Ethical Issues of HIV and AIDS in Health Care

1. Ethical Issues of HIV and AIDS in Health Care Presented by Yu-Fen Lin

2. HIV & AIDS • HIV Human Immunodeficiency Virus • AIDS Acquired Immune Deficiency Syndrome

3. The legal definition of AIDS • When a person’s T-cell count goes below 200, he/she is considered as having AIDS.

4. Three primary types of contact that can result in transmission of HIV • Sexual contact, that is, contact with infected genital secretions (semen, vaginal fluids, menstrual blood) • Injection of infected blood through transfusions or needle sharing • Pregnancy in an infected mother

5. Transmission that is not biological possible • Shaking hands • Sharing a toilet • Sharing eating utensils • Being sneezed upon • Living in the same household • Working in the same room or attending the same classroom • Closed-mouth kissing

6. Social stigmatization • HIV disease, in particular, carries with it the social stigmatization that complicates mental health and threatens life-sustaining activities. “Telling friends I’m HIV positive is not the same as telling them I’m gay”—double coming out, the first closet and the second closet

7. Ethics issues related to HIV & AIDS • Disclosure • Disability rights • Economical resources • Employment rights • Medication & Treatments • Suicide • Duty to warn

8. Disclosure • To tell or not? Decisions whether to disclose the diagnosis in the workplace. • A doctor with HIV needs not to disclose?

9. Disability Rights • Disability rights awareness e.g., “Somehow a check-out person at a local grocery store found out I had AIDS and started wearing latex gloves every time she waited on me. I called their legal department and informed them that this needed to stop or I would sue them”

10. Economical resources • Financing treatment e.g., “Medicare doesn’t pay for my prescriptions anymore.” • Different kind and degree of services than a person who is employed and who has health insurance and other resources available.

11. Employment • Can they decide whether to stay in their current position or not? e.g., “My old job as a nursing assistant was too high risk, so I had to leave.” • Emotionally missing work e.g., “Work had always been important to me and it really hit me all at once that I wasn’t able to do it anymore.”

12. Medication & Treatments • Dissatisfactory with the treatment providers e.g., “A lot of times I’m not in the mood to talk with the doctors in the clinic. They don’t listen and they are very clinical.”

13. Medication & Treatments contd. • Treatment effects e.g., “I had a very bad reaction to the drug I was taking and had to go back into the hospital”

14. Suicide: the dilemma of the right to die • High suicidal rate the relative risk of suicide in men with AIDS aged 20-59 years was 36.30 times…that of men aged 20-59 years without this diagnosis. (New York City, 1988) • Seven people during a 6-week period took their own lives after testing positive for the virus, even though they were asymptomatic (Miami, 1987)

15. Is there a legal duty to protect or warn third parties • Whether a therapist has a duty to protect third parties when his or her patient, if HIV-positive, persists in engaging in unprotected sex with an unknowing partner involves complex clinical and legal questions which have not been adequately addressed.

16. Counselor’s guide to make an ethical decision • Moral Principles • Ethical decision making model

17. Moral principles • Autonomy: individual freedom and choice • Nonmaleficence: do no harm to clients • Beneficence: the welfare of the clients • Justice: If an individual is to be treated differently, the counselors needs to offer a rationale that explains • Fidelity: loyalty, faithfulness and honoring commitments

18. Ethical decision making model • Identify the Problem • Apply the ACA Code of Ethics • Determine the nature and dimensions of the dilemma • Generate potential consequences of all options and determine a course of action

19. Contd. 5. Consider the potential consequences of all options and determine a cause of action. 6. Evaluate the selected course of action. 7. Implement the course of action.

20. Counseling implications • Counselors require to be knowledgeable about federal, state, and local laws. Especially when illegal treatment in the workplace takes place, counselors advocate for clients who have encountered discrimination

21. About disclosure,counselors can… • Help clients identify the risks and benefits they are likely to encounter by disclosing their illness. • Help clients explore concerns associated with the fear of disclosure, living with nondisclosure.

22. About the treatment issues, counselors can/may • May find their clients feeling overwhelmed with their medical treatment, medical personnel, and health care systems. • Can help clients to cope with emotional reactions to their illness and to interpersonal insensitivity from medical care providers.

23. Risk reduction counseling is suggested • Safer sex practice • No needle sharing • Avoid pregnancy

24. References Bartlett, J.G. (1991). The Guide to Living with HIV Infection, Baltimore: The John Hopkins Press. Forester-Miller, H. & Davis, T. (1996). A practitioner’s guide to ethical decision making., http://aca.convio.net/site/PageServer?pagename=resources_prac_guide Gaughan, D.M. (2004). Psychiatric Hospitalizations Among Children and Youths with Human Immunodeficiency Virus Infection.Pediatrics, vol.113, e544-e551.

25. Reference Contd. Hunt, B., Jaques, J., Niles. S. G., & Wierzalis E. (2003). Career concern for people living with HIV/AIDS. Journal of Counseling & Development, 81, 55-81. Klitzman, R. (1997). Being Positive. Chicago: Ivan R. Dee. Pope, K.S. () New Research, Ethical Responsibilities, Evolving Legal Frameworks & Published Resources., http://kspope.com/ethics/aids-hiv.php