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Ethical Issues of HIV and AIDS in Health Care

Presented by Yu-Fen Lin

HIV & AIDS

HIV

Human Immunodeficiency Virus

AIDS

Acquired Immune Deficiency Syndrome

The legal definition of AIDS

When a persons T-cell count goes below 200, he/she is considered as having AIDS.

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

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
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Social stigmatization

HIV disease, in particular, carries with it the social stigmatization that complicates mental health and threatens life-sustaining activities. Telling friends Im HIV positive is not the same as telling them Im gaydouble coming out, the first closet and the second closet
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Ethics issues related to HIV & AIDS


Disclosure Disability rights Economical resources Employment rights Medication & Treatments Suicide Duty to warn
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Disclosure

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

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
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Economical resources

Financing treatment e.g., Medicare doesnt 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.

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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 wasnt able to do it anymore.

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Medication & Treatments

Dissatisfactory with the treatment providers e.g., A lot of times Im not in the mood to talk with the doctors in the clinic. They dont listen and they are very clinical.

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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

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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 timesthat 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)
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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.
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Counselors guide to make an ethical decision


Moral Principles Ethical decision making model

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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
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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
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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.

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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

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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.

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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.
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Risk reduction counseling is suggested


Safer sex practice No needle sharing Avoid pregnancy

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References
Bartlett, J.G. (1991). The Guide to Living with HIV Infection, Baltimore: The John Hopkins Press.
Forester-Miller, H. & Davis, T. (1996). A practitioners 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.
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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
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