The Patient as Victim and Vector Ethics and Infectious Disease by Margaret P. Battin, Charles B. Smith, Leslie P. Francis, Jay A. Jacobson

From the Publisher

Bioethics emerged at a time when infectious diseases were not a major concern. Thus bioethics never had to develop a normative framework sensitive to situations of disease transmission. The Patient as Victim and Vector explores how traditional and new issues in clinical medicine, research, public health, and health policy might look different in infectious disease were treated as central. The authors argue that both practice and policy must recognize that a patient with a communicable infectious disease is not only a victim of that disease, but also a potential vector- someone who may transmit an illness that will sicken or kill others. Bioethics has failed to see one part of this duality, they document, and public health the other: that the patient is both victim and vector at one and the same time.

The Patient as Victim and Vector is jointly written by four authors at the University of Utah with expertise in bioethics, health law, and both clinical practice and public health policy concerning infectious disease. Part I shows how the patient-centered ethic that was developed by bioethics- especially the concept of autonomy- needs to change in the context of public health, and Part II develops a normative theory for doing so. Part III examines traditional and new issues involving infectious disease: 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, beginning with a controversial thought experiment, considers constraint in the control of infectious disease, include pandemics, and Part V 'thinks big'about the global scope of infectious disease and efforts to prevent, treat, or eradicate it.

This volume should have a major impact in the fields of bioethics and public health ethics. It will also interest philosophers, lawyers, health law experts, physicians, and policy makers, as well as those concerned with global health.

Doody Review Services

Reviewer:Nathaniel J Brown, B.S. (Saint Louis University Department of Health Care Ethics)
Description:Although this is a textbook of sorts, it is intended for a wide audience, not just students. It is also an introduction and contribution to ethical reflection in the arena of infectious disease. It is a timely book, given the increased awareness of infectious diseases in recent years, that addresses pressing issues of recent interest including pandemic flu, HPV, and antibiotic resistance.
Purpose:It aims to contribute to what the authors describe as a dearth of works on infectious disease. It introduces bioethics and public health ethics as separate fields of inquiry and brings them together to offer insights into ethical dilemmas raised or altered by our interactions with infections diseases. The book presents most of the ethical dilemmas through the lens of infection and communicability, which at times challenges the more common individual-centered ethics.
Audience:The book is aimed at students and professional ethicists as well as those from other disciplines interested in the topic. The layout allows those with familiarity in one area to easily skip to the material new to them.
Features:This well organized book begins by setting up its infectious disease lens with chapters explaining how and why, in the authors' views, infectious diseases were largely overlooked at the genesis of bioethics. They briefly consider the dominant theoretical models used in bioethics before presenting the alterations to these theories that their "patient as victim and vector" model requires. Once they have established theirsystem, they use it to both define and analyze dilemmas in areas such as research, containment, immunizations, and screening.
Assessment:This is a fresh contribution to an area of inquiry where there is not a great deal of work. It is well written and will be a valuable addition to the field of infectious disease ethics.

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