LEGAL AND ETHICAL ISSUES IN TUBERCULOSIS CONTROL nid]/2_2.pdf LEGAL AND ETHICAL ISSUES IN TUBERCULOSIS

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  • TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE May 8-11, 2018

    Curry International Tuberculosis Center, UCSF

    300 Frank H. Ogawa Plaza, Suite 520

    Oakland, CA; Office (510) 238-5100

    LEGAL AND ETHICAL ISSUES IN

    TUBERCULOSIS CONTROL

    LEARNING OBJECTIVES

    Upon completion of this session, participants will be able to:

    1. Describe the ethical principles of protecting patient rights and public health

    2. Discuss the legal framework regarding TB care in California that supports both of these ethical principles

    3. Apply this knowledge to understand the limits and opportunities of these laws in their own jurisdictions to enforce best practices of TB care

    INDEX OF MATERIALS PAGES

    1. Legal and Ethical Issues in Tuberculosis Control – slide outline Presented by: Chris Keh, MD

    1-20

    SUPPLEMENTAL MATERIALS

    1. Sample Legal Order

  • TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE May 8-11, 2018

    Curry International Tuberculosis Center, UCSF

    300 Frank H. Ogawa Plaza, Suite 520

    Oakland, CA; Office (510) 238-5100

    ADDITIONAL REFERENCES

    • Centers for Disease Control and Prevention, Public Health Law Program. Legal tools for Tuberculosis Control. Last updated April 13, 2012. URL: http://www.cdc.gov/phlp/publications/topic/tb.html

    • Centers for Disease Control and Prevention. Tuberculosis Laws and Policies. Last updated June 4, 2012. URL: http://www.cdc.gov/tb/programs/Laws/default.htm

    • ChangeLab Solutions. TB Control and the Law. URL: http://changelabsolutions.org/tb-control- and-law

    • Coker RJ, Mounier-Jack S, Martin R. Public health law and tuberculosis control in Europe. Public Health. 2007 Apr;121(4):266-73.

    • Coker RJ. Public health impact of detention of individuals with tuberculosis: systematic literature review. Public Health. July 2003; 117(4):281-287.

    • Doyal L. Moral problems in the use of coercion in dealing with nonadherence in the diagnosis and treatment of tuberculosis. Ann N Y Acad Sci. 2001; 953:208-215.

    • Dye C. Breaking a law: tuberculosis disobeys Styblo's rule. Bull World Health Organ. 2008 Jan; 86(1):4.

    • Fidler DP, Gostin LO, Markel H. Through the quarantine looking glass: drug-resistant tuberculosis and public health governance, law, and ethics. J Law Med Ethics. 2007 Winter;35(4):616-28, 512.

    • Goemaere E, Ford N, Berman D, McDermid C, Cohen R. XDR-TB in South Africa: detention is not the priority. PLoS Med. 2007 Apr;4(4):e162.

    • Harris A, Martin R. The exercise of public health powers in an era of human rights: the particular problems of tuberculosis. Public Health. July 2004; 118(5):313-22.

    • Moszynski P. Doctors disagree over detention of patients with extensively drug-resistant tuberculosis. BMJ. 2007 Feb3;334(7587):228.

    • Parmet WE. Legal power and legal rights--isolation and quarantine in the case of drug-resistant tuberculosis. N Engl J Med. 2007 Aug; 357(5):433-5.

    • Selgelid MJ, Kelly PM, Sleigh A. Ethical challenges in TB control in the era of XDR-TB. Int J Tuberc Lung Dis. 2008 Mar;12(3):231-235.

    • Senanayake SN, Ferson MJ. Detention for tuberculosis: public health and the law. Med J Aust. June 2004; 180(11):573-6.

    http://www.cdc.gov/phlp/publications/topic/tb.html http://www.cdc.gov/tb/programs/Laws/default.htm http://changelabsolutions.org/tb-control-and-law http://changelabsolutions.org/tb-control-and-law

  • TB CASE MANAGEMENT AND CONTACT INVESTIGATION INTENSIVE May 8-11, 2018

    Curry International Tuberculosis Center, UCSF

    300 Frank H. Ogawa Plaza, Suite 520

    Oakland, CA; Office (510) 238-5100

    • Simpson JB, Graff S, Ashe M. California tuberculosis control law. Public Health Institute, Public Health Law Program. 2003. URL: http://changelabsolutions.org/sites/default/files/tb_law_paper.pdf

    • Wielawski IM. HIPAA, TB, and me. Health Aff (Millwood). July-Aug 2006; 25(4):1127-32.

