2. • Consequences: what are the consequences of any given course of action?
• Consider both benefits and harms.
• Duties and Obligations: what are the duties of the clinician?
• Is this a case of conflict of duties?
• To whom does the clinician owe these duties?
• If so how best can this dilemma be resolved?
• Consider the categorical imperatives. Is this a case of respect for
autonomy and informed consent?
• If so are there sufficient grounds to ignore her wishes?
• Application of principles. How might the four key ethical principles of
ethical clinical practice be applied?
• If necessary remind yourself of these principles.
• What other considerations might apply?
• What are your conclusions about the best course of action? Give your
reasons
3. Balancing Nonprofit Interests
By Jessica Silliman
• Paul Champion works in the nonprofit sector at a grassroots HIV/AIDS program in
the Bay Area. As with many such organizations, this small nonprofit struggled with
funding and had to reorganize its programs.
• "Given the limited resources, there were often debates amongst leaders under
financial pressure in the HIV/AIDS nonprofit world about what resources should be
given priority: prevention or treatment," says Paul. Supporting prevention would
mean devoting funds to educational efforts and condom distribution. Supporting
treatment would mean devoting funds to medical care for the already infected.
With limited funds, the organization couldn't support both approaches. As a
lobbyist for the organization, Paul had a heavy hand in the process. He advocated
for a small advancement in both the prevention and treatment sector of the
organization, instead of a large change to favor one or the other. Paul felt this
would best serve the community they were charged with helping because it would
put funds toward two segments that surround the issue of HIV/AIDS-those who
are at risk and those who have been diagnosed.
4. • But those above Paul felt differently. "We play a more beneficial role by focusing on treatment,"
said Paul's boss. The upper management reasoned that money and services would have a greater
impact if it focused on the treatment option. Those needing treatment were a defined population,
whereas those in prevention were hard to define or narrow as an area to serve. With so little
money to work with, the upper management felt that it would be better to devote significant funds
to one faction, with the possibility of making a difference, rather than splitting their time and
money, thereby reducing the effectiveness and possible impact on the community. Their reasoning
was sharply questioned by others who felt favoring prevention was a better option, even if the
long-term result would reduce the number of infections.
• "HIV infections are more likely to continue absent strong prevention programs," says Paul. "But a
focus on treatment comes at the expense of the prevention programs-even at the national level."
• Paul's job changed with the decision. He no longer was able to advocate for both treatment and
prevention. Instead, his grant writing and petitions for government funding were focused on
treatment. The organization still supported prevention, but only in theory.
• After fighting a losing battle for six months, Paul left the non-profit. "Even guys in white hats-
organizations designed to do good-face ethical challenges created by financial pressures," said
Paul.
• Discussion Questions:
• What should the goal of a nonprofit HIV/AIDS organization be?
• Once the upper management made its decision to favor treatment, should Paul have resigned?
• Do you think Paul's decision was fair to the community served?
• Should Paul have gone to the newspaper or other media outlets?
