The Patient as Victim and Vector

Abstract

Bioethics emerged at a time when infectious disease was not a major concern, and thus never developed a normative framework sensitive to disease transmission. This book develops the “patient as victim and vector” view to explore issues in clinical medicine, research, public health, and health policy. The central idea of this book is that a patient with a communicable infectious disease should be understood both as a victim of that disease and also as a potential vector—both a person who is ill and may die but who also may transmit an illness that could sicken or kill others. Bioethics has in general failed to see one part of this duality, and public health the other: that the patient is both victim and vector at one and the same time. Part I of the book shows why patient-centered concepts like autonomy and informed consent need to change in the context of communicable infectious diseases; Part II develops a normative theory for doing so. Part III examines traditional and new issues: the ethics of quarantine and isolation, research, disease screening, rapid testing, antibiotic use, and immunization, in contexts like multi-drug-resistant tuberculosis, syphilis, hepatitis, HIV/AIDS, and HPV. Part IV begins with a controversial thought experiment to consider constraints in the control of infectious disease, including pandemics, and Part V “thinks big” about global efforts to prevent, treat, or eradicate infectious disease.