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Bioethics emerged at a time when infectious diseases were not a major concern. Thus bioethics never had to develop a normative framework sensitive to situations of disease transmission. The Patient as Victim and Vector explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different in infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others. Bioethics has failed to see one part of this duality, they document, and public health the other: that the patient is both victim and vector at one and the same time. The Patient as Victim and Vector is jointly written by four authors at the University of Utah with expertise in bioethics, health law, and both clinical practice and public health policy concerning infectious disease. Part I shows how the patient-centered ethic that was developed by bioethics- especially the concept of autonomy- needs to change in the context of public health, and Part II develops a normative theory for doing so. Part III examines traditional and new issues involving infectious disease: the ethics of quarantine and isolation, research, disease screening, rapid testing, antibiotic use, and immunization, in contexts like multi-drug-resistant tuberculosis, syphilis, hepatitis, HIV/AIDS, and HPV. Part IV, beginning with a controversial thought experiment, considers constraint in the control of infectious disease, include pandemics, and Part V 'thinks big' about the global scope of infectious disease and efforts to prevent, treat, or eradicate it. This volume should have a major impact in the fields of bioethics and public health ethics. It will also interest philosophers, lawyers, health law experts, physicians, and policy makers, as well as those concerned with global health.
E-Book Content
THE PATIENT AS VICTIM AND VECTOR
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THE PATIENT AS VICTIM AND VECTOR Ethics and Infectious Disease Margaret P. Battin Leslie P. Francis Jay A. Jacobson Charles B. Smith
1 2009
1 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam
Copyright © 2009 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data The patient as victim and vector : ethics and infectious disease / Margaret P. Battin, Leslie P. Francis, Jay A. Jacobson, Charles B. Smith p. ; cm. Includes bibliographical references. ISBN: 978-0-19-533584-2 (cloth) ISBN: 978-0-19-533583-5 (pbk.) 1. Communicable diseases—Moral and ethical aspects. 2. Bioethics. 3. Epidemics—Prevention—Moral and ethical aspects. [DNLM: 1. Communicable Diseases. 2. Bioethical Issues. 3. Disease Transmission—ethics. 4. Disease Outbreaks—prevention & control. 5. Health Policy. 6. World Health. WA 110 P298 2009] I. Battin, M. Pabst. II. Francis, Leslie P. III. Jacobs