The stigmatization dilemma in public health policy--the case of MRSA in Denmark.

Thomas Ploug,Søren Holm,Mickey Gjerris

doi:10.1186/s12889-015-2004-y

Abstract

BackgroundMulti-resistant bacteria pose an increasing and significant public health risk. As awareness of the severity of the problem grows, it is likely that it will become the target for a range of public health interventions. Some of these can intentionally or unintentionally lead to stigmatization of groups of citizens.DiscussionThe article describes the phenomenon of stigmatization within the health care area by discussing the concept in relation to AIDS and psychiatric diagnosis. It unfolds the ethical aspects of using stigmatization as a public health instrument to affect unwanted behaviours e.g. smoking. Moreover it discusses stigmatization as an unintended albeit expected side effect of public health instruments potentially used to counter the challenge of multi-resistant bacteria with particular reference to the Danish case of the growing problems with Methicillin-resistant Staphylococcus aureus (MRSA) within pig production.SummaryWe argue that using stigmatization as a direct means to achieve public health outcomes is almost always ethically illegitimate. Autonomy and dignity considerations count against it, and the cost-benefit analysis that might by some be taken to outweigh these considerations will be fundamentally uncertain. We further argue that interventions where stigmatization is a side-effect need to fulfil requirements of proportionality, and that they may fall prey to ‘the stigmatization dilemma’, i.e. the dilemma that arises when all policy options are potentially stigmatizing but stigmatize different groups. When this dilemma obtains the decision-maker should choose the intervention that does not lead to permanent stigmatization and that stigmatizes as few as possible, as briefly as possible, and as little as possible.

Highlights

Multi-resistant bacteria pose an increasing and significant public health risk
We further argue that interventions where stigmatization is a side-effect need to fulfil requirements of proportionality, and that they may fall prey to ‘the stigmatization dilemma’, i.e. the dilemma that arises when all policy options are potentially stigmatizing but stigmatize different groups
In this article we consider the ethical aspects of adopting public health instruments to counter the challenge of multi-resistance that lead to stigmatization; in particular we focus on Staphylococcus Aureus (MRSA) in the Danish public health sector

Summary

Discussion

The ethics of stigmatization and public health intervention–three perspectives There are many aspects of the question of ethical legitimacy concerning stigmatizing interventions to promote public health. Failure to make the information publicly available may result in more citizens contracting MRSA and suffering stigmatization Add to this the stigmatization that may be suffered by farmers on non-infected farms, and it is clear that public health interventions in this field are likely to be faced with a stigmatization dilemma. In light of the MRSA case this could be taken to imply that it must be considered a worse act by the health authorities to impose stigmatization on the farmers as the aim of a public health intervention than to omit such actions with the stigmatization of citizens as a result In both situations stigmatization of a group of people is the outcome, but in the former case it is the outcome of an act, in the latter case it is the outcome of an omission.

Findings

Background