Table 4: TB and the Right to Bodily Integrity
Examples of Human Rights Violations
- A patient is involuntarily hospitalized for treatment even though it has not been shown that she has failed to adhere to her treatment regimen.
Note: The right to bodily integrity is not specifically recognized under the ICCPR or ICESCR, but has been interpreted to be part of the right to security of the person, to freedom from torture and cruel, inhuman, and degrading treatment, and the right to the highest attainable standard of health.
Similarly, the right to bodily integrity is not specifically recognized in CEDAW, although CEDAW has been widely interpreted to include the right to protection from violence against women. (See concluding observations to Thailand, CEDAW/C/1999/I/L.1/Add.6 (1999) stating that “sexual harassment, rape, domestic violence and marital rape, whether in the family, the community or the workplace, constitute violations of women’s right to personal security and bodily integrity.”
WHO Guidance on ethics of tuberculosis prevention, care and control (WHO, 2010):
Overarching goals and objectives. Autonomy can be defined in many ways, but is generally seen as guaranteeing individuals the right to make decisions about their own lives, including health care…. For example, respecting autonomy means that patients generally should have the right to choose among treatment options.
Information, counselling and the role of consent. There are several reasons to ensure that individuals undergoing TB testing and treatment receive complete and accurate information about the risks, benefits, and alternatives available to them. First, at the most basic level, people have a right to know what is being done to their bodies, and why it is being done.
Supporting adherence to TB treatment. Directly observed therapy should be seen as a process for providing support, motivation, and understanding to patients. It is a necessary part of TB care, but is not intended to be a method for “forcing” patients to do something against their will…. In rare instances, if all reasonable efforts to promote adherence have failed and the patient still remains infectious, involuntary isolation or detention may be considered.
Involuntary isolation and detention as last-resort measures. While contagious TB patients who do not adhere to treatment or who are unable or unwilling to comply with infection control measures pose significant risks to the public, those risks can be addressed by isolating the patient. Patients who are isolated should be offered the opportunity to receive treatment, but if they do not accept, their informed refusal should be respected, as the isolated patient no longer presents a public health risk. Forcing these patients to undergo treatment over their objection would require a repeated invasion of bodily integrity.
Beijing Call for Action on Tuberculosis control and patient care: together addressing the global MDR-TB and XDR-TB epidemic (WHO, 2009):
Para. 1(b). Ensuring the removal of financial barriers to allow all TB patients equitable access to TB care, that their rights are protected, and that they are treated with respect and dignity.
Patients’ Charter for Tuberculosis Care (World Care Council, 2006):
Dignity. The right to be treated with respect and dignity, including the delivery of services without stigma, prejudice, or discrimination by health providers and authorities. The right to quality healthcare in a dignified environment, with moral support from family, friends, and the community.
Choice. The right to accept or refuse surgical interventions if chemotherapy is possible and to be informed of the likely medical and statutory consequences within the context of a communicable disease. The right to choose whether or not to take part in research programs without compromising care.