Ethical issues in tuberculosis diagnosis and treatment

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.