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Ethics, which are the moral guidelines towards acceptable behavior in a particular setting, are very important in ensuring that people live in harmony. The medical profession has not been left out in as far as ethics are concerned. Ethics in the medical profession ensure that the medical practitioners offer competent and appropriate services to the patients. The case of HIV/AIDS is considered a very delicate matter hence much caution should be reinforced in regard to the issue of medical ethics. HIV/AIDS is a degenerative disease whose condition deteriorates with each passing day. At some point in time, the physician or medic handling the patient may be tempted to carry out euthanasia so as to slowly end the suffering of the patient. But then, with medical ethics in place, this is unacceptable, and instead, the physician is supposed to provide sufficient medical care to the patient up to the last breath. While treating the patient, the physician should also keep note of the society’s health. This is carried out to ensure that the condition of the patient does not cause any harm in relation to the society members’ health. By so doing, justice in ensuring that everyone’s health status has been taken into consideration as far as a certain disease is concerned will have prevailed.
We are all aware of how HIV/AIDS is perceived in our societies and what it means if the society finds out that one is infected. However, this perception has changed with time since people have become more enlightened due to dissemination of knowledge by the various medical professionals about the disease. Nevertheless, HIV/AIDS continues to be regarded as a bad omen. It is therefore obvious that the implication would be devastating when a doctor goes public and reveals one’s diagnosis of HIV/AIDS, if tested positive. HIV/AIDS is associated with immoral behavior thus when one is diagnosed as positive and the society comes to know about it, the person is regarded as an outcast by the so “virtuous” society. We should be grateful of the invention of medical ethics as they promote the delivery of acceptable health services without violating or harming the condition of a patient.
Medical ethics are a set of moral rational guidelines which have been agreed on by a body of medical professionals and should be applied to both the theoretical and practical fields (Charles et al. 2009). It gives those persons in the medical field a guideline of what is right and what is wrong. In recent days, the field of medicine and health uses a conceptual framework known as the principles of Bio-ethics: (1, 2) to analyze medico-moral questions (Benn & Boyd 1996). These principles entail; autonomy, beneficence, non-malfeasance and justice. Each principle is important and should be observed while in the medical profession unless it conflicts with any of the other principles. In the case of HIV/AIDS however, you find that there are complicated facts that are intrinsically ambiguous and this is where you find a medic incorporating his or her personal values and beliefs to make a rational decision.
HIV/AIDS is a multifaceted issue and therefore it may leave a doctor or any other physician in a state of ethical dilemma. When such a case happens, personal judgment of the physician, nurse or any other medical professional dealing with the patient should be considered. We can not always remain tied to prescribed rules and regulations, especially when a human life is at stake. Ethical dilemma occurs when there are incidences of mutually exclusive decisions that may violate some of these ethical principles while at the same time, gain the support of some other principles (Onotai, Nwaorgu & Okoye 2004). At such a point: ethical dilemma, the issue is not to violate a certain principle but to choose an action that violates any of the principles at a lesser extent. It is therefore very clear that ethical principles are not the ultimate solution to a medical problem. They only enable those in the medical profession to speak one language so as to “address, analyze and discuss medico-moral questions of cross-cultural concern” (Benn & Boyd 1996).
The first ethical principle, autonomy is highly valuable in this condition of HIV/AIDS. It gives empowerment to a patient as the patient can help make important decisions especially when an ethical dilemma is involved (Shaw 2009). A medic should respect this aspect of autonomy by enlightening the patients about their medical condition so that when need be, the patient will help to make desirable decisions. This issue of autonomy is debatable because some patients do not want to know about their condition and are therefore not involved in making decisions pertaining to their health being. An instance is when a person is diagnosed as HIV positive but will not accept this fact. Instead, the person ignores what he or she has been told and says it is a lie and does not want to hear something like that again. The work of a medic in respecting autonomy is clearly portrayed when he or she accepts either decision by the patient; to both know and accept their condition or not to know, when one refuses to accept the truth regarding their health condition (Spencer 2006).
When persons are fully aware of their conditions, they are able to adjust with the environment and consequently accept their fate as it unfolds. One incidence is given by Pinching, in his work about the impact of AIDS on medical ethics when one patient had positively accepted his fate when he bid the doctors farewell after he realized that his time to leave the world had reached. This is a great show of autonomy hence making the right decision as he had seen to it that he achieves his dreams before dying (Pinching 2000). The person was well aware of his HIV/AIDS condition and had made the necessary and right decisions about his life so that he would spend his last days in joy and peace.
