Ethical Issues of AIDS

I remember that weekend when no patient in the intensive care unit was over the age of forty. i remember the intern who tearfully refused to come to the emergency room to see the fourth AIDS patient I had admitted to her in as many hours. She never did meet him; he died before she calmed down.

Abigail Zuger, M.D.,1986

Hundreds of thousands of lost lives later, the initial impact is over. The thunderbolt of AIDS are starting to become a fact of life. Some sense of continuity with the rest of history has become possible.  AIDS continues to be a source of uniquely complex medical, legal, and social dilemmas; nonetheless, it has evolved into an entity provoking fewer immediate panicked reactions and more measured, mature analysis.

Abigail Zuger, M.D.,1993

 Acquired  Immune Deficiency Syndrome (AIDS) continues to grow as a worldwide epidemic. The disease, which at one time was centered within certain high-risk groups, has now spread into all segments of the population. The study of high-risk groups is no longer the best way to identify those at risk for the disease; rather, risk should be measured through the observance of certain high-risk behaviors.

Due to the frightening consequences of the disease and its relative newness, the public has reacted very negatively toward those infected. Victims of the disease have been stigmatized, exposed to humiliation,  and have experienced loss of work, insurance, and housing. The issue of confidentiality and the attempts to sustain a level of privacy beyond that provided for other diseases often create problems for the patient and health care provider. AIDS is the only disease about which there is any question as to whether health care providers should be told the diagnosis of their patients.

Ethical issues involved with this disease include confidentiality, the duty to treat infected individuals, the need for universal screening, the duty of infected health care providers to warn patients , and the need for equitable distribution of medical care and research dollars. It is clear that the resources that will be needed to care for these patients threatens to overwhelm an already burdened health care delivery system.

None of these issues has yet been satisfactorily addressed. How we finally addressed  and resolve this problems will speak either well or ill of the ethical foundations of the American health care system. Because of the scope of the ethical problems associated with the AIDS epidemic, our actions in response to it will leave either a proud or a shameful heritage for future health care providers.


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