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 c lear. 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 b y the desire to discuss the situation more fully with your patient before p rescribing a drug. The local public health team, of which you are a part, i s currently evaluating the impact on the community's health of a patient ed ucation programme which necessitates informing all new leprosy cases of the ir diagnosis. What should you do? And can bio-ethics help?