The Ethics of Controlling Disease Spread

Medical Ethics Sexually Transmitted Diseases and Contact Tracing MG is a 27-year-old graduate student, recently married, who comes into the student health clinic for a routine pelvic exam and Pap smear. During the course of the exam, the gynecology resident performing the exam obtains the Pap smear, but also obtains cervical cultures for gonorrhea and chlamydia. The examination concludes uneventfully. Several weeks later, MG receives a postcard indicating that the Pap smear was normal, with no evidence of dysplasia, but that the cervical culture for gonorrhea was positive.

The card instructs her to come into the clinic to discuss treatment, and that "public health authorities" have been notified for contact tracing, which refers to the identification and diagnosis of sexual partners, as required by law. The young woman is terrified that her husband will be contacted.

Is contact tracing ethically justified? While it is definitely not a good thing that the woman has gonorrhea and there is a chance that she is the one whose behavior that is spreading it, there are a lot of assumptions that could be made and most of them would be wrong regardless of the actual reason she has contracted gonorrhea. Indeed, it may be because of unprotected sex on the part of the woman with more than one partner but the same could be true of the husband.

While whomever the victim of all of this happens to be, it is a bridge too far to demand that the source of the gonorrhea be tracked. The guilty party could lie and/or the person who gave it to the woman may have gotten cured already. Second, gonorrhea is easily treatable and is not nearly as potentially or definitely damaging as HIV / AIDS, herpes or HPV, the last of which could cause cervical cancer.

However, even with the best of intentions when it comes to contact tracing, the overall practice is generally ineffective in practice. Beyond that, many STD's (including gonorrhea) can be asymptomatic for a long while. It is entirely possible that the woman had the disease before she started having sex with her husband. It certainly does not necessarily mean that she has been unfaithful and/or that he has done the same.

That all being said, if the woman is having unprotected sex with her husband (which is likely), he should be notified. The reason the agency doing so is ethically dubious is because it would plant the seed that his wife is being unfaithful and this, by itself, could break them up. Even worse, the couple in question may have one or more children and a potential separation or divorce could impact them greatly and negatively.

Generally speaking, public health officials should probably refrain from contact tracing except as it relates to more dangerous diseases. Public health education and so forth would be the wiser course as changing the root habits that lead to the spread of STD's is the real root problem (Boskey, 2016). Further, there needs to be a cost benefit analysis when it comes to the practice as resources should be spent on the most severe problems (Armbruster & Brandea, 2007). Forced Treatment for Multidrug-Resistant Tuberculosis MW is a 33-year-old man with multidrug-resistant tuberculosis (MDR-TB).

He is homeless, and has a pattern of missing many of his scheduled clinic visits. Upon starting a multi-drug regimen for his condition, MW initially comes to his scheduled clinic visits, but after a few weeks begins missing them. The provider contacts the social work case manager, who arranges supervised drug administration (also known as "directly observed therapy"). Nevertheless, MW often cannot be found and this approach is deemed to be failing. Should MW be forced into treatment against his will? Absolutely.

While one could make the case for or against the contact tracing and similar measures noted above for the case of gonorrhea. Unless it is clearly provable that MW is not contagious, he should absolutely be held against his will and treated until he is better or he happens to die from the disease .. and for a few reasons. First, tuberculosis is a very virulent disease and it can have a high level lethality if an outbreak occurs.

Anyone can theoretically die from simpler and tamer viruses like influence and the common cold. However, tuberculosis is much nastier and the containment of people that are infected is sometimes necessary. An easy assumption to make is that MW will probably associate with or otherwise be around the general public as well as fellow homeless people. He will be in person-rich areas like homeless shelters and the city streets. The chances he will transmit the disease to others is very high.

The second reason forced treatment and detainment is called for is that he has a drug-resistant version of tuberculosis. Just like MRSA (drug-resistant staph) has to be treated very aggressively and contained very completely, much the same thing is true of drug-resistant tuberculosis. MW is a danger to the public and he is not cooperating when it comes to his treatment. As such, he needs to be detained and treated until the disease has run its course ...