Should Sick People Be Put in Jail?

April 4, 2007 — -- When an Arizona man with tuberculosis didn't follow his doctor's instructions to wear a mask during the summer, he was put in jail.

The action sparked a debate about balancing an individual's civil liberties with the need to maintain public safety.

Robert Daniels, the 27-year-old man infected with TB, has been held since July -- not because he committed a crime, but because his condition is highly contagious.

"He chose not to wear a noncontagion mask to cover his face," said Jack MacIntyre of the Maricopa County Sheriff Office.

Daniels suffers from a rare, drug-resistant strain of the disease and refused treatment. While it's not common practice to lock patients up, in this case officials said it was necessary to keep the virulent form of TB from spreading.

Daniels' cell phone was confiscated, as is the case with other prisoners. He remains in isolation and is kept from the showers. He is reportedly forced to clean with wet wipes.

"He definitely needs to be confined. He shouldn't be free," said Art Caplan, a bioethicist at the University of Pennsylvania. "I think his liberty has to take a back seat to public health. … But jail isn't quite the right place for this guy."

TB was at an all-time low in the United States last year, but the new, drug-resistant strains of the highly contagious disease have health officials concerned.

"People with untreated TB pose a danger to anyone who shares the same air," said Dr. Richard Chaisson, the director of the Johns Hopkins Center for TB Research. "With good therapy for TB, we can cure people in six months. Drug-resistant [strains are] harder to cure and can take up to two years. The new extremely resistant TB [is] extraordinarily difficult to treat and frankly we don't know how long it takes to cure."

Authorities say that's what they're dealing with in this case.

The man contracted it while living in Russia and said he initially came to the United States for better treatment. His wife and children are still there. Medical ethicists say it is a difficult balance.