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AIDS and  Health Care Practice
<ul><li>1981 – CDC reports unusual outbreak </li></ul><ul><li>Infection control methods: </li></ul><ul><ul><li>Decreasing ...
<ul><li>Ethical issues in an epidemic: </li></ul><ul><ul><li>Is there a duty to treat? </li></ul></ul><ul><ul><li>Confiden...
<ul><li>Ethical issues in an epidemic (continued): </li></ul><ul><ul><li>Human subject research/experimental treatments </...
<ul><li>Provide service consistent with skills </li></ul><ul><li>Obtain skills as needed by patient population as consiste...
<ul><li>Provide accurate and up-to-date information </li></ul><ul><li>Promote the patient’s best interest regardless of pe...
<ul><li>The ethic of the Good Samaritan does not require that the rescuer take unacceptable risks in the process </li></ul...
<ul><li>Useful guidelines for determining moral duty or moral option to treat: </li></ul><ul><ul><li>Patient at significan...
<ul><li>Useful guidelines for determining moral duty or moral option to treat (continued): </li></ul><ul><ul><li>Practitio...
<ul><li>A physical therapist off duty, you stop to help at a traffic accident on the way home </li></ul><ul><li>A victim i...
<ul><li>Duty-oriented view:  </li></ul><ul><ul><li>Individual’s right of self-determination requires control over personal...
<ul><li>Virtue-oriented belief:  </li></ul><ul><ul><li>A special  patient-provider relationship exists </li></ul></ul>Copy...
<ul><li>A balance between: </li></ul><ul><ul><li>Duty to our patients </li></ul></ul><ul><ul><li>Legal obligations </li></...
<ul><li>Review the case study “A Duty to Warn?” </li></ul><ul><ul><li>Is there a duty to warn? </li></ul></ul>Copyright ©2...
<ul><li>Mandatory testing for everyone: </li></ul><ul><ul><li>Early diagnosis could lead to early treatment </li></ul></ul...
<ul><li>Concerns: </li></ul><ul><ul><li>Cost/benefit ratio </li></ul></ul><ul><ul><li>Potential for increased discriminati...
<ul><li>Dr. David Acer case – Florida dentist </li></ul><ul><li>Behringer  v.  Medical Center  at Princeton </li></ul><ul>...
<ul><li>Should experimental drugs be available to dying patients? </li></ul><ul><li>Practice would not meet legal standard...
<ul><li>Difficult to assess autonomous consent in situation where patient is coerced by lack of options </li></ul><ul><li>...
<ul><li>AIDS epidemic threatens vulnerable populations in Asia, Africa, Eastern Europe </li></ul><ul><ul><li>Disease threa...
<ul><li>Review the case </li></ul><ul><li>Does principle of distributive justice have meaning in an international context?...
<ul><li>Assuming that we decided not to provide the drugs, is it reasonable or racist to conduct the study outlined in the...
<ul><li>Review Exercise F in the review exercises </li></ul><ul><li>Do countries such as the United States have a duty to ...
<ul><li>If you decide that countries such as the United States have a duty to assist: </li></ul><ul><ul><li>To what extent...
<ul><li>Ethical issues faced by health care providers in an epidemic such as AIDS </li></ul><ul><li>Standard precautions a...
<ul><li>What duty is owed to infected health care providers? What duty do they owe patients? </li></ul><ul><li>In a global...
