HIV Ethics Caring for Persons

HIV Ethics

Caring for persons with HIV / AIDS has become a fundamental feature of all health care professions, due to the staggering rates of infection worldwide. Deontological ethical theories underlie the roles and responsibilities of the health care professional, informing the duty to care. Moreover, deontological ethics create categorical imperatives that outline absolute right and wrong actions. Often categorical imperatives become codified into institutional rules or societal laws. However, health care professionals who encounter HIV / AIDS frequently face situational decision-making demanding reliance on personal ethical principles. For example, issues related to confidentiality, patient autonomy, paternalism, and egoism may all come into play when treating patients with a life-threatening and highly contagious illness. Discrimination against persons with HIV / AIDS, as well as the socio-economic implications of the disease may also affect a health care professional's choices. The patient's religious affiliation and potential conflicts with friends and/or family members also weigh heavily on doctors, nurses, and other practitioners. Becoming aware of the numerous nuances in ethical reasoning can help guide a health care professional's decisions in providing optimal care for patients diagnosed with HIV / AIDS.

Patient autonomy is a central issue in health care in general. Preserving patient confidentiality and minimizing medical paternalism have become keys to providing ethical treatment for all patients. Patients with HIV / AIDS deserve similar ethical treatment and are entitled by law and by hospital regulations to a reasonable assumption of both autonomy and confidentiality. Decisions regarding courses of treatment, for example, should be made by the patient except in extreme cases in which patient consciousness has been compromised. Similarly, patients with HIV / AIDS assume the preservation of confidentiality. Ethical dilemmas regarding confidentiality and patient autonomy can easily arise when health care professionals suspect that a patient with HIV / AIDS is not taking adequate precautions to prevent the transmission of the illness. For example, a health care worker may suspect that a patient diagnosed with HIV / AIDS engages in unprotected sex. The health care worker faces a clear deontological dilemma: on the one hand, duty demands the maintenance of confidentiality but on the other hand, duty to maintain public health demands intervention: such as by divulging the patient's diagnosis to affected parties. In this case, the health care worker would do best to confront the patient first, expressing concern over the possible spread of the illness before brazenly breaking confidentiality agreements. Virtue ethics also uphold the integrity of health care workers in making informed decisions for the betterment of the patient and for the community.

Therefore, health care workers cannot rely on categorical imperatives: no absolute guidelines can ease the decision-making process regarding HIV / AIDS. While certain actions including preserving confidentiality may be ethical imperatives most of the time, no action can be right all of the time. Thus, some degree of ethical consequentialism and of utilitarianism must inform best practices. For example, the consequences of breaking confidentiality may be to preserve public health: one of the key responsibilities of the health care professional. In other cases, preserving confidentiality or entrusting the doctor with treatment-related decisions may be in the best interest of the patient and his or her family or community. Health care workers should carefully weigh consequences, in light of deontological ethics and institutional regulations.

Health care professionals working with patients with HIV / AIDS must be careful to temper consequentialism with deontology, to balance the psychological needs of the patient for confidentiality and autonomy with the practical needs of public health; or to balance the physical needs of a patient with HIV / AIDS with medical paternalism. Furthermore, discrimination against patients with HIV / AIDS is commonplace and often occurs inadvertently. Health care workers are obliged to confront their own biases regarding HIV / AIDS because to withhold adequate treatment is to violate a series of ethical principles including those based on deontology and on utilitarianism. For example, a health care worker might subconsciously resist touching a patient diagnosed with HIV / AIDS or otherwise withhold complete care giving. Health care workers are obliged to treat all patients with empathy and to not react out of irrational fear. A health care worker who does not provide adequate treatment for a patient with HIV / AIDS should be removed from the case, in the best interest of the patient. At the same time, health care workers, however, might understandably act on ethical egoism: to take into account self-interest under reasonable circumstances. Suspecting that a patient might be considering deliberately infecting a health care worker or might be withholding pertinent information, a health care worker might choose to act out of self-interest before providing treatment.