HIV and Ethical Issues in Health Care

Table of Content

Abstract3

Introduction4

Discussion5

Conclusion10

References12

Annotated Bibliography15

Abstract

This paper will examine the ethical issues related to HIV/AIDS in health care. Key issues analyzed include confidentiality, informed consent, and end of life, research design, conflict of interest, vulnerable populations, and vaccine research. Although many examples are drawn from the United States, these issues are also explored from a global perspective.

HIV and Ethical Issues in Health Care

Introduction

There are three widely recognized principles in American bioethics that apply to both clinical and research ethics: respect for persons, beneficence, and justice. Respect for persons entails respecting the decisions of autonomous persons and protecting persons who lack decisionmaking capacity and therefore are not autonomous (Gittler 2000). It also imposes an obligation to treat persons with respect by maintaining confidences and keeping promises. Beneficence imposes a positive obligation to act in the best interests of patients or research participants. It often is understood to require that the risks of research be minimized and that the risks be acceptable in light of the potential benefits of research. Finally, justice requires that people be treated fairly (English 2001). It is often understood to require that benefits and burdens be distributed fairly within society(Dodson 2002).

Although the ethical principles are useful guidelines that help to focus discussion, they cannot be mechanically or rigidly applied (Dodson 2002). Nor are they absolute; exceptions to the principles may be appropriate in particular cases. Furthermore, they often conflict. Accordingly, these ethical principles must be interpreted in the context of specific cases. Although appeal to these three principles is the dominant approach in American bioethics, other approaches have been suggested and vary dramatically according to different trains of philosophic thought(Bowleg 1996):

The utilitarian perspective embodies the idea that acts should be evaluated according to their consequences.

The deontological approach stresses that research ethics should be guided by generalizable rules or obligations.

The casuistry approach uses paradigmatic cases to guide decisionmaking.

The ethic of caring judges acts based on their effect on relationships.

Communitarians evaluate acts based on their consequences for the community (Bowleg 1996).

Virtue ethics focuses on the motivation or character of the actor, rather than the act itself.

Discussion

In the United States, all medical information generally is considered confidential and protected under the law. Because of the sensitivity of HIV-related information, many states in the U.S. have adopted laws that provide additional protection to HIV-related medical records. For example, in many states, HIV information may not be disclosed based on a general release of medical information-specific authorization for release of HIV-related information must be obtained (Bowleg 1999).

Exceptions to the legal and ethical obligation to maintain the confidentiality of HIV-related information exist. For example, health care providers in the U.S. have a duty to report HIV infections and AIDS cases to public health authorities. The benefits to the public health of this reporting are felt to outweigh the risk to individuals. Reporting of AIDS cases has always included the patient's name and other identifying information (Bowleg and B.J. Bridgeham). Although reporting of HIV infections initially ...