Patient Adherence
Situation
While working at a health clinic at a homeless shelter, you discover
that F.C., a 64-yr-old man with tuberculosis (TB), has not been taking
his prescribed medications. He tells you that it is hard for him to get
to the clinic to obtain the medication, much less to keep on a
schedule. You are concerned not only about this patient, but about
the risks for the other people at the shelter, in the park, and at the
meal sites where he often visits.
Ethical/Legal Points for Consideration
• Adherence is a complex issue involving a person’s culture,
values, and beliefs, perceived risk for disease, availability of
resources, access to treatment, and perceived consequences of
failure to adhere to treatment.
• Advocacy for the patient and the community obliges you to
involve other members of the health care team, such as social
services, to aid in obtaining resources or support for the patient
to complete a course of treatment.
• Some cities and states have a stepwise legal process for managing
nonadherent TB patients.
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• Legally the constitutional right to control one’s own body may be
limited by state and federal obligation to protect public health
and safety. Most of these laws have provisions for the protection
of constitutional rights, such as right to counsel, right to least
restrictive alternative in terms of confinement setting, and right
to prompt judicial review.
• The federal government and many states have provisions for
quarantine, detention, and treatment. With the threats of
bioterrorism and the globalization of exposure to highly lethal
infectious diseases, it seems unlikely that the government’s
power to detain will be removed.
Discussion Questions
1. What alternatives of care can we offer to F.C.?
2. Under what circumstances, if any, are HCPs justified in
overriding a patient’s autonomy or decision making?
