Drug-resistant TB strain raises ethical dilemma

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Life in detention
Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals. He said sheriff’s deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

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Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here, and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

He said that he lost 50 pounds and was constantly coughing and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

“Where I come from, the doctors don’t wear masks,” he said. “Plus, I was 26 years old, you know. Nobody told me how TB works and stuff.”

County health officials and Daniels’ lawyer, Robert Blecher, would not discuss details of the case. But in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor’s orders.

“It’s very uncommon that someone would both not want to take treatment and will willingly put others at risk,” England said. “It’s only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody.”

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Pandemics will raise ethical dilemmas
University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

“Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again,” Caplan said. “We may find ourselves dipping into our history to answer them.”

Daniels said he realizes now that he endangered the public. But “I thought I’d come to a country where I’d finally be treated like a person, and bam, here I am.”

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