There are other patients who go into formidable denial when they get to learn about their health status in relation to HIV and AIDS. They choose not to accept and do not want to get further information about their status. They completely refuse to accept their condition and as a coping mechanism, they make big plans for the future. This is referred to as positive avoidance as Pinching calls it (Pinching 2000). Despite the fact that the health professional(s) dealing with such a patient are faced with a rough time, they have to accept the patients’ decision not to get further information concerning their health. In such a case, the physician is forced to make decisions on behalf of the patient until that time when he or she will choose to accept reality. A similar incidence is where the family members ask the medic to withhold information about the patient if the patient is considered to be emotionally unstable. This is done so as to protect the patient from emotional turmoil and stigma but on the other hand, it becomes a huge burden on the medics however their hands are tied until they convince the family members otherwise through meetings and conferences (Fiack, Wager, Graf, Rowlands & Robinson 2009).
Autonomy, which has led to empowerment is viewed as a gate pass towards the maintenance of long term health. This is because patients have accepted their statuses regarding HIV/AIDS and know how to take care of themselves. They also help in making appropriate decisions linked to deploying available agents when it comes to virus replication, drug resistance and recoverability of immune damage (Pinching 2000). The patient will also help in making a decision on whether to administer maximal suppression at the early or later stages.
The medical ethics promote competent medical care that has compassion for and respects human dignity and rights (http://www.isuesinmedicalethics.org/152do84.html). By so saying, the physician is dedicated to the providence of efficient and effective services that will not harm the patient. This is very much applicable in the case of HIV/AIDS because the physicians may choose to neglect their duties on the basis that a patient is virtually dying but this should not be the case. As long as the patient is under the physician’s care, he or she is entitled to full and maximum support from the care giver who is a doctor. Even if the patient is on the verge of death, physicians are not supposed to withdraw any help from the patients.
This medical care should be aimed at seeing to it that the patient benefits maximally from the care provided. Scholars like Edmund Pellegrino argue out that beneficence is the sole principle in medical ethics (cited in http://depts.washington.edu/bioethx/tools/prin2cs.html ). By so saying, actions such as contraception and cosmetic surgery should be wiped out. It is sad to learn that practitioners in India do not value this principle and are usually the first to discriminate and reject patients suffering from HIV/AIDS. From a study by APAC, out of one hundred doctors interviewed in India, twenty of them did not entertain patients with HIV/AIDS and related sexually transmitted diseases (cited in http://www.isuesinmedicalethics.org/152do84.html). Consequently, efforts such as training have been implemented and executed by the APAC to the health care providers to see to it that the doctors and related staff treat the patients in accordance to the outlined code of medical ethics so that the health status of the patients is not jeopardized (http://www.isuesinmedicalethics.org/152do84.html).
Thus, this is a clear manifestation of how unfair discrimination against those suffering from HIV/AIDS should be done away with in the field of medicine. As outlined in the Indian journal of medical ethics, it is important for national medical associations to work in liaison with the patients groups, concerned national and international organizations as well as the governments with the purpose of enhancing national health policies in eliminating discrimination against both persons infected and affected by HIV/AIDS (http://www.isuesinmedicalethics.org/152do84.html).
Closely related to autonomy is the principle of informed consent. This occurs when a patient is fully aware of his health condition so that he or she can make informed decisions about the mode of treatment the physician should apply. This is because the patient is well aware of the associated benefits and risks with the various proposed modes of treatment and will then make a decision that suites him or her best. This principle faces a challenge when the patient goes into an impenetrable facade of denial of his or her status as HIV positive thus will not be involved in making decisions related to his or her medical wellbeing (Boyle 2004). Despite the fact that a patient goes into a denial state, the physicians should do all that is in their power to make the patient come to terms with reality. The physicians should see to it that the most effective action is taken so that the patient can accept what is happening with his or her life and subsequently make informed choices about it. Counseling sessions would be the ideal action to execute and would greatly influence the perception of such a patient so that he or she could come to accept and adapt the current health situation revolving around him or her (http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102238727.html).
