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Ethic Analysis on Contact Tracing Rapid Essay
Ethic Analysis on Contact Tracing Rapid Essay
Sexually transmitted infections (STIs) represent one of the most pervasive public health issues in the United States, with nearly half of all new cases acquired by young adults every year. In fact, 1-in-every-4 sexually active young adult women have an STI such as chlamydia, gonorrhea or human papillomavirus (HPV).[footnoteRef:1]
The current case in question focuses on MG, a recently married young woman and a graduate student who has recently been screened for STIs through a routine pelvic exam, Pap test, and cervical gonorrhea and chlamydia (GNC) test. Within weeks, MG is notified by mail of her normal Pap smear but abnormal cervical test results, indicating she has tested positively for gonorrhea.
She has also been recommended to return to the clinic for treatment and required to identify of all sexual partners for diagnostic testing a protocol known as contact tracing. The most concerning ethical dilemma in question here is whether or not contact tracing while helpful for the purposes of STI testing and treatment interventions may violate MGs personal privacy, and place her in more harm than is necessary or justifiable.
Thus, we must ask ourselves, is contact tracing in the case of a sexually-transmitted infection an ethical application of the public health’s mandate to contain communicable disease outbreaks? [1: Centers for Disease Control and Prevention (CDC). 2013 sexually transmitted diseases surveillance. Division of STD Prevention, Centers for Disease Control and Prevention. (2013). Available at: http://www.cdc.gov/std/stats13/adol.htm]
Before any decision on the ethical nature of this case can be made, we must first explore the full scope of factual information available. First, we have established the fact that MG’s diagnosis of gonorrhea requires clinical treatment in order to limit further harm to her or others.
We also know that gonorrhea is positively correlated with pelvic inflammatory disease (PID) and if left untreated, may lead to infertility.[footnoteRef:2] Furthermore, many women who have STIs like chlamydia and gonorrhea may actually be asymptomatic, meaning that they have no noticeable symptoms for long periods of time.
It is with this information that we arrive at our first point of contention. In this case, we are unclear about the causal factor for MG’s infection. It is not clear if MG was infected with gonorrhea recently, or several years ago; if she was infected by a previous or a current partner; nor are we given any information about her sexual history or risk behavior.
However, it begs the question – even if we had access to this information, should public health authorities be privy to this sensitive information? [2: CDC. STDs and infertility. Division of STD Prevention, Centers for Disease Control and Prevention. (2013). Available at: http://www.cdc.gov/std/infertility/default.htm]
A second deficiency of information arises when we consider the effectiveness of the contact tracing method. First, we are aware that contact tracing – in addition to partner notification is a key control measure for containing infectious diseases.[footnoteRef:3]
However, several scholars doubt the effectiveness of contact tracing and its ability to accurately identify disease transmission pathways for a number of reasons: (1) individuals may not always know or be able to contact their former partners; (2) individuals may have certain constraints that limit their ability to be honest about former and current partners or behaviors.
Thus, imperfect information and patient behavior may limit the effectiveness of the contact tracing approach. In this case, we know that MG is “terrified that her husband will be contacted.” Although we recognize that this degree of fear is present, we are unclear about the source of such fear.
Is MG simply concerned about the potential emotional hardship that may arise from revealing her status? Or is there a more insidious reason for her fear (such as the risk of interpersonal violence by the hands of her current partner) that may result in unintended harm executed by the public health agency’s contact tracing action?
In this case, we will assume that the public health agency cannot obfuscate its role to respond to infections disease outbreaks with consideration for unintended consequences, no matter how complicated MG’s domestic situation might be. [3: Eames KT & Keeling MJ. (2003). Contact tracing and disease control Proc Biol Sci. 270(1533);2565-2571.]
Lastly, what is perhaps most troubling is the lack of clarity around the actual protocol for contact tracing that the public health authorities in question will use. There are multiple models for contact tracing some of which involve mandatory notification of all partners and collection of STI status in patient registry databases.
Other contact tracing strategies are less invasive, using counseling and educational methods to teach individuals how to share information about their status to current and former partners. Still others involve voluntary referral services through anonymous mechanisms, or some combination of the above.[footnoteRef:4]
Although the case itself refers to a legal requirement for contact tracing, the actual method for conducting contact tracing is not specified here, which makes it difficult to provide a complete ethical analysis of this case.
Nonetheless, we will use the current information known to consider all options available in this case. [4: Varghese B, Peterman TA & Holtgrave DR. (1999). Cost-effectiveness of counseling and testing and partner notification: a decision analysis. Epidemiology and Social Papers. 13(13);1745-1751.]
Undoubtedly, the most significant stakeholder in this case is MG, herself. She is perhaps most directly affected by any decision made. However, there are other stakeholders we must consider, with regard to the impact of our decision. First, we recognize the role of MG’s spouse, who will certainly be affected by any decision that comes from this case.
Regardless of the outcome, MG’s spouse has likely been exposed to gonorrhea and should be tested and treated, if necessary. We are then concerned about other potential partners either from MG or her spouse who may have been exposed to gonorrhea. Since we have no current information on possible partners, nor do we know the original source of the transmission, we must assume that any and all former partners are at-risk for gonorrhea.
It also begs the question, who else might be at risk (i.e. future partners) if any positive cases of gonorrhea are left untreated. In this case, we have neither an accurate estimate of potential exposure, nor a full understanding of the degree of potential harm until contact tracing is completed, further underscoring the urgency of its role.
Finally – and most central to this case – we must contend for the role of the public health agency and the clinical providers in this case. They likely have the highest degree of authority, at least legally, over this case, and they are considered the responsible party for any health information collected and action taken to limit the transmission. With this in mind, we assume that public health officials will act in the way that achieves the greatest good for the greatest number of people, maximizing utility for the population of focus.
Inherent in this ethical case are several values and principles that must be upheld in any decision. First, we consider the importance of beneficence – the duty to achieve good and refrain from harm – for MG as the primary patient in question. As public health professionals, we uphold the decision to notify MG of her diagnosis and recommend expedited treatment as soon as possible to minimize the long-term risks associated with delayed treatment.
We must also consider the importance of beneficence toward MG’s spouse and any other sexual partners that may be at-risk for exposure. Reducing harm to the most socially acceptable level and maximizing benefits of treatment for all at-risk individuals is truly a core concept of the public health mandate; these core values reflect the utilitarian approach toward achieving “the greatest good for the greatest number of people,” thus, the ultimate decision made by public health authorities must draw on these principles in order to be considered ethical action.
[Rapid analysis: write the second part of the values assessment for this case. Choose one additional value, define it, and succinctly apply it to the case, making clear any differential interpretations by your stakeholders]
Read the attached ethical analysis written on the case of MG and contact tracing for sexually-transmitted infections (STIs). The problem state, landscape section, stakeholder assessment, and a partial values statement have been written for you.
After reading all the text, write the second half of the values statement, being sure to choose one additional value, define it, and apply it in the context of the case (as presented in the problem statement).
Your rapid analysis should be only 1 dditional page
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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Ethic Analysis on Contact Tracing Rapid Essay
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