Needing to know? Ethical dilemmas in leprosy treatment and control.

A young man presents to your local clinic in a leprosy endemic country with a small patch of discoloured skin on his right forearm. The diagnosis is clear. You start to explain, but the man stops you: he doesn't want to hear more, just requests the medicine. But you are 'in conflict', and not just by the desire to discuss the situation more fully with your patient before prescribing a drug. The local public health team, of which you are a part, is currently evaluating the impact on the community's health of a patient education programme which necessitates informing all new leprosy cases of their diagnosis. What should you do? And can bio-ethics help?