From Chaos to Coercion Detention and the Control of Tuberculosis

In the 1980s and early 1990s, New York City experienced an unprecedented outbreak of tuberculosis. Inadequate healthcare services, an increase in social alienation of the poor, and the emergence of drug-resistant strains led city health officials to respond with draconian policies to ensure compliance, including the use of detention of non-infectious individuals--sometimes for up to two years--that violated individual civil liberties. The New York TB epidemic has since been controlled, but this public health triumph has come at great cost. This gripping narrative of medicine and morality raises ethical issues that are of increasing importance in the world of modern medicine. Richard J. Coker warns the international community against assuming a fortress mentality, advocating a more just balance between health, liberty, and the burdens society should be prepared to accept in the pursuit of both.

Richard J. Coker is Consultant Physician at St. Mary's Hospital and Honorary Senior Lecturer at the Imperial College School of Medicine in London.