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AORN JOURNAL AUGUST 19x7, VOI.. 46, NO 2 Editorial Ignorance about AIDS testing hurts patients, nurses, physicians t wasn’t so long ago that the majority of I Americans naively mused about the terrible ravages of the acquired immune deficiency syndrome (AIDS) with a certain safe, detached air. We leisurely discussed the pros and cons of various AIDS-related proposals and legislation as curiosities, not serious issues. We gave the ethical issues surrounding it about as much serious deliberation as we do in deciding whether to plant marigolds or zinnias in our gardens. And the conclusions we reached had about as much impact on society as the composition of our flower gardens. We, as a society, adopted this cavalier attitude because we really didn’t believe that AIDS was our problem; it belonged to that “other group.” Fortunately, that mind-set is gone; we now know only too well that AIDS is a serious problem for all of us. Unfortunately, it took a worldwide epidemic to get our attention. There is no escaping it now. As long as AIDS remains a fatal disease, we must analyze the social issues it presents and make some ethical decisions that will best serve us all. The issue of testing for the human immunode- ficiency virus (HIV) is among those stirring considerable ethical controversy. Questions such as whether testing should be mandatory, whether only members of high-risk groups should be tested, and whether that testing must be confidential or anonymous are plaguing and dividing us. Those dilemmas are the red herrings, distracting us from the real issue-AIDS discrimination. Whether or not mandated AIDS testing is for the good of society at large is a decision that should be left to the epidemiologists. Lay people, especially legislators,have no business making that decision. We have accepted the requirement for certain childhood immunizations for the good of society, and I believe we would accept AIDS testing if there was good scientificrationale offered. We have not yet heard enough rationale for mandated testing, but when tests for HIV are done on patients, I believe that health care workers have the right to know the results. I support confidential testing for the AIDS virus to prevent those who are seropositive from experiencing discrimination from insuranc:e companies, school officials, employers, landlords, and some legislators.There is no doubt that AIDS discrimination is morally and ethically wrong and, as such, should be made illegal. Insurance companies that continue to practice AIDS discrimination should be punished. More attention should be given to preventing such discrimination than in preventing health care workers from learning the test results. And that is the consequence of anonymous testing. I cannot support anonymous testing. With confidential testing, the test result would be recorded on the patient’s medical record; it would be kept confidential just as any other entry on that chart. And as confidential information, it would be available to those health care profes- sionals who normally have a m s to that record. I fail to see anything wrong with that approach. Anonymous testing, on the other hand, would require that the patient be given a number, and the test result would be recorded under that number instead of by name. It would not be 178

Ignorance about AIDS testing hurts patients, nurses, physicians

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AORN J O U R N A L AUGUST 19x7, VOI. . 46, NO 2

Editorial

Ignorance about AIDS testing hurts patients, nurses, physicians

t wasn’t so long ago that the majority of I Americans naively mused about the terrible ravages of the acquired immune deficiency syndrome (AIDS) with a certain safe, detached air. We leisurely discussed the pros and cons of various AIDS-related proposals and legislation as curiosities, not serious issues. We gave the ethical issues surrounding it about as much serious deliberation as we do in deciding whether to plant marigolds or zinnias in our gardens. And the conclusions we reached had about as much impact on society as the composition of our flower gardens.

We, as a society, adopted this cavalier attitude because we really didn’t believe that AIDS was our problem; it belonged to that “other group.” Fortunately, that mind-set is gone; we now know only too well that AIDS is a serious problem for all of us. Unfortunately, it took a worldwide epidemic to get our attention. There is no escaping it now. As long as AIDS remains a fatal disease, we must analyze the social issues it presents and make some ethical decisions that will best serve us all.

The issue of testing for the human immunode- ficiency virus (HIV) is among those stirring considerable ethical controversy. Questions such as whether testing should be mandatory, whether only members of high-risk groups should be tested, and whether that testing must be confidential or anonymous are plaguing and dividing us. Those dilemmas are the red herrings, distracting us from the real issue-AIDS discrimination.

Whether or not mandated AIDS testing is for the good of society at large is a decision that should

be left to the epidemiologists. Lay people, especially legislators, have no business making that decision. We have accepted the requirement for certain childhood immunizations for the good of society, and I believe we would accept AIDS testing if there was good scientific rationale offered. We have not yet heard enough rationale for mandated testing, but when tests for HIV are done on patients, I believe that health care workers have the right to know the results.

I support confidential testing for the AIDS virus to prevent those who are seropositive from experiencing discrimination from insuranc:e companies, school officials, employers, landlords, and some legislators. There is no doubt that AIDS discrimination is morally and ethically wrong and, as such, should be made illegal. Insurance companies that continue to practice AIDS discrimination should be punished. More attention should be given to preventing such discrimination than in preventing health care workers from learning the test results. And that is the consequence of anonymous testing.

I cannot support anonymous testing. With confidential testing, the test result would be recorded on the patient’s medical record; it would be kept confidential just as any other entry on that chart. And as confidential information, it would be available to those health care profes- sionals who normally have a m s to that record. I fail to see anything wrong with that approach.

Anonymous testing, on the other hand, would require that the patient be given a number, and the test result would be recorded under that number instead of by name. It would not be

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A O R N J O U R N A L AUGUST 1987. VOL. 46. NO 2

recorded on the chart, and health care professionals would not have access to that information. I do see something wrong with not allowing profes- sionals dedicated to delivering health care to know that they might be in a situation that will expose them to a deadly disease.

Most physicians and nurses are familiar with the recommendations for preventing transmission of AIDS published by the Centers for Disease Control (CDC), Atlanta. (See “Recommendations for preventing transmission of A I D S reprinted in this issue.) Proponents of anonymous testing say that health care workers do not need to know whether a patient is seropositive for HIV because the precautions needed for that patient are no different from those that apply for preventing the transmission of the hepatitis B virus. That may be true; however, the fact that a patient has hepatitis B is never deliberately kept from the medical or nursing staff. It seems almost unethical

to withhold that information when it comes to the HIV.

Despite the recommendation that all patients be afforded the same standard of care, the reality is that if a nurse knows a patient has tested positive for HIV, he or she will be extra careful. And what is wrong with that? I am not advocating that nurses use any special techniques; CDC has already declared most of them unnecessary. I am, however, advocating that health care workers be given the opportunity to raise their consciousness about this disease and behave appropriately, without hysteria, to prevent its transmission in the hospital. With the number of AIDS patients being hospitalized increasing every year, physicians and nurses should have the information they need to care for the patients, protect themselves, and fight AIDS discrimination.

PAT NIESSNER PALMER, RN, MS EDITOR

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