Confinement in the management of drug-resistant TB: The unsavoury prospect of balancing individual human rights and the public good

Abstract

In the context of an expanding TB and HIV epidemic in South Africa, the decision to enforce involuntary admission for XDR TB raises many ethical and human rights dilemmas, principally because it trades off the human rights of individuals for the public good. However, the dichotomy may also be about competing rights claims and rights obligations of the state to control infectious diseases. A more careful rights analysis is provided, using established analytical frameworks, to tease out the possible criteria that could justify limitation of individual rights. Generally, only in very restricted situations, where there is a clearly defined risk to one or more third parties, based on evidence, and conditional on thorough consideration of available alternatives, could involuntary admission be considered. Community-based strategies will need to be developed to cope with infection control without forced admission for most cases. Even when involuntary admission is needed, strict adherence to administrative justice procedures would be required. Confinement has no place as a strategy for the broader control of the epidemic which is contingent on improved health system functioning and addressing the abysmal investment in research and development for drugs for neglected diseases worldwide.