Lerner B H
Department of Medicine, Columbia University, New York, NY 10032, USA.
Am J Public Health. 1996 Feb;86(2):257-65. doi: 10.2105/ajph.86.2.257.
Repeatedly noncompliant tuberculosis patients (who are often homeless or substance users) are once again being forcibly detained. Health officials intend that confinement be used only when "less restrictive alternatives" have failed. Past programs of detention can inform current efforts. In 1949, Seattle's Firland Sanatorium established a locked ward. Although initially intended only for active public health threats, the ward was eventually used to maintain order among Firland's alcoholic patients. That is, the staff detained alcoholics--regardless of their infectivity or compliance with medications--for breaking sanatorium rules. In this manner, maintaining institutional order became a legitimate reason for invoking public health powers. Although new detention regulations strive to protect patients' civil liberties, attention must also be paid to the day-to-day implementation of coercive measures. When public health language is used to justify administrative or institutional requirements, disadvantaged patients may be stigmatized.
屡次不遵守规定的肺结核患者（他们通常无家可归或有药物滥用问题）再次被强制拘留。卫生官员打算仅在“限制较少的替代措施”失败时才使用监禁手段。过去的拘留项目可为当前的努力提供参考。1949年，西雅图的费尔兰疗养院设立了一个封闭病房。尽管该病房最初仅用于应对对公众健康的实际威胁，但最终被用于维持费尔兰酗酒患者的秩序。也就是说，工作人员会拘留那些违反疗养院规定的酗酒者——无论他们是否具有传染性或是否遵守药物治疗规定。通过这种方式，维持机构秩序成为了援引公共卫生权力的合理理由。尽管新的拘留规定努力保护患者的公民自由，但也必须关注强制措施的日常实施情况。当使用公共卫生措辞来为行政或机构要求辩护时，弱势患者可能会受到污名化。
