| Course | HLTH 5023 Legal and Ethical Issues in Public Health |
|---|---|
| Module | Module 5 |
| Paper type | Public health policy recommendation |
| Length | 1,200 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | Master of Public Health |
| Updated | September 2026 |
Free sample paper for HLTH 5023 Module 5
Support First, Order Second, Confinement Last: A Lawful and Ethically Defensible Tuberculosis Treatment Adherence Policy for a County Health Department
Student Name
American College of Education
HLTH5023: Legal and Ethical Issues in Public Health
Module 5 Assignment
Instructor Name
November 2, 2026
The Problem the Policy Solves
The county's handling of a man with infectious tuberculosis who stopped treatment, examined throughout this course, exposed a gap. The department had legal authority and good intentions but no written policy. Staff did not know which steps to take in what order, what the state statute required before a court petition, how to support a patient without housing, or what information could be shared with a shelter. Each case was improvised, which risks both under-reaction, leaving an infectious person untreated, and over-reaction, confining someone who could have been helped at far less cost to his liberty.
This paper recommends that the board of health adopt a Tuberculosis Treatment Adherence Policy. It sets out the policy's provisions, explains how each meets legal and ethical requirements, and proposes how its use will be reviewed.
Provision One: Support-Based Observed Therapy for Every Patient
Every person with active tuberculosis will be offered case management and observed therapy from diagnosis, consistent with the national guideline's preference for directly observed therapy and case management (Nahid et al., 2016). The case manager will ask at the first visit what could interfere with treatment, such as side effects, work hours, transport, housing, alcohol or drug use, or stigma, and will address it: adjusting dosing times, arranging transport or food support, and choosing a place for observation that protects privacy.
Video-observed therapy will be offered as the default option for patients who can use it. A randomized trial across 22 clinics in England, where more than half the patients had histories such as homelessness, prison, drug or alcohol problems or mental illness, found that 70% of those observed by smartphone video met the target of observing at least 80% of doses over two months, against 31% of those observed in person (Story et al., 2019). The department will provide smartphones and data plans where needed, as the trial did.
Provision Two: Housing During the Infectious Period
Patients who are infectious and have no stable place to stay will be offered a private room, such as a hotel room under contract, until they are no longer infectious, with meals and observed therapy provided. This provision serves both ethics and effectiveness. It is the least restrictive way to separate an infectious person from others in a shelter, it addresses the unfairness that would otherwise make compulsion fall mostly on people without homes, and it removes one of the most common reasons for interrupting treatment. It is also likely to cost less than hospital confinement, which the policy reserves for the rare cases that require it.
Provision Three: Written Orders With Notice of Rights
If a patient who is infectious, or who has not completed treatment, declines observed therapy after the supports in the first two provisions have been offered, the health officer may issue a written order. The order will state, in plain language and in the patient's preferred language, what the patient must do, such as take observed doses daily; why, including the medical basis; what supports remain available; what will happen if the order is not followed; and the patient's right to ask for review and to be represented by counsel. A copy of the supports offered and the patient's responses will be kept in the file, because the policy requires evidence that less restrictive measures were tried before any further step.
Provision Four: Court-Ordered Isolation as a Last Resort
The health officer may petition a court for isolation only when four conditions are met: the patient is infectious based on laboratory evidence; the patient has not complied with a written order; supported and less restrictive options have been offered and documented; and isolation is necessary to protect others. The petition will follow the state statute's procedures and the due process protections courts have required, including a hearing, counsel and a clear and convincing standard of proof. Isolation will be in a medical setting, never a jail, will last only as long as the patient is infectious, will include treatment for substance use if the patient wishes, and will end with a written plan to complete treatment in the community. The court will review continued isolation at intervals set by statute or, if none, every 30 days.
Provision Five: Privacy in Contact Investigations
Contact investigations will follow the national contact investigation guidelines and the privacy safeguards set out in the previous module: contacts will not be told the source's identity, data requested from shelters and other non-clinical partners will be limited to what the investigation needs under a written data use agreement, and nothing gathered for the investigation will be handed to police or immigration agencies. Case and contact records will live only in the department's protected surveillance database, where every look at a record is logged.
Legal and Ethical Justification
The policy rests on the state's police power, recognized for over a century in cases such as Jacobson v. Massachusetts, and on the state communicable disease statute that delegates authority to the health officer. It respects the limits the courts have set: restrictions must be tied to real risk, based on individualized evidence, and imposed with due process. Ethically, it is built on the justificatory conditions of Childress et al. (2002). Each step must be effective, proportionate to the risk, necessary because the step before it failed, the least infringing option available, and explained openly to the patient and the public. The policy's order of steps is its ethics: every provision exists so that the one after it is rarely needed.
Costs and Implementation
The policy's main costs are modest and partly offset. Video-observed therapy requires phones, data plans and staff time to review videos, but it reduces travel by outreach workers, who now drive to each patient's location. Hotel rooms for infectious patients without housing cost money, typically for a few weeks per patient, yet a single avoided hospital confinement can cost more than all the hotel stays the county is likely to need in a year. The department will fund the housing provision through a standing agreement with two hotels, drawing on its tuberculosis control grant where allowable and on local funds otherwise. Implementation will begin with training for tuberculosis nurses and outreach workers on the new sequence, the written order template and the documentation the policy requires, and the county attorney will review the order and petition templates before use. The first review of the policy's operation will take place six months after adoption, to correct problems early rather than waiting for the full two-year review.
