Ethic Analysis on Contact Tracing Rapid Essay

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Type	Essay
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Ethic Analysis on Contact Tracing Rapid Essay

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Ethic Analysis on Contact Tracing Rapid Essay

Problem Statement

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]

Landscape Assessment

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.]

Stakeholder Analysis

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.

Values Assessment

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

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