Questões éticas sobre o tratamento da tuberculose: o Programa Nacional de Controle da Tuberculose do Brasil

Abstract

Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (MTB), which affects the lungs during the initial contagion and can be transmitted through coughing, talking, or sneezing. The World Health Organization (WHO, 2019) classified TB as the leading cause of death in the world by a single etiological agent, ahead of the Human Immunodeficiency Virus (HIV), still being considered a serious Public Health problem and, in 1993, declared TB a global state of emergency, given the high incidence and mortality rates existing at the time. In 1999, Brazil standardized its National Tuberculosis Control Program (PNCT) and this happened in the face of the permanence of the “TB problem”, with high rates of treatment abandonment, reduction in the cure rate, and identification of cases. The PNCT introduced: the extension of coverage (with free distribution of medication), directly observed treatment (in which the patient must take the medication in front of a health agent), and the active search for people with latent TB infection (LTBI). There are, in fact, social, political, and economic issues that still influence the permanence of TB, considered a Social Determinant of Health (SDH). However, there are ethical issues involved in the way TB is approached by Public Health, both by the PNCT and the WHO, which also influence the high rates of TB cases in society and the differentiation of this society. Even with effective drugs (including LTBI treatment), TB remains an ethical challenge for the government because, in practice, it was the government that allowed the individual to get sick. Principlism, as one of the bioethical references of medical practice in Brazil, will be the basis of this reflection, to help understand how public health policies are carried out in Brazil and what their priorities should be, reconciling the interests of society and the individual. In comparison with other realities that face the same problem, such as England, the debate on the justifications of the WHO for its End TB Strategy and the rights of patients with TB will also contribute to the search for what these ethical issues are and how they can collaborate in the approach and eradication of TB in the world, changing the narrative and perspective of how to “see” the disease and the sick person.