Ethical issues in tuberculosis care and control
Tuberculosis (TB) prevention, care and control raise important ethical and policy issues that need to be adequately addressed. These concerns have been accentuated by the problem of multidrug-resistant TB (MDR-TB) and, most recently, by the emergence and spread of “extensively” drug-resistant TB (XDR-TB) which is especially difficult to detect and treat.
Following the recommendation of the WHO Task Force on XDR-TB at their 2nd meeting (April 2008), the Ethics and Health Team of the Department of Ethics, Equity, Trade and Human Rights and the Stop TB Department jointly established a WHO Task Force on Addressing Ethical Issues in TB Care and Control Programmes in August 2008.
The aim was to undertake a comprehensive analysis of ethical issues in TB and to lay the groundwork for the formulation of WHO guidance in order to help governments and other stakeholders to implement TB care and control programmes in an ethical manner.
Composition of the Task Force
Twenty-two members from a variety of fields, including national TB programmes, civil society, ethics, human rights, and health law.
Discussion papers on the following topics were commissioned:
- Access to diagnosis and treatment;
- Obligations and rights of health care workers and patients;
- Public health measures; and
Development of WHO guidance
The Task Force held its first meeting 8-10 December 2008 at the Joint Center for Bioethics at the University of Toronto, a WHO Collaborating Center for Bioethics. During the meeting, members discussed the background papers prepared for the meeting and the main points to be included in the global guidance document.
A second meeting of the Task Force was held 26-28 August 2009 at WHO in Geneva. The goal was to draft an outline for the WHO guidance document.
On 15 October 2009, a consultation with additional representatives of civil society and national TB programmes took place in Geneva. The goal was to discuss the outline of the guidance document and to ensure further input and participation of civil society, national TB programme managers, policy-makers, and field workers.
Currently, the draft WHO document, entitled "Ethical guidance for TB Care and Control Programmes" is being finalized by the Secretariat and Task Force.
The draft document was presented at the STB department's Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) in November 2009 and at the 40th Union World Conference on Lung Health in December 2010 in order to receive final input.
In addition, the draft document will be shared with other key stakeholders for comment in order to engage a full range of end users to ensure the practical interpretation, adaptability and use of the guidance document.
The final guidance document was published in December 2010.
Planned activities for 2011
The development of case studies is planned in order to give concrete examples of ethical dilemmas that decision-makers face in TB policies and programmes, and to illustrate some of the challenges and solutions proposed in the guidance document.
Training materials for ethics and TB will be developed and used in workshops for programme managers and other stakeholders in order to build capacity at the local level.