Ethical aspects of directly observed treatment for tuberculosis: a cross-cultural comparison

Sagbakken, M; Frich, JC; Bjune, GA; Porter, JDH; (2013) Ethical aspects of directly observed treatment for tuberculosis: a cross-cultural comparison. Bmc Medical Ethics, 14. ISSN 1472-6939 DOI:

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Background: Tuberculosis is a major global public health challenge, and a majority of countries have adopted a version of the global strategy to fight Tuberculosis, Directly Observed Treatment, Short Course (DOTS). Drawing on results from research in Ethiopia and Norway, the aim of this paper is to highlight and discuss ethical aspects of the practice of Directly Observed Treatment (DOT) in a cross-cultural perspective. Discussion: Research from Ethiopia and Norway demonstrates that the rigid enforcement of directly observed treatment conflicts with patient autonomy, dignity and integrity. The treatment practices, especially when imposed in its strictest forms, expose those who have Tuberculosis to extra burdens and costs. Socially disadvantaged groups, such as the homeless, those employed as day labourers and those lacking rights as employees, face the highest burdens. Summary: From an ethical standpoint, we argue that a rigid practice of directly observed treatment is difficult to justify, and that responsiveness to social determinants of Tuberculosis should become an integral part of the management of Tuberculosis.

Item Type: Article
Keywords: Tuberculosis, Directly Observed Treatment, Ethics, Socially, Disadvantaged, public-health ethics, patient costs, addis-ababa, ethiopia, tb, determinants, experiences, management, diagnosis, countries
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 23819555
Web of Science ID: 321555600001


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