Intended for healthcare professionals

Education And Debate

Is there a moral obligation not to infect others?

BMJ 1995; 311 doi: (Published 04 November 1995) Cite this as: BMJ 1995;311:1215
  1. John Harris, professor of bioethics and applied philosophya,
  2. Soren Holm, senior research fellowb
  1. aCentre for Social Ethics and Policy, University of Manchester, Manchester M13 9PL
  2. bDepartment of Medical Philosophy and Clinical Theory, University of Copenhagen, DK-2200 Copenhagen, Denmark
  1. Correspondence to: Professor Harris.
  • Accepted 3 August 1995

The emergence of HIV infection and AIDS has refocused concern on the obligations surrounding the carrying and transmission of communicable diseases. This article asks three related questions: Is there a general duty not to spread contagion? Are there special obligations not to communicate disease in the workplace? And does the mode of transmission of the disease affect the ethics of transmission and, if so, how and to what extent? There seems to be a strong prima facie obligation not to harm others by making them ill where this is avoidable, and this obligation not to communicate disease applies as much to relatively trivial diseases like the common cold as it does to HIV disease. The reasonableness of expecting people to live up to this obligation, however, depends on society reciprocating the obligation in the form of providing protection and compensation.

The AIDS epidemic has revitalised many questions about communicable diseases. These questions arose at a time when most communicable diseases were untreatable and controlling the spread of contagion was a mainstay in the battle against disease, illness, and death. The responsibilities of disease carriers and the response of society towards communicable diseases have again come into focus, but many of the new answers given to these old questions have been influenced by the special features of HIV disease.1

We believe that these questions are pertinent to a far wider range of diseases than just HIV infection and that they can best be analysed within a framework of reciprocity. Such a framework means that the burdens put on people carrying a disease must be reciprocated by society's commitment to treatment, care, non-discrimination, and, in certain circumstances, compensation.2

In this paper we analyse three related questions about the responsibilities of carriers of communicable diseases: Is there a general duty not …

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