[Tuberculosis and human rights].
Tuberculosis (TB) patients must be hospitalized while the smear of sputum is positive because TB spreads through air. Cooperation of a patient is important in order to complete the treatment of TB. However, a small number of patients are noncooperative for the treatment and may sometimes refuse it. At this symposium, we discussed about whether we could restrict the human rights of noncooperative TB patients. Although the patients' human rights must be protected, we also have to protect the human rights of people who may receive TB infection. The balance of the both people's rights is fully considered in the TB control policy. It is epoch-making that the TB society took up the theme about the human rights' restriction of TB patients. Five speakers presented their papers from each position. There were presentations about the scientific evidence of isolation, the actual cases, the situation of the United States, and the legal view on the human rights' restriction of TB patients. The present situation and the legal problems in Japan became clear at this symposium. We need further discussion about the human rights' restriction of TB patients for the revision of the Tuberculosis Protection Act and have to obtain the national consensus on it. 1. The evidence for isolation: Emiko TOYODA (International Medical Center of Japan) To determine appropriate periods of respiratory isolation, available biological, clinical, and epidemiological issues and data were studied. Although absolute lack of infectiousness requires consecutive culture negative and it takes too long and impractical periods. There seems to be no established evidence for noncontagiousness after 2 to 3 weeks effective treatment. Practically conversion to 3 negative consecutive smear results may used as a surrogate for noninfectiousness, even though a small risk of transmission still be present. Chemical isolation has been more important and administration with DOT should be indicated to keep compliance. 2. Discontinued hospitalization in tuberculosis patient: Yoshiko KAWABE (National Hospital Organization Tokyo National Hospital) We investigated the background of tuberculosis patients who entered our hospital in 11 years from 1993 to 2003 and discontinued hospitalization. Out of 4,126 cases 76 cases (1.8 %) discontinued hospitalization. We classify three groups. One is self discharged group who leaved hospital without permission. Second is obligatory discharged group who were displaced for some trouble. Third is transferred group who were transferred to another hospital including mental hospital that have ward for tuberculosis. Major reasons were drinking during hospitalization, violence, roam because of dementia and major backgrounds were repeatedly noncompliant patients, homeless people, and suffering from senile dementia. We concluded we need some legal intervention for few cases who cannot continue hospitalization. 3. Tuberculosis control policy and human rights in public health center: Keiko FUJIWARA (Infection Diseases Control Division, Public Health Bureau, City of Yokohama) It is required for a success of the tuberculosis control policy to consider human rights. Patients' human rights should be respected, and surrounding people's human rights should also be respected. We sometimes see a tuberculosis patient who cannot continue tuberculosis treatment. A society as a whole has to share the recognition of tuberculosis as a social illness. The completion of tuberculosis treatment is not only the benefit of individual, but also it is very important as social defense. When we revise the tuberculosis control policy, we should think about both protecting a society from tuberculosis and protecting tuberculosis patients' human rights and obtain national consensus. 4. The mandatory TB control policy in the US: Hidenori MASUYAMA (Shibuya Dispensary, Japan Anti-TB Association) The mandatory TB control policy in the US was discussed. If the mandatory health policy would be applied, the following three criteria of human rights must be satisfied. 1. The health of others will be adversely affected without a mandatory program. 2. The mandatory program is the least restrictive alternative. 3. The mandatory program is implemented equitably without purposeful bias. For example, the mandatory DOT could not satisfy these criteria. Before applying the mandatory TB control policy in Japan, the TB patient's autonomy and social cooperation of TB therapy need to be considered. 5. Tuberculosis and guarantee of human rights: Shigeru TAKAHASHI (Graduate School of Law, Hitotsubashi University) In modern administrative Law the relations between Governments and peoples are regarded not as the facing relationships between Governments and the peoples, who submit to the interventions by Government, but as the triangle relationships between Governments, the peoples who submit to the interventions by Governments and the peoples who enjoy benefits from the interventions by Governments. When we make a new design of the Tuberculosis Protection Act, we must at first take considerations of the human rights of the tuberculosis patients from the view points of due Process of Law. And we must also take considerations of the human rights of the peoples who are threatened with the risks of tuberculosis infection.