Accountability and Review
The tuberculosis program manager will report to the board of health twice a year on the number of patients treated, the share completing treatment, the number receiving housing support, the number of written orders issued and petitions filed, and the outcome of each petition, with demographic breakdowns to detect whether compulsion falls disproportionately on any group. Any use of court-ordered isolation will be reviewed by the medical director and the county attorney within 30 days. The policy will be reviewed in full after two years, or sooner if state law changes.
References
Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain. Journal of Law, Medicine & Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x
Nahid, P., Dorman, S. E., Alipanah, N., Barry, P. M., Brozek, J. L., Cattamanchi, A., Chaisson, L. H., Chaisson, R. E., Daley, C. L., Grzemska, M., Higashi, J. M., Ho, C. S., Hopewell, P. C., Keshavjee, S. A., Lienhardt, C., Menzies, R., Merrifield, C., Narita, M., O'Brien, R., ... Vernon, A. (2016). Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: Treatment of drug-susceptible tuberculosis. Clinical Infectious Diseases, 63(7), e147-e195. https://doi.org/10.1093/cid/ciw376
Story, A., Aldridge, R. W., Smith, C. M., Garber, E., Hall, J., Ferenando, G., Possas, L., Hemming, S., Wurie, F., Luchenski, S., Abubakar, I., McHugh, T. D., White, P. J., Watson, J. M., Lipman, M., Garfein, R., & Hayward, A. C. (2019). Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: A multicentre, analyst-blinded, randomised, controlled superiority trial. The Lancet, 393(10177), 1216-1224. https://doi.org/10.1016/S0140-6736(18)32993-3
Reading the HLTH 5023 Module 5 instructions
HLTH 5023 Module 5 usually asks you to bring law and ethics together in a policy recommendation. Prompts typically ask you to define a public health problem, propose a policy or set of provisions, show that the policy rests on valid legal authority and respects constitutional and statutory limits, justify it with an ethics framework, and explain how it will be implemented and reviewed. Some versions ask for a formal policy document; others a memo to a board or legislator. Graders expect each provision to be tied to a legal or ethical reason and to be written clearly enough that staff could follow it. Where the course has followed one topic, the policy should grow out of the earlier papers; Canvas will say whether the audience is a board, a legislator or agency staff.
How this HLTH 5023 Module 5 example is built
The sample defines the policy gap from the course's case and explains the risks of acting without a written policy. It then sets out five provisions in order of restrictiveness, each with its evidence or legal basis: support and video observation, housing during the infectious period, written orders with notice of rights, court-ordered isolation under four stated conditions, and privacy in contact investigations. A combined justification section ties the policy's structure to the police power, due process and a named ethics framework. The paper ends with reporting, case review and policy review provisions that keep the use of coercive powers visible.
Reading the HLTH 5023 Module 5 rubric
Policy recommendation rubrics in public health law courses generally reward a clearly defined problem, specific provisions, sound legal grounding, explicit ethical justification and attention to implementation and accountability. Graders check that the policy rests on real authority and respects due process and other limits. Graders reward an ethics section that tests each provision against a named framework rather than naming the framework once. Evidence for effectiveness, such as trials or guidelines, strengthens the recommendation. Accountability measures, including data on who is affected, are often rewarded. Clear, organized writing suited to the audience and APA 7 citation of cases, regulations and studies complete the rubric.
HLTH 5023 Module 5 help from the desk
Policy papers lose points when provisions are vague, such as calling for better adherence support without saying what it is. Another frequent weakness is a legal section that cites Jacobson and nothing else, ignoring due process and statutory limits. Students also justify coercive steps without showing that less restrictive ones come first. Write provisions a staff member could follow. Tie each to law or evidence. Put the least restrictive steps first and say when the next step is allowed. Include reporting that shows who is affected. Policies on vaccine requirements, outbreak closures or data sharing suit this format as well; outline the problem, attach the instructions, and we will shape a Module 5 recommendation to your audience.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More HLTH 5023 and Master of Public Health sample papers
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- HLTH 5023 Module 2: Court Case Analysis
- HLTH 5023 Module 3: Public Health Ethics Analysis
- HLTH 5023 Module 4: Data Privacy and Surveillance
- HLTH 5033 Module 3: Service Cost Analysis
- HLTH 5083 Module 3: Capstone Options Analysis
- HLTH 5053 Module 1: Health Literacy Assessment
- HLTH 5063 Module 5: Policy Recommendation
HLTH 5023 Module 5 questions, answered
What does HLTH5023 Module 5 usually ask for?
HLTH5023 frequently ends with a policy recommendation that must be both lawful and ethically defensible, drawing on the legal authority, case law and ethics frameworks studied earlier. The policy problem is set by your own section.
Is video-observed therapy as good as in-person directly observed therapy for tuberculosis?
A randomized trial in England found that far more patients completed most scheduled observations with video-observed therapy than with in-person observation, including many with complex social needs.
When can a health department seek court-ordered isolation for tuberculosis?
Generally only when the person is infectious, has not followed a written order, less restrictive options have been tried and documented, and isolation is necessary, with due process protections in court.
Where can I find a free HLTH 5023 Module 5 sample paper?
Here, complete: the Module 5 policy recommendation for tuberculosis treatment adherence, with five provisions from support and video observation to court-ordered isolation, their legal and ethical justification, and review.
Why include housing in a tuberculosis policy?
Providing a private room during the infectious period is less restrictive than confinement, supports adherence and prevents coercive measures from falling mainly on people without homes.