The Acquired Immunodeficiency Syndrome (AIDS) epidemic has had an enormous impact on health care provision in the United States. This impact has occurred largely because the AIDS epidemic has forced the medical community to openly address the needs of populations who have historically been marginalized in our society: gay men and intravenous drug users. The influence of the epidemic was felt on many levels. On the federal level AIDS activists forced the more rapid approval of medicines by the Federal Food and Drug Agency (FDA). State and city departments of public health had to organize culturally sensitive, anonymous HIV counseling and testing centers and on the individual practice level, physicians were forced to confront their own biases to provide ongoing care for a new and possibly transmissible epidemic.
AIDS cases seen by the author in his own practice are used to try to demonstrate some, but certainly not all, of the many ethical issues that confront the practitioner in the day to day care of people with AIDS.
Case 1 addresses these questions:
- What is the legal decision-making status of a long-term partner?
- How should I facilitate communication between family members?
- Who are some other staff members who may be able to help?
- How should I deal with any prejudices I may have in this case?
Case 2 addresses:
- What should you do if a patient refuses to be tested?
Case 3 addresses:
- When should you report a patient's HIV status to the Public Health Department?
Case 4 addresses:
- Should you prescribe protease inhibitors to a patient who is unlikely to follow through on the treatment regimen?