Communicable disease control and contemporary themes in public health law

The power of detention in the management of non-compliance with tuberculosis treatment: a survey of Irish practitioners and analysis of potential legal liability

Objectives

The detention of patients infected with tuberculosis has recently been the subject of significant professional and public interest. In Ireland, the power to detain and isolate probable sources of infectious disease is found in the Health Act 1947. The objective of this study was to describe the use of the power to detain, and to examine relevant legal implications.

Study design

Cohort survey.

Methods

Respiratory and infectious disease physicians practising in the public sector were invited to complete a self-administered postal questionnaire.

Results

Of the 44 clinicians surveyed, 33 responded, representing a total of 356 years of specialist practice (mean 10.8 years). Although 70% of respondents had made use of threats of formal detention in dealing with non-compliant patients, only one formal detention under statutory powers was identified. Infrastructural and legal concerns with the use of detention were common. There was widespread support for a broadening of the range of additional public health powers, including a power of prolonged detention in the setting of multi-drug-resistant tuberculosis.

Conclusion

Detention and isolation of non-compliant tuberculosis patients remains in active use. Physicians detaining, or threatening to detain, patients continue to expose themselves to legal liability because of the outdated legal framework underlying those powers.

Detention and the evolving threat of tuberculosis: evidence, ethics, and law

The issue of detention as a public health control measure has attracted attention recently. This is because the threat of strains of tuberculosis that are resistant to a wider range of drugs has been identified, and there is renewed concern that public health is threatened. This paper considers whether involuntary detention is justified where voluntary measures have failed or where a patient poses a danger, albeit uncertain, to the public. We discuss the need for strengthening evidence-based assessments of public health risk and suggest that we should reflect more profoundly on the philosophical foundations upon which our policies and practices are grounded.