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Spring 2002
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Communicable Diseases Bob Foster Bob Foster is a board-certified Health care provider (physician’s assistant, radiology technician, nurse, pharmacist, dentist, physician, occupational therapist, physical therapist, nutritionist, etc.) in a tertiary care hospital’s trauma center with 5 years of post-training experience. He is also HIV positive. Bob Foster believes that he was infected about 1 year ago by a needle stick. He admits to anger about this on-the-job exposure. He has known his HIV status for 8 months and has told his wife (and has pledged her to absolute secrecy) but not his two preteen children. His physician has put him on AZT prophylactically. Bob Foster remains completely physically asymptomatic, but he is very worried, particularly because recent policy shifts from the Centers for Disease Control, the American Medical Association, American Dental Association, American Nurses Association, American Pharmacist Association, and all Allied Health Code of Ethics. Furthermore, his own hospital (others may be legislated soon) has said that he must make his AIDS-infected status public. Bob Foster believes that the mandate to reveal is unwarranted because the risk of his infecting a patient is insignificant. He also feels that to come forward, either by restricting his delivery of care or by notifying potential patients would end his career. The guidelines state that infected health care workers should cease performing invasive procedures or inform their patients. Bob Foster feels that the scientific literature does not yield what he considers a political conclusion. There are virtually no documented cases of health care workers infecting their patients, who have practical careful universal precautions. The few sensationalized illustrations have created a panic Bob Foster believes. He does not want to sacrifice his professional life to a climate of panic and antagonism. Bob Foster has heard of other health care workers who have conformed to the recommendations. Their patients have been panicked or outraged; the health care workers have been barred from hospital practice or employment or have been shifted to meaningless busy work. Bob also fears a lawsuit if a patient who is now HIV positive or has AIDS ascribes the infection to his prior treatment. Adding to Bob Foster’s grievance is his supposition that an ER patient infected him. He realizes that there are many thousands of health care workers who are HIV positive, from a variety of possible causes. But he also knows that the greater danger comes not from health care workers but to them. He has heard rumblings about policies and procedures being developed to protect persons in his situation, but he has seen no action taken. Bob Foster is proceeding cautiously. He is certainly attentive to precautions in the ER, but he is still performing invasive procedures; that is part of his job. He has never refused to provide care to patients in high-risk categories (in his ER many drug abusers who share needles are seen); nor does he feel that his own reluctance to make his condition known is irrational. “I am not going to be a scapegoat,” he tells his spouse. “I know that I am not going to live a normal lifespan. But I am going to keep going as long as possible.” QUESTIONS Provide ethical justifications(s) for your responses to questions 1-5. Should Bob Foster reveal his HIV status to his patients? Do they have a right to know? Should he reveal his HIV status to his patients/ do they have a right to know? Does he have a right to privacy? Since patients don’t have to reveal their HIV status and can’t be tested without their permission shouldn’t health care workers have the same right? If not, why not? Should health care workers who are involved in invasive procedures be required to undergo regular HIV testing? Propose a system in which the conflicting values of health care workers and their patients will result in a minimum of harm to either party!
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Course
Overview