Intended for healthcare professionals


Public health, civil liberties, and tuberculosis

BMJ 1999; 318 doi: (Published 29 May 1999) Cite this as: BMJ 1999;318:1434

How society encourages compliance reflects society's approach to the vulnerable

  1. Richard Coker, Consultant physician
  1. St Mary's Hospital, London W2 1NY

    Drug resistant tuberculosis is a global health threat. Perhaps because of the size and urgency of the threat and the fact that vulnerable populations are most affected by the disease, some control programmes include coercion. The responses to this threat reflect how society views those on the margins, who are vulnerable—perhaps homeless, stateless, or psychologically disturbed. When treatment compliance is required for public health reasons (to prevent the development of drug resistant strains) how society encourages compliance reflects as much on society itself as it does on the irresponsible, poorly compliant individual.

    A tension has always existed between the protection of individual civil liberties and the protection of public health. In the liberal era of the 1960s and 1970s somewhat draconian approaches to the mentally ill, for example, were questioned. Legislation was amended to put individual patients at the centre, to emphasise their rights, and to provide them with greater legal protection. Detention of the mentally ill became dependent on a determination of the threat they posed to themselves or others. Historically a similar …

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