12.4 ETHICAL ISSUES IN WORKING WITH YOUTH LIVING WITH HIV

Abstract

Ethical issues may arise in the treatment of transitional-age youth (TAY) living with HIV. Many TAY who come for care are from racial/ethnic minorities, and/or from the LGBTQ community. They have frequently experienced adversity and discrimination in addition to the stigma of being diagnosed with HIV. As a result, TAY may have mental health issues and socially complex needs that affect their care. There are multiple ethical issues that arise in the care of TAY. There may be conflict between established methods of delivering care and TAY’s ability or motivation to engage with mental healthcare providers. The decision-making capacity of TAY may be in question due to cognitive impairment or their preferences not being respected due to age or laws that vary from state to state. Issues regarding confidentiality arise when TAY do not want their HIV-positive status disclosed to sexual partners or to family members. Specific case examples will be utilized to explore ethical issues using Jonsen’