This document discusses several ethical issues that arise during epidemics like AIDS, including a health care provider's duty to treat patients, maintain confidentiality, and determine appropriate testing and treatment approaches. It also examines ethical considerations in treating infected health care workers and conducting experimental research. Globally, questions are raised about distributive justice and the duties of developed nations in responding to epidemics threatening vulnerable populations.

1. Chapter Twelve AIDS and Health Care Practice

2. AIDS 1981 – CDC reports unusual outbreak Infection control methods: Decreasing susceptibility of hosts Eliminating the source of the organisms Interrupting the mode of transmission High-risk behaviors Occupational risk

3. AIDS (continued) Ethical issues in an epidemic: Is there a duty to treat? Confidentiality and the duty to warn Who should be tested? What to do with the infected health care provider?

4. AIDS (continued) Ethical issues in an epidemic (continued): Human subject research/experimental treatments How far does duty extend in a global epidemic?

5. Professional Duties in an Epidemic Provide service consistent with skills Obtain skills as needed by patient population as consistent with scope of practice

6. Professional Duties in an Epidemic (continued) Provide accurate and up-to-date information Promote the patient’s best interest regardless of personal feelings

7. Duty to Treat The ethic of the Good Samaritan does not require that the rescuer take unacceptable risks in the process A nonswimmer is not required to jump into pool to save another The practice of universal precautions removes the unacceptable risk

8. Moral Duty or Moral Option? Useful guidelines for determining moral duty or moral option to treat: Patient at significant risk of harm if practitioner does not assist? Practitioner intervention directly related to preventing harm?

9. Moral Duty or Moral Option? (continued) Useful guidelines for determining moral duty or moral option to treat (continued): Practitioners intervention will probably prevent the harm? Does the potential patient benefit outweigh harm the practitioner might incur?

10. Case – a Moral Duty or Moral Option? A physical therapist off duty, you stop to help at a traffic accident on the way home A victim is lying on the ground, not breathing, and bleeding from the mouth You are CPR-certified, but with no form of protective barrier mask with you Moral duty or moral option?

11. Foundations for Confidentiality Duty-oriented view: Individual’s right of self-determination requires control over personal privacy Utilitarian view: Breaking of confidentiality would have a chilling effect on therapeutic relationship and health care in general

12. Foundations for Confidentiality (continued) Virtue-oriented belief: A special patient-provider relationship exists

13. Confidentiality and AIDS A balance between: Duty to our patients Legal obligations Appropriate disease control within the community Our duty to protect vulnerable individuals

14. Confidentiality and AIDS (continued) Review the case study “A Duty to Warn?” Is there a duty to warn?

15. Mandatory Testing Mandatory testing for everyone: Early diagnosis could lead to early treatment Early counseling could lead to early cessation of high-risk behaviors Better statistics to guide public health activities

16. Mandatory Testing (continued) Concerns: Cost/benefit ratio Potential for increased discrimination (false positives) False sense of security Perhaps drive disease underground to avoid testing

17. Infected Health Care Worker Dr. David Acer case – Florida dentist Behringer v. Medical Center at Princeton Privacy and confidentiality are also rights for a infected practitioners What to do in the case of an infected practitioner? How do we protect both the patients and practitioners?

18. Experimental Treatment Should experimental drugs be available to dying patients? Practice would not meet legal standard of “customary care”

19. Experimental Treatment (continued) Difficult to assess autonomous consent in situation where patient is coerced by lack of options Difficult to assess research results from desperate individuals who self- medicate

20. The Global Epidemic AIDS epidemic threatens vulnerable populations in Asia, Africa, Eastern Europe Disease threatens to overcome social structure in developing nations Medication costs out of reach for most Developed world slow to respond Moral duty or moral option?

21. Case – Tuskegee in Africa Review the case Does principle of distributive justice have meaning in an international context? In a situation such as this, should American drug companies be forced to provide the needed drugs at little or no cost?

22. Case – Tuskegee in Africa (continued) Assuming that we decided not to provide the drugs, is it reasonable or racist to conduct the study outlined in the case?

23. Global Epidemic Review Exercise F in the review exercises Do countries such as the United States have a duty to assist another nation in the face of an overwhelming epidemic?

24. Global Epidemic (continued) If you decide that countries such as the United States have a duty to assist: To what extent can our assistance be predicated on changes in social convention and lifestyles of another people?

25. Key Concepts Ethical issues faced by health care providers in an epidemic such as AIDS Standard precautions and the issue of the health care provider’s duty

26. Key Concepts (continued) What duty is owed to infected health care providers? What duty do they owe patients? In a global epidemic, what ethical principles are involved?