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Chapter12

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  1. 1. AIDS and Health Care Practice
  2. 2. <ul><li>1981 – CDC reports unusual outbreak </li></ul><ul><li>Infection control methods: </li></ul><ul><ul><li>Decreasing susceptibility of hosts </li></ul></ul><ul><ul><li>Eliminating the source of the organisms </li></ul></ul><ul><ul><li>Interrupting the mode of transmission </li></ul></ul><ul><li>High-risk behaviors </li></ul><ul><li>Occupational risk </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  3. 3. <ul><li>Ethical issues in an epidemic: </li></ul><ul><ul><li>Is there a duty to treat? </li></ul></ul><ul><ul><li>Confidentiality and the duty to warn </li></ul></ul><ul><ul><li>Who should be tested? </li></ul></ul><ul><ul><li>What to do with the infected health care provider? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  4. 4. <ul><li>Ethical issues in an epidemic (continued): </li></ul><ul><ul><li>Human subject research/experimental treatments </li></ul></ul><ul><ul><li>How far does duty extend in a global epidemic? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  5. 5. <ul><li>Provide service consistent with skills </li></ul><ul><li>Obtain skills as needed by patient population as consistent with scope of practice </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  6. 6. <ul><li>Provide accurate and up-to-date information </li></ul><ul><li>Promote the patient’s best interest regardless of personal feelings </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  7. 7. <ul><li>The ethic of the Good Samaritan does not require that the rescuer take unacceptable risks in the process </li></ul><ul><li>A nonswimmer is not required to jump into pool to save another </li></ul><ul><li>The practice of universal precautions removes the unacceptable risk </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  8. 8. <ul><li>Useful guidelines for determining moral duty or moral option to treat: </li></ul><ul><ul><li>Patient at significant risk of harm if practitioner does not assist? </li></ul></ul><ul><ul><li>Practitioner intervention directly related to preventing harm? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  9. 9. <ul><li>Useful guidelines for determining moral duty or moral option to treat (continued): </li></ul><ul><ul><li>Practitioners intervention will probably prevent the harm? </li></ul></ul><ul><ul><li>Does the potential patient benefit outweigh harm the practitioner might incur? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  10. 10. <ul><li>A physical therapist off duty, you stop to help at a traffic accident on the way home </li></ul><ul><li>A victim is lying on the ground, not breathing, and bleeding from the mouth </li></ul><ul><li>You are CPR-certified, but with no form of protective barrier mask with you </li></ul><ul><li>Moral duty or moral option? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  11. 11. <ul><li>Duty-oriented view: </li></ul><ul><ul><li>Individual’s right of self-determination requires control over personal privacy </li></ul></ul><ul><li>Utilitarian view: </li></ul><ul><ul><li>Breaking of confidentiality would have a chilling effect on therapeutic relationship and health care in general </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  12. 12. <ul><li>Virtue-oriented belief: </li></ul><ul><ul><li>A special patient-provider relationship exists </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  13. 13. <ul><li>A balance between: </li></ul><ul><ul><li>Duty to our patients </li></ul></ul><ul><ul><li>Legal obligations </li></ul></ul><ul><ul><li>Appropriate disease control within the community </li></ul></ul><ul><ul><li>Our duty to protect vulnerable individuals </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  14. 14. <ul><li>Review the case study “A Duty to Warn?” </li></ul><ul><ul><li>Is there a duty to warn? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  15. 15. <ul><li>Mandatory testing for everyone: </li></ul><ul><ul><li>Early diagnosis could lead to early treatment </li></ul></ul><ul><ul><li>Early counseling could lead to early cessation of high-risk behaviors </li></ul></ul><ul><ul><li>Better statistics to guide public health activities </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  16. 16. <ul><li>Concerns: </li></ul><ul><ul><li>Cost/benefit ratio </li></ul></ul><ul><ul><li>Potential for increased discrimination (false positives) </li></ul></ul><ul><ul><li>False sense of security </li></ul></ul><ul><ul><li>Perhaps drive disease underground to avoid testing </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  17. 17. <ul><li>Dr. David Acer case – Florida dentist </li></ul><ul><li>Behringer v. Medical Center at Princeton </li></ul><ul><ul><li>Privacy and confidentiality are also rights for a infected practitioners </li></ul></ul><ul><ul><li>What to do in the case of an infected practitioner? How do we protect both the patients and practitioners? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  18. 18. <ul><li>Should experimental drugs be available to dying patients? </li></ul><ul><li>Practice would not meet legal standard of “customary care” </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  19. 19. <ul><li>Difficult to assess autonomous consent in situation where patient is coerced by lack of options </li></ul><ul><li>Difficult to assess research results from desperate individuals who self- medicate </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  20. 20. <ul><li>AIDS epidemic threatens vulnerable populations in Asia, Africa, Eastern Europe </li></ul><ul><ul><li>Disease threatens to overcome social structure in developing nations </li></ul></ul><ul><ul><li>Medication costs out of reach for most </li></ul></ul><ul><ul><li>Developed world slow to respond </li></ul></ul><ul><li>Moral duty or moral option? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  21. 21. <ul><li>Review the case </li></ul><ul><li>Does principle of distributive justice have meaning in an international context? </li></ul><ul><li>In a situation such as this, should American drug companies be forced to provide the needed drugs at little or no cost? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  22. 22. <ul><li>Assuming that we decided not to provide the drugs, is it reasonable or racist to conduct the study outlined in the case? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  23. 23. <ul><li>Review Exercise F in the review exercises </li></ul><ul><li>Do countries such as the United States have a duty to assist another nation in the face of an overwhelming epidemic? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  24. 24. <ul><li>If you decide that countries such as the United States have a duty to assist: </li></ul><ul><ul><li>To what extent can our assistance be predicated on changes in social convention and lifestyles of another people? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  25. 25. <ul><li>Ethical issues faced by health care providers in an epidemic such as AIDS </li></ul><ul><li>Standard precautions and the issue of the health care provider’s duty </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  26. 26. <ul><li>What duty is owed to infected health care providers? What duty do they owe patients? </li></ul><ul><li>In a global epidemic, what ethical principles are involved? </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
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