Health care provider obligations in caring for patients with tuberculosis

It is well acknowledged that physicians and other health care providers have an obligation to provide clinical care to their patients even under occasionally difficult circumstances. However, the exact degree and extent of that obligation, and the various scenarios under which it might be lessened or even cease to exist, have recently become the focus of much discussion and debate. The reason for this emerging debate is twofold: the recent occurrence of pandemic viruses such as severe acute respiratory syndrome and H1N1, and the emergence of highly resistant strains of infectious pathogens such as multi and extensively drug-resistant tuberculosis (TB). Health care providers have been asked to place themselves at risk to an extent many did not foresee when they chose to enter their profession, and many have done so under difficult conditions, often without adequate supplies and support. The present article explores the ethical obligations as well as the reciprocal rights of health care providers who are caring for patients with TB, with a particular focus on drug-resistant strains of the bacterium. It is a condensed version of a World Health Organization (WHO) Working Paper prepared for the WHO Working Group on Ethics and Tuberculosis.