Upload
bholmes
View
904
Download
2
Tags:
Embed Size (px)
Citation preview
AIDS and Health Care Practice
1981 – CDC reports unusual outbreak Infection control methods:
Decreasing susceptibility of hosts Eliminating the source of the organisms Interrupting the mode of transmission
High-risk behaviors Occupational risk
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Ethical issues in an epidemic: Is there a duty to treat? Confidentiality and the duty to warn Who should be tested? What to do with the infected health care
provider?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Ethical issues in an epidemic (continued): Human subject research/experimental
treatments How far does duty extend in a global
epidemic?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Provide service consistent with skills Obtain skills as needed by patient
population as consistent with scope of practice
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Provide accurate and up-to-date information
Promote the patient’s best interest regardless of personal feelings
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
The ethic of the Good Samaritan does not require that the rescuer take unacceptable risks in the process
A nonswimmer is not required to jump into pool to save another
The practice of universal precautions removes the unacceptable risk
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Useful guidelines for determining moral duty or moral option to treat: Patient at significant risk of harm if
practitioner does not assist? Practitioner intervention directly related to
preventing harm?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Useful guidelines for determining moral duty or moral option to treat (continued): Practitioners intervention will probably
prevent the harm? Does the potential patient benefit
outweigh harm the practitioner might incur?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
A physical therapist off duty, you stop to help at a traffic accident on the way home
A victim is lying on the ground, not breathing, and bleeding from the mouth
You are CPR-certified, but with no form of protective barrier mask with you
Moral duty or moral option?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Duty-oriented view: Individual’s right of self-determination
requires control over personal privacy Utilitarian view:
Breaking of confidentiality would have a chilling effect on therapeutic relationship and health care in general
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Virtue-oriented belief: A special patient-provider relationship
exists
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
A balance between: Duty to our patients Legal obligations Appropriate disease control within the
community Our duty to protect vulnerable individuals
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Review the case study “A Duty to Warn?” Is there a duty to warn?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Mandatory testing for everyone: Early diagnosis could lead to early
treatment Early counseling could lead to early
cessation of high-risk behaviors Better statistics to guide public health
activities
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Concerns: Cost/benefit ratio Potential for increased discrimination (false
positives) False sense of security Perhaps drive disease underground to
avoid testing
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Dr. David Acer case – Florida dentist Behringer v. Medical Center at
Princeton Privacy and confidentiality are also rights
for a infected practitioners What to do in the case of an infected
practitioner? How do we protect both the patients and practitioners?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Should experimental drugs be available to dying patients?
Practice would not meet legal standard of “customary care”
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Difficult to assess autonomous consent in situation where patient is coerced by lack of options
Difficult to assess research results from desperate individuals who self- medicate
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
AIDS epidemic threatens vulnerable populations in Asia, Africa, Eastern Europe Disease threatens to overcome social
structure in developing nations Medication costs out of reach for most Developed world slow to respond
Moral duty or moral option?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Review the case Does principle of distributive justice
have meaning in an international context?
In a situation such as this, should American drug companies be forced to provide the needed drugs at little or no cost?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Assuming that we decided not to provide the drugs, is it reasonable or racist to conduct the study outlined in the case?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Review Exercise F in the review exercises
Do countries such as the United States have a duty to assist another nation in the face of an overwhelming epidemic?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
If you decide that countries such as the United States have a duty to assist: To what extent can our assistance be
predicated on changes in social convention and lifestyles of another people?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
Ethical issues faced by health care providers in an epidemic such as AIDS
Standard precautions and the issue of the health care provider’s duty
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
What duty is owed to infected health care providers? What duty do they owe patients?
In a global epidemic, what ethical principles are involved?
Copyright ©2009 Delmar, Cengage Learning. All rights reserved.