Centre for Human Bioethics, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia.
Global Tuberculosis Institute, New Jersey Medical School, Newark, New Jersey, USA.
Int J Tuberc Lung Dis. 2011 Jun;15 Suppl 2:9-13. doi: 10.5588/ijtld.10.0434.
Drug-resistant tuberculosis (TB) has highlighted the need for discussion of ethical questions about TB diagnosis and treatment. Drug resistance is a human-made phenomenon. It is caused by lack of patient adherence in drug taking and/or physician failure in prescription making. The global burden of TB is also partly explained by the lack of industry motivation to develop new TB drugs and diagnostics. This article explores the primary ethical issues associated with TB diagnosis and treatment: the human rights requirements regarding universal access to care and universal standards of care, treatment exclusion and cessation, privacy and stigmatisation in the context of directly observed therapy, and diagnostic challenges posed by limited laboratory capacity. Inter alia, it argues that: 1) the ethical imperative to improve individual patient care is partly based on the need to prevent the spread of infection and the exacerbation of the problem of drug resistance; 2) human rights and the imperative to protect the greater good of public health may call for increased regulation of the private sector; and 3) industry should be given further incentives to develop new tools for TB control.
耐药结核病（TB）凸显了讨论结核病诊断和治疗相关伦理问题的必要性。耐药性是人为造成的现象。它是由患者服药不依从和/或医生处方不当引起的。全球结核病负担部分还可以归因于缺乏行业动力来开发新的结核病药物和诊断方法。本文探讨了与结核病诊断和治疗相关的主要伦理问题：获得治疗的普遍可及性和普遍护理标准方面的人权要求、治疗排除和停止、直接观察治疗背景下的隐私和污名化问题，以及实验室能力有限带来的诊断挑战。本文认为：1）改善个体患者护理的道德紧迫性部分基于防止感染传播和加剧耐药问题的需要；2）人权和保护公共卫生更大利益的必要性可能要求加强对私营部门的监管；3）应进一步激励行业开发新的结核病控制工具。