    • World Health Organization. Guidance on ethics of tuberculosis prevention, care and control. Report No: WHO/HTM/TB/2010.16. Geneva, Switzerland: World Health Organization, 2010. URL: http://whqlibdoc.who.int/publications/2010/9789241500531_eng.pdf

    http://whqlibdoc.who.int/publications/2010/9789241500531_eng.pdf

  • Legal and ethical issues in TB control

    TB Case Management and Contact Investigation Intensive

    Curry International Tuberculosis Center

    May 8-11, 2018 1

    San Francisco Department of Public Health Population Health Division

    Chris Keh, MD

    TB Prevention and Control, San Francisco Department of Public Health

    Assistant Clinical Professor, Division of Infectious Diseases, UCSF

    Curry International Tuberculosis Center, CMCI, May 2018

    Population Health Division

    Legal and Ethical Issues in Tuberculosis Control

    Protecting and Promoting Health and Equity

    San Francisco Department of Public Health

    San Francisco Department of Public Health Population Health Division

    Objectives

    • Describe the ethical principles of protecting patient rights and public health

    • Discuss the legal framework regarding TB care in California that supports both of these ethical principles

    • Apply this knowledge to understand the limits and opportunities of these laws in their own jurisdictions to enforce best practices of TB care

  • Legal and ethical issues in TB control

    TB Case Management and Contact Investigation Intensive

    Curry International Tuberculosis Center

    May 8-11, 2018 2

    San Francisco Department of Public Health Population Health Division

    Legal enforcement of laws to control TB is a balancing act

    Patient rights Public Health

    HIPAA State Health

    and Safety

    Code, e.g. Title

    17

    Local

    Ordinances

    San Francisco Department of Public Health Population Health Division

    The Balance: Patient Rights

    Establish trust

    Avoid stigma

    Preserve patient

    autonomy

    Patient rights Public Health

  • Legal and ethical issues in TB control

    TB Case Management and Contact Investigation Intensive

    Curry International Tuberculosis Center

    May 8-11, 2018 3

    San Francisco Department of Public Health Population Health Division

    Patient Rights

    • Confidentiality/Privacy

    • Autonomy

    • Access to own medical records and information

    • Right to refuse treatment

    San Francisco Department of Public Health Population Health Division

    The Balance: Public Safety

    Establish trust

    Avoid stigma

    Preserve patient

    autonomy

    Public Health

    Prevent disease

    transmission

    Protect the public

    Prevent drug

    resistance

    Weigh risk to one individual vs. Benefit to other individuals

    Patient rights

  • Legal and ethical issues in TB control

    TB Case Management and Contact Investigation Intensive

    Curry International Tuberculosis Center

    May 8-11, 2018 4

    San Francisco Department of Public Health Population Health Division

    Public Health Police Power

    • Gives TB Control officials authority to take action to protect public health (this authority rests solely with the public health system)

    However: • Public health officials do not have unlimited authority • Must balance protecting the public health and

    respecting individual autonomy because the US Constitution places certain restraints on public health officials

    • Patients have a constitutional right to procedural due process and equal protection.

    San Francisco Department of Public Health Population Health Division

    Duties of Health Officers (HSC 120175 and 121365)

    • Must take measures to prevent spread of communicable diseases or occurrence of additional cases.

    • May issue any orders (TB examination, isolation, completion of appropriate treatment, DOT, detention, exclusion from attendance at the workplace if infectious) s/he deems necessary to protect public health or the health of any other person, and may make application to a court for enforcement of the orders.

  • Legal and ethical issues in TB control

    TB Case Management and Contact Investigation Intensive

    Curry International Tuberculosis Center

    May 8-11, 2018 5

    San Francisco Department of Public Health Population Health Division

    Risks of Public Health Measures to Individual’s Autonomy

    • Loss of privacy (through reporting or contact identification)

    • Loss of liberty and self-determination (through health orders for DOT, home isolation or involuntary confinement)

    • Loss of patient rights

    • Justice (unequal imposition of restrictions/interventions)

    San Francisco Department of Public Health Population Health Division

    Minimizing Risk to Individual

    • Use least restrictive alternatives first – Education – Incentives/enablers – Engage family, medical providers

    • Institutional requirements (school, health care facilities)

    • Individualize assessments • Ensure due process • Establish policies to protect against

    discrimination

  • Legal and ethical issues in TB control

    TB Case Management