Ethical Dilemma in Tuberculosis

Case Study: Risk to Public Health

Ann Singer was first diagnosed with tuberculosis (TB) in February and immediately began treatment. In June of that year she was diagnosed with multidrug-resistant tuberculosis (MDR-TB), a strain of TB that is resistant to treatment using “first-line” drugs that are usually effective against TB. She was advised by county public health officials not to fly via commercial airlines because she would be putting others at risk. She was scheduled to be married in June, and then take an extended honeymoon throughout Europe. Despite the public health risk, she decided to go through with her plans. When she was in Paris, France, she was contacted by a representative from the United States Centers for Disease Control and Prevention (CDC), who advised her that it was discovered that she had extremely drug-resistant tuberculosis (XDR-TB). XDR-TB is very contagious and is extremely difficult to treat. Mrs. Singer was told that she was put on a no-fly list, and the only way she could fly back to the United States would be to charter a private plane. Mrs. Singer then booked a commercial flight that left earlier than the one she originally booked, flew to Denmark, and then to Canada, where she and her husband rented a car and drove to the United States. Despite an alert attached to her passport, she was not detained at the Canadian border. Mrs. Singer then voluntarily checked into a Denver hospital for treatment.

All passengers on all flights with Mrs. Singer were identified, contacted, and required to undergo TB testing. French public health officials asserted that the United States did not contact them in a timely fashion. The case made national and international news. Mrs. Singer considered suing the CDC for revealing her name and breaching her privacy.

Discussion Questions

1. How were the interests of Mrs. Singer and population health involved in this case?
2. There was no evidence of team-based care in this case. How do you think team-based care could have affected this case?
3. How could cooperation among healthcare professionals involved in this case (nationally and internationally) have been improved?
4. Do you think Mrs. Singer had a trusting relationship with the public health representatives? Explain why or why not and how this may have affected the outcome.
5. Is there an ethical dilemma present in this case? How would you manage the dilemma?
6. Did the various people involved in this case act with honesty and integrity in their relationships? Explain.

1. In this case, the interests of Mrs. Singer and population health were in conflict. Mrs. Singer’s primary concern was her personal health and her desire to continue with her wedding and honeymoon plans, which put the public at risk of contracting a highly contagious and difficult-to-treat disease. On the other hand, the public health officials were focused on protecting the health of the population by advising against her traveling on commercial flights and notifying passengers who may have been exposed to TB during her flights.
2. Team-based care could have significantly affected this case by ensuring better coordination among healthcare professionals involved. If there had been a multidisciplinary team, including physicians, public health officials, and legal experts, they could have collaborated to develop a more effective and well-coordinated response. This could have included better communication with Mrs. Singer, timely contact with international health agencies, and a more comprehensive plan for managing her case.
3. Cooperation among healthcare professionals, both nationally and internationally, could have been improved through better communication and information sharing. In this case, the CDC should have promptly notified French public health officials about Mrs. Singer’s condition to ensure a timely response. International cooperation is crucial in managing infectious disease cases that cross borders, and there should be established protocols for such situations.
4. Mrs. Singer may not have had a trusting relationship with the public health representatives, especially after her name and condition were revealed by the CDC. This breach of privacy could have eroded her trust in the healthcare system. The lack of trust may have influenced her decision to disregard the advice and travel despite the potential risks. Building trust with patients in public health situations is essential for effective disease control and management.
5. Yes, there is an ethical dilemma in this case. The dilemma revolves around the balance between an individual’s right to privacy and the need to protect public health. While Mrs. Singer had a right to privacy, her actions posed a significant risk to public health. Managing this dilemma requires a careful consideration of the principle of proportionality, where public health interventions should be proportionate to the threat posed by the individual.
6. The actions of the various people involved in this case raise questions about honesty and integrity. While public health officials had a duty to protect public health, the CDC’s decision to reveal Mrs. Singer’s name could be seen as a breach of privacy. Transparency and open communication are essential in public health, but revealing a patient’s identity without their consent should only be done when absolutely necessary to protect the public. The actions of healthcare professionals should be guided by ethical principles, including respecting patient confidentiality, while also prioritizing public health concerns. Further investigation may be required to determine if there were any ethical violations in this case.