Ethical evaluation of immigration screening policy for latent tuberculosis infection

Denholm, Justin T.;McBryde, Emma S.;Brown, Graham V.

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.

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Australian and New Zealand Journal of Public Health

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1753-6405

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Wiley-Blackwell

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DOI

10.1111/j.1753-6405.2012.00895.x