Bioethics ISSN 0269-9702 (print); 1467-8519 (online) Volume 19 Number 4 2005 © Blackwell Publishing Ltd. 2005, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. Blackwell Publishing Ltd.Oxford, UK and Malden, USABIOTBioethics0269-9702Blackwell Publishing Ltd. 20052005194307322Articles HOW INFECTIOUS DISEASES GOT LEFT OUTLESLIE P. FRANCIS ET AL. HOW INFECTIOUS DISEASES GOT LEFT OUT – AND WHAT THIS OMISSION MIGHT HAVE MEANT FOR BIOETHICS LESLIE P. FRANCIS, MARGARET P. BATTIN, JAY A. JACOBSON, CHARLES B. SMITH, AND JEFFREY BOTKIN ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy and the harm principle, to infectious examples. We argue that this is insufficient, how- ever. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as auton- omous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. At the time bioethics emerged as a field – the period of the late 1950s through the 1970s – infectious disease was largely thought to have been an area of medicine almost completely conquered. In 1972, as we are now often reminded, the United States Surgeon General opined, ‘It is time to close the book on infectious disease.’ 1 In this article, we explore how the absence – or oblique and 1 This much-cited quotation apparently stems from a speech by William Stewart, the Surgeon General in 1967. William H. Stewart. 1967. A Mandate for State Action. Presented at the Association of State and Territorial Health Officers, Washington, DC, Dec. 4, 1967. See http://pages.pomona.edu/ ~nvh04747/Bio189L/intro.html#1 (accessed 15 May 2005); see also Margie