耐多药结核病的接触调查:伦理挑战。

IF 1.6 Q2 ETHICS Monash Bioethics Review Pub Date : 2024-06-01 Epub Date: 2024-03-02 DOI:10.1007/s40592-024-00188-0
Hnin Si Oo, Pascal Borry
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引用次数: 0

摘要

接触调查是一种以证据为基础的耐多药结核病(MDR-TB)干预措施,通过阻断传播链来保护公众健康。在进行接触调查时,患者的耐多药结核病状况必须(在必要的最低限度内)向第三方披露,以便追踪接触者。然而,向第三方披露病情往往会无意中导致 MDR-TB 患者遭受社会歧视和羞辱。因此,患者不太愿意透露自己的 MDR-TB 感染情况,这成为接触者调查中的一个重要问题。这一问题无疑会对公众利益造成负面影响。在对 MDR-TB 病情保密和保护公众健康之间,出现了与此相关的矛盾。关于 MDR-TB 的管理,患者遵从治疗和接触调查同样重要。患者可能无法坚持抗结核治疗,并因担心泄露而不愿寻求医疗服务。为了保证治疗的依从性,MDRTB 患者不应因披露而遭受社会歧视和羞辱,结核病团队有责任为他们提供支持,以实现互惠互利。然而,由于 MDRTB 患者的生活环境和处境各不相同,即使承诺为患者提供互惠支持,作为公共卫生政策的接触调查的实施仍具有挑战性。没有一劳永逸的解决办法,但需要为每种不同的情况提供适当的理由,以便在个人保密和公共利益之间取得平衡。
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Contact investigation in multidrug-resistant tuberculosis: ethical challenges.

Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.

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来源期刊
CiteScore
2.70
自引率
6.20%
发文量
16
期刊介绍: Monash Bioethics Review provides comprehensive coverage of traditional topics and emerging issues in bioethics. The Journal is especially concerned with empirically-informed philosophical bioethical analysis with policy relevance. Monash Bioethics Review also regularly publishes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. Produced by the Monash University Centre for Human Bioethics since 1981 (originally as Bioethics News), Monash Bioethics Review is the oldest peer reviewed bioethics journal based in Australia–and one of the oldest bioethics journals in the world. An international forum for empirically-informed philosophical bioethical analysis with policy relevance. Includes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. One of the oldest bioethics journals, produced by a world-leading bioethics centre. Publishes papers up to 13,000 words in length. Unique New Feature: All Articles Open for Commentary
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