The Patient as Victim and Vector: Ethics and Infectious Disease

by Battin, Margaret P; Francis, Leslie P; Jacobson, Jay A; Smith, Charles B

• ISBN13: 9780195335835
• ISBN10: 019533583X
• Edition: 1st
• Format: Paperback
• Copyright: 2008-10-31
• Publisher: Oxford University Press

Summary

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 maytransmit 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 theglobal 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.

Author Biography

Margaret P. Battin is Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah Leslie P. Francis is Professor of Philosophy, Professor of Law, and Adjunct Professor of Internal Medicine in the Division of Medical Ethics and Humanities at the University of Utah Jay A. Jacobson MD is Professor of Internal Medicine at the University of Utah and Chief of the Division of Medical Ethics and Humanities Charles B. Smith MD served as Chief Medical Officer at the Seattle Veterans Administration Hospital and is Emeritus Professor of Medicine at the University of Utah School of Medicine

Table of Contents

Preface	p. ix
Seeing Infectious Disease as Central	p. 1
Seeing Infectious Disease as Central	p. 3
The Biological Basics of Infectious Disease	p. 14
Characteristics of Infectious Disease That Raise Distinctive Challenges for Bioethics	p. 26
How Infectious Disease Got Left Out of Bioethics	p. 41
Closing the Book on Infectious Disease: The Mischievous Consequences for Public Health	p. 60
Theoretical Considerations	p. 75
Embedded Autonomy and the "Way-Station Self"	p. 77
The Multiple Perspectives of the Patient as Victim and Vector View	p. 93
Health Care Dilemmas Through the Lens of Infectious Disease	p. 111
Old Wine in New Bottles: Traditional Issues in Bioethics from the Victim/Vector Perspective	p. 113
From the Magic Mountain to a Dying Homeless Man and His Dog: Imposing Isolation and Treatment in Tuberculosis Care	p. 141
The Ethics of Research in Infectious Disease: Experimenting on This Patient, Risking Harm to That One	p. 164
Vertical Transmission of Infectious Diseases and Genetic Disorders	p. 184
Should Rapid Tests for HIV Infection Now Be Mandatory During Pregnancy or In Labor?	p. 200
Antimicrobial Resistance	p. 229
Immunization and the HPV Vaccine	p. 248
Constraints, Pandemics, and What We Owe Each Other as Victims and Vectors	p. 281
A Thought Experiment: Rapid-Test Screening for Infectious Disease in Airports and Places of Public Contact	p. 283
Constraints in the Control of Infectious Disease	p. 305
Pandemic Planning: What Is Ethically Justified?	p. 329
Compensation and the Victims of Constraint	p. 359
Pandemic Planning and the Justice of Health-Care Distribution	p. 382
Making Use of the Patient as Victim and Vector View	p. 407
Thinking Big: Emerging Global Efforts for the Control of Infectious Disease	p. 409
The Patient as Victim and Vector View as Critical and Diagnostic Tool	p. 461
References	p. 489
Acknowledgments	p. 539
Index	p. 541
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