Ethical evaluation of immigration screening policy for latent tuberculosis infection

Denholm, Justin T., McBryde, Emma S., and Brown, Graham V. (2012) Ethical evaluation of immigration screening policy for latent tuberculosis infection. Australian and New Zealand Journal of Public Health, 36 (4). pp. 325-328.

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Abstract

Objective: In Australia and New Zealand, immigration screening policy relating to tuberculosis is targeted towards identifying potential new arrivals with active infectious pulmonary disease. Recently, extensions of immigration policies to include latent tuberculosis infections have been proposed, which raise a new spectrum of ethical issues.

Methods: Existing Australian and New Zealand immigration policy was reviewed. A principle-based analytic framework was adopted for consideration of the ethical implications of proposed public health policy. Potential extensions of current policy in relation to latent tuberculosis infection are evaluated using this approach.

Results: Current immigration policies related to tuberculosis focus on identification of immigrants with active infection. A principle-based analytic framework allows evaluation of potential extensions of public health policy to incorporate screening and treatment for latent tuberculosis.

Conclusions: Our paper explores the dynamic ethical tensions related to burdens and benefits of immigration screening for latent tuberculosis, and suggests that such policies could be justified under certain circumstances, including non-arbitrary screening and post-arrival management. The results of testing should not influence immigration outcome, but be used to mandate medical review and consideration of voluntary preventative treatment.

Implications: Immigration strategies targeting latent tuberculosis could be ethically justified within appropriate guidelines. Proposed changes to policy should be evaluated on ethical grounds prior to introduction.

Item ID: 40348
Item Type: Article (Research - C1)
ISSN: 1753-6405
Keywords: ethics; latent tuberculosis; immigration; public health; interferon-gamma release assays; tuberculin test
Date Deposited: 08 Oct 2015 02:22
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 40%
16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 20%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 50%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
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