Implicit in the power to protect the public health is the power to treat disease
carriers despite their objections. Since treatment is a less restrictive alternative
to quarantine or isolation, it is favored as a disease control measure. A patient
who refuses to accept treatment for a contagious disease may be ordered to
accept the treatment by a health officer or, depending on the jurisdiction, a
court. A common practice is to incarcerate a recalcitrant patient until the
patient consents to the treatment. This coerced consent is not obtained as a
sham on an informed consent but to obviate the need for physically subduing
the patient. It also gives the patient an opportunity to contest the treatment
through a habeas corpus proceeding.
Although coerced treatment for a communicable disease violates a person’s
autonomy, it is permissible under the U.S. Constitution. The alternative is to
allow the infected person to threaten the health and life of others. With
tuberculosis, failure to force a contagious homeless person to accept treatment
may result in the infection of other persons with whom the person comes into
contact in shelters. Since many of these contacts, especially the children, are
poorly nourished or chronically ill, they will be susceptible to fast-spreading
infection that is difficult to treat. This problem is already evident in the high
rates of tuberculosis in homeless shelters.