Another thing that should be looked at is confidentiality. As earlier said, if a physician discloses the status of a patient as having HIV, then a lot of damage is inflicted upon the patient; emotionally, psychologically and even physically as the person may attempt suicide or get physical beating from his or her society. The latter happens in societies that regard persons who have HIV/AIDS as outcasts. Confidentiality in relation to HIV/AIDS is a key factor as mandated by HIPAA laws (http://education.illinois.edu/ber/webpages/HumanSubjects.html). In addition, there are legal policies which will see to it that physicians do not reveal their patients health condition even while under oath. Unfortunately, there are some situations which pose as a threat to this principle of confidentiality. One such case is where physicians are required to report gunshot wounds as well as impaired drivers. With HIV/AIDS, it also becomes a challenge for the physician to conceal information from the patient’s spouse if there is one. This is because by adhering to one principle, the physician will be violating another which is more harmful. According to the Hippocratic Oath that has been updated by the Declaration of Geneva and the International Code of Medical Ethics in India affirms that the medical practitioners should respect the secrets of the patients confided in them (http://www.isuesinmedicalethics.org/152do84.html).
The Principle of non-malfeasance is very distressing to the doctors and to the patients as well. According to the works of the University of Washington, school of medicine, the principle of non-malfeasance declares that, while treating a patient and harm upon this patient cannot be avoided but then there are two options available, a physician is advised to choose that method which produces less harm upon the patient (http://depts.washington.edu/bioethx/tools/prin2cs.html). This is because, the situation may entail treatment despite the fact that this treatment is not meant to cure the patient and another aspect like giving pain relievers which are only meant to relieve pain. This principle is very much applicable in the very late stages of HIV/AIDS. At these stages, there is usually grim hope on improvement of the patient’s condition but all in all, it is the responsibility of the physician to ensure that the patients can access competent and appropriate medical care. This kind of care should be provided up to the last breath of the patient (Boyle 2004).
If a physician feels that he or she cannot offer appropriate medical care to the HIV/AIDS patient, then it would be preferable for them to refer the patient to a medical center that will ensure the patient is attended to according to the outlined code of ethics (http://education.illinois.edu/ber/webpages/HumanSubjects.html). For those patients who are still in the early stages of the disease, the physicians should counsel them on responsible behavior to reduce spread of the disease, strategies to be used by the patients to protect themselves and on how to watch out for certain contacts such as sexual and needle-sharing contacts as well as medical contact that involves syringes. It is not wise for one to share out such items.
Sometimes this principle of non-malfeasance is not considered by some people depending on their cultures. For instance, during the last stages of HIV/AIDS, the patient has got complicated medical conditions such as kidney failure and he or she is forced to live on dialysis. According to this principle, as long as the patient has accepted the medication prescribed for him or her, the physician is in no position to deny the patient access to this medication. On the contrary, another person may choose to abandon this dialysis treatment based on the personal belief that it would be better to die than to live in pain with the support of some artificial equipment which may not be sustainable due to its high price. In such a situation that calls for dialysis, the physician should promote and encourage that method which will prolong the patient’s life unless otherwise (Charles et al. 2009).
A statement by the World Medical Association on HIV/AIDS and the medical profession as indicated in the Indian journal of medical ethics states that a test for HIV is mandatory in the case of blood donation, blood fractions, transplantation and collection of semen or ova for the purposes of reproduction. However, no one should be forced to take a HIV test against their will as this will be in violation of human rights. Once more thing that needs to be kept in mind is the act of justice upon the wider community. In the case of HIV/AIDS, the community should be enlightened on issues pertaining to HIV/AIDS in terms of mode of spread and transmission. This is mostly applicable in a marriage situation where the health of one spouse is at risk. In such a situation, the physician is faced with the obligation of notifying the person(s) at risk of being exposed to HIV/AIDS; in this case, the spouse. Subsequently, necessary steps are taken to assist this person(s) so that they can access testing and treatment (http://www.isuesinmedicalethics.org/152do84.html).
It is very clear that the issue of ethics in the medical profession is inevitable. This is because they enable patients to come to terms with reality gradually without oppressing them. This is mostly evident when the code of medical ethics protects patients from the cruel “virtuous” society. A physician should adhere to all aspects of this code of medical ethics in relation to HIV/AIDS with a purpose of ensuring no harm befalls the patient.