Ethics

Article Abstract:

Ethical questions raised by AIDS (acquired immunodeficiency syndrome) are reviewed with emphasis on issues related to the availability of treatment early in the course of the disease. Now that early use of zidovudine (AZT) and (for some people sensitive to zidovudine) dideoxyinosine seems to mitigate AIDS symptoms, an attitude of resignation is no longer appropriate. Issues about confidentiality and anonymity are discussed, especially regarding the rights of contacts of HIV-positive individuals (demonstrate reaction to human immunodeficiency virus, which is associated with AIDS) to know that they may have been infected. Should mandatory testing take place? If so, of whom? Zidovudine therapy is expensive, costing about $3,200 per year at the current recommended dose level. Who should pay, since many AIDS patients are poor? Should drug manufacturers reduce the price of zidovudine, given the circumstances of AIDS patients? It will be necessary for more physicians and hospitals to provide AIDS treatment, with better allocation of resources between AIDS patients and patients without AIDS. Do patients have an obligation to health care workers to be tested for AIDS in cases of accidental needle sticks? Changes in the National Institutes of Mental Health's drug testing regimen have been made so that promising drugs could become available sooner. Reasons for this seem clear for sick patients, but less clear for asymptomatic patients. Uncontrolled drug trials can lead to premature, incorrect conclusions, based on inaccurate data. The ethics of testing pregnant women for HIV can be debated, as can criteria for offering them treatment. Activists demand that people with AIDS be involved in designing experiments, which may ultimately be beneficial for the research process. Another complex issue is the exchange of dirty needles for clean ones; needle-exchange programs have reported varying results. AIDS poses ethical decisions for the practitioner at virtually every phase of care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Reports, Clinical trials, HIV (Viruses), HIV, AIDS patients, Disease transmission, AIDS (Disease), Confidential communications, HIV testing, HIV tests, AIDS research, Physician-patient privilege

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Ethics

Article Abstract:

The Patient Self-determination Act, which went into effect in Dec 1991 gives patients the right to decide which treatment they will receive if they become incompetent. Health care institutions must inform patients of their legal rights to make these decisions, called advance directives. Advance directives can instructor give others the right to make decisions. Living wills, medical directives or values histories are examples of instructional directives. Proxy designations, such as the durable power of attorney for health, give another person the authority to make decisions for the patient. These directives protect the patient's moral and legal right to make decisions, and save families and care givers the anxiety of making life and death decisions. Living wills are best for persons who do not have someone trustworthy, while proxy designations are best if a patient does not want the family to become the automatic decision maker.

Medical care decision-making authority (Law), Medical care decision making authority (Law), Living wills, Durable power of attorney

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Ethics

Article Abstract:

The question in medical ethics has shifted from a patient's right to refuse treatment to a patient's, or a patient's surrogate's, right to demand treatment. These cases usually involve a surrogate's demand for additional treatment, though that treatment is considered futile by the physician. The concept of the futility of treatment is subject to value judgements by all participants in the decision-making process. In order to avoid imposing value judgements on physicians, patients or patient surrogates, codification of the criteria of futility has been proposed. Though codification could itself reinforce a right to demand treatment. The limits of both patient and physician autonomy and the debate about futile medical care are important daily considerations for most practitioners.

Standards, Physician and patient, Physician-patient relations, Right to refuse treatment, Treatment refusal

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