the incidence of HIV both in and out of prison (Annas, 1993). It is known that the highly infectious bacterium that causes TB poses a serious risk to patients already infected with HIV. Owing to this position it is also equally important to increase the screening and treatment of HIV patients to manage the spread of the disease more effectively.
Third, about HIV the strict management of only the homeless while paying little or no attention to groups indulging in high-risk sexual behavior is likely to make the policy fail at achieving its goals (Gostin & Mann, 1994). Commercial sex workers, gay groups, and other such groups face a much higher risk of contracting HIV and should thus also be screened. It has already been mentioned that individuals suffering or exposed to HIV are prone to infection by TB and as such groups exposed to HIV should be more effectively monitored (Annas, 1993). These groups are also just as likely to be unable to complete the treatment regimen required.
This policy is likely to place some burdens on the rights of confined individuals. It has been reported that the Supreme Court has ruled that illness alone is not adequate grounds for confinement (Annas, 1993). This implies that involuntary confinement to complete treatment is an infringement on personal liberty. However, many federal courts still rule to permit confinement when the patient is considered a risk to public health owing to proven behavior or medical facts.
However, this infringement is difficult to circumvent given that government has inherent powers that allow it to act in the interests of public safety. These powers also known as “Police powers” reside at the state level and public health issues are almost always tackled at the state level (Annas, 1993). Although confinement should only be used as a last resort, its availability as a legal option should be considered for further discussion.
Annas, G. J. (1993). Control of Tuberculosis: The Law and the Public’s Health. The New England Journal of Medicine, 328, 585-588.
Gostin, L. & Mann, J. M. (1994). Towards the development of a Human Rights Impact Assessment for the formulation and evaluation of Public Health Policies. Health and Human Rights, 1, 60-79.