Ethical Issues in the Care of PLHIV

1. Ethical Issues in the Care of PLHIV HAIVN Harvard Medical School AIDS Initiatives in Vietnam

2. Learning Objectives By the end of this session, participants should be able to: • List 4 common ethical challenges/duties in the clinical care of PLHIV • Explain benefits of universal precautions that can protect patients from stigma and discrimination • Explain patients’ rights regarding HIV testing

3. 4 Duties in Caring PLHIV • Duty to care versus fear of personal risks • Duty to protect patients versus duty warn others • Duty to maintain patient confidentiality • Duty to protect patient autonomy

4. Duty to Care • All patients should receive the best possible care • All indicated procedures must be performed • Invasive diagnostic procedures • Therapeutic procedures • Hands-on care

5. Duty to Care: Dilemma • Medications • Devices • Tools • Patient wards • Human resources… Resources are scarce : • Questions: • Who should get medication first? • Who decide this?

6. Reducing Fear of Personal Risk • Educate health care workers about their rights to: • protect themselves and patients. • adequate equipment and supplies to protect themselves • Universal precautions should be standard of practice for ALL patients and settings

7. Duty to Protect (1) • Protects health care workers from acquiring infections in the course of their work • Protects patients from acquiring infections from health care workers

8. Duty to Protect (2) • If there are HIV-infected Health Care Workers in health settings, the manage should consider: • The type of patient contact they have – does it represent a true risk for transmission to patients or others • Are patients exposed to the Health Care Worker’s blood or body secretions? • In most cases, there is no risk and the Health Care Worker is not ethically required to reveal his or her infection

9. Duty to Protect: Universal Precautions • Definitions: • Treat ALL blood and body fluids as if they are potentially infectious • Benefits: • Do not identify any particular patient as HIV-infected -> Reduces stigma • Protects everyone Universal Precautions are only effective if implemented with all patients in all settings

10. Confidentiality (1) • Maintaining the privacy of patient information is an ethical duty • Discussion about patients should be: • limited to those with a direct need to know • and conducted in private areas • No signs on patient rooms or labels on outside of medical records

11. Confidentiality (2) • Dilemma: Health care workers need to: • maintaining the privacy of the infected patient • inform people at risk • If the patient is putting another individual at risk for HIV infection: • Encourage the patient to: • inform the person at risk • change his/her behavior • Offer to help the patient inform the person at risk • If possible, inform the person at risk without revealing the identity of the infected individual

12. Right to Autonomy(1) • Patients have the right: • to decline HIV testing • Except for cases specified as per MOH guidelines • to the information they need to make treatment choices • Results of HIV tests should be presented privately • It is unethical to give a patient a positive HIV test result without also providing emotional support and information

13. Right to Autonomy (2) End of life decisions: • Whether or not to provide advanced care • who decides? Physician? Family? Patient? • When to stop medications? Which medications to continue? • Is pain relief adequate? Is hands-on care adequate? • Choice of place of death?

14. Ethical Obligations • To provide the best possible care for all patients • To protect patient privacy • To maintain patient autonomy • To provide emotional support and information to all patients • To continue care until the end of life

15. Key Points • All patients should receive the best possible care • Universal Precautions are used with ALL patients • Patients should never receive a positive HIV test result without also receiving information and psychological support • Health care workers must never abandon patients

16. Thank you! Questions?