Reader Comments

Post a new comment on this article

The Siracusa principles: a blanket approval?

Posted by plosmedicine on 31 Mar 2009 at 00:09 GMT

Author: Michael Keizer
Position: Student
Institution: La Trobe University, Australia
Submitted Date: May 13, 2007
Published Date: May 15, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In their thought-provoking article on XDR-TB in South Africa [1], Singh, Uphsur, and Padayatchi invoke the Siracusa Principles [2] as support for a policy that infringes on individuals' human rights in name of the greater good of public health. They do so by quoting section 25 of the Principles, which states, "[p]ublic health may be invoked as a ground for limiting certain rights in order to allow a state to take measures dealing with a serious threat to the health of the population or individual members of the population."

However, this is a highly selective and, as a result, somewhat misleading reading of the Siracusa Principles. For instance, section 11 clearly states that “[i]n applying a limitation, a State shall use no more restrictive means than are required for the achievement of the purpose of the limitation”. It can be argued that in the South African case the limitation is not strictly required. The problem could possibly be solved by allocating more resources to the treatment (as is actually noted by the authors by referring specifically to a WHO guideline concerning resource-constrained settings). Other possible approaches are for instance pointed out by Goemaere in his response [3]. Hence section 11 would preclude the application of restrictions on the freedom of the patients in the name of public health concerns.

Other sections of the Principles impose further constraints on the application of section 25.

Whether or not the South African situation satisfies the constraints implied in e.g. section 11 of the Siracusa Principles is impossible for me to judge. However, by selectively quoting from those Principles, the authors have damaged their argument considerably.


1. Singh JA, Upshur R, Padayatchi N (2007) XDR-TB in South Africa: No Time for Denial or Complacency. PLoS Med 4(1): e50 doi:10.1371/journal.pmed.0040050
2. United Nations Economic and Social Council, Commission on Human Rights (1984) Status Of The International Covenants On Human Rights. Available http://documents-dds-ny.u.... Accessed 14 May 2007.
3. Goemaere E, Ford N, Berman D, McDermid C, Cohen R (2007) XDR-TB in South Africa: Detention is not the priority. PLoS Med 4(4): e162. doi:10.1371/journal.pmed.0040162

No competing interests declared.