Mycobacterium tuberculosis, the causative agent of tuberculosis. Obtained from the CDC Public Health Image Library. Image credit: CDC/ Elizabeth "Libby" White (PHIL #8433).

A Principle-Based Framework Needed for Screening and Treatment of TB

In That Case Comment on “The Ethics of Isolation for Patients With Tuberculosis in Australia” by Jane Carroll, published in the Journal of Bioethical Inquiry 13(1).

Hafid Soualhine, Ph.D.
Institut National de sante publique du Quebec
Montréal, Québec, Canada

Bioethics emerged in the 1960s as an interdisciplinary field of inquiry concerned with the moral, social, and religious issues related to health and treatment. In pluralistic societies, where the flux of immigrants and refugees has grown, interaction between patients from different ethnic backgrounds and health workers is becoming routine. Tuberculosis (TB) remains a significant public health problem on a global scale. In Canada, few cases of extensively drug-resistant (XDR) tuberculosis have been imported. Screening and treatment of latent tuberculosis were incorporated several years ago.

In the case described by Carroll, Xiang surely has a dormant bacillus in his lungs that was not detected upon visa emission. The cost of multidrug-resistant tuberculosis (MDR-TB) treatment is more than $50,000, and this cost can reach up to $200,000 in the case of XDR-TB. Active and contagious TB patients must rest and should not be allowed to leave a region via air travel. Patients with positive acid-fast bacilli (AFB) smears, mainly for MDR-TB or XDR-TB, must be isolated in a separate and negatively pressured room until smear conversion to avoid transmission of resistant bacilli. On the other hand, the host country of any non-citizen TB patient must then bear the cost. In an ideal scenario, the temporary visitor, like Xiang, should subscribe to insurance protection to cover his outcome losses upon invalidity. More importantly, developed countries must integrate a principle-based analytic framework to allow screening and efficient treatment of latent TB. The results of testing should not influence immigration outcome, but be used to mandate medical review and consideration of voluntary preventative treatment.