KMILLER%BROWNVM.BITNET@oac.ucla.edu (Ken Miller) (10/03/89)
Steven L. Karon reacted to the story of a Dr. Day's leaving a certain aspect of medical practice (in part) because of being unable to gain information about the HIV status of patients. Steve argued that such information should be kept hidden from medical care workers and bid Dr. Day farewell from the profession by writing: > It is my opinion that Dr. Day is not >fufilling her duties as a doctor if she is not willing to help someone that >may put her in some risk, and therefore bid her a fare goodbye from her >profession. In the same message Steven wrote: > It seems that by giving health workers knowledge about hiv infected patients >would result in Health workers, doctors and nurses not giving the same amount >of care that they would if these people were not infected. In the case of >doctors this leads to a breaking of their hippocratic oaths, ... I don't think that I could disagree more. What confuses me is the attitude that AIDS is a "special" disease, which must be treated differently than any other disease. This attitude leads to the mystique that AIDS is something that must be kept secret and whispered about. AIDS then becomes a matter of shame and embarassment. I know that the issue is complex, but I will make two points that I hope will stimulate discussion. First - I believe that heath care workers have the right to know the medical status of ANY patient, especially when that status might put them at risk. Knowing that someone is HIV positive doesn't lead medical works to deny care - it simply gives them the knowledge that they need to care for patients while protecting themselves and others. It is an unfortunate fact that quite a few medical workers have been infected by HIV as a result of their work. We should recognize that medical workers as a group have accepted the danger of caring for the sick as part of their calling. We have a right to ask them to care for HIV patients. It does not follow that we have a right to keep them from knowing if a patient has HIV. Second - The continued emphasis on secrecy with HIV results inhibits efforts to stop the AIDS epidemic, and will ultimately cost lives. The standard technique in halting the spread of STD's and similar diseases is by testing and contact tracing. In all but a few states this cannot be done because the law forbids it. Ironically, less serious diseases (like gonorrhea) are routinely traced this way, helping to control infections. It is often claimed that HIV-status must be kept secret because of the "stigma" associated with the disease. But doesn't the emphasis on secrecy actually produce the stigma? In short, wouldn't the interests of AIDS patients, HIV-carriers, medical care workers, and those yet-to-be-infected with the virus best be served by a system in which HIV status was available to health care workers - with strong laws against workplace and insurance discrimination in place? It might even keep Dr. Day in practice helping to prolong the lives of HIV+ individuals.
Hoffman.es@XEROX.COM (10/05/89)
I would like to reply to Ken Miller's two points in article 1289. Miller says: (1) Health care workers have the right to know the medical status of ANY patient. My comment: I agree, BUT.... But people who ought to know better, including health care workers, continue to misinterpret an HIV antibody test as an AIDS test, and continue to forget about the time delay between infection and a positive antibody test. That is, people think HIV-positive = AIDS and HIV-negative = "NO AIDS". In the health professions, that second misinterpretation, the one equating HIV-negative with "SAFE" is especially stupid and hazardous. Once again, the lesson is that EVERY patient should be treated as though s/he might have AIDS. And, that being the case, what's the point of testing / revealing HIV antibody status? Sure, health care workers have the right to know the medical status of any patient, but a patient's HIV antibody status, esp. if negative, is pretty worthless! - - - - - - Miller says: (2) The continued emphasis on secrecy with HIV inhibits efforts to stop the AIDS epidemic. (He lauds the "standard technique in halting the spread of STD's" through testing and contact tracing.) My comment: Until discrimination against AIDS patients in employment, housing, insurance, etc. is approximately the same as that against any other STD, I cannot agree. It's not just the "stigma" that is the problem here; it's the very real, sometimes catastrophic, discrimination. -- Rodney Hoffman
geb@cadre.dsl.pitt.edu (Gordon E. Banks) (10/06/89)
No patient has a right to demand that a physician treat him. However, there is a duty on the part of physicians to treat patients who need it. This may sound contradictory, but I don't think it is. The duty is something voluntarily taken upon oneself by entering the profession and can not nor should not be enforced coercively. If the time comes that Dr. Day and others feel that they can not accept the duty, they are free to depart. However, physicians also have a right to place some conditions on accepting the patient for treatment. If the patient refuses to follow the advise of the physician or accept recommended diagnostic and therapeutic procedures, the physician may discharge the patient. The physician-patient relationship must be one of mutual agreement. Neither party should be in a dictatorial role. Thus, the physician should be able to say to the patient, "all of the patients that I perform surgery on are tested for HIV". If this is not acceptable to the patient, he can look elsewhere for a surgeon or be treated by some other modality. Alternatively, special precautions can be taken to prevent infection of operating room personnel, even should this make surgery less convenient, or even less safe for the patient.