Ethical Issues of HIV and AIDS
in Health Care
Presented by
Yu-Fen Lin
1
HIV & AIDS

HIV
Human Immunodeficiency Virus

AIDS
Acquired Immune Deficiency Syndrome
2
The legal definition of AIDS

When a person’s T-cell count goes
below 200, he/she is considered as
having AIDS.
3
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
4
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
5
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
6
Ethics issues related to HIV &
AIDS







Disclosure
Disability rights
Economical resources
Employment rights
Medication & Treatments
Suicide
Duty to warn
7
Disclosure


To tell or not?
Decisions whether to disclose the
diagnosis in the workplace.
A doctor with HIV needs not to
disclose?
8
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”
9
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.
10
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.”

11
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.”
12
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”
13
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)
14
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.
15
Counselor’s guide to make an
ethical decision


Moral Principles
Ethical decision making model
16
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
17
Ethical decision making model
1.
2.
3.
4.
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
18
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.
19
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
20
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.
21
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.
22
Risk reduction counseling is
suggested



Safer sex practice
No needle sharing
Avoid pregnancy
23
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=res
ources_prac_guide
Gaughan, D.M. (2004). Psychiatric Hospitalizations
Among Children and Youths with Human
Immunodeficiency Virus Infection. Pediatrics, vol.113,
e544-e551.
24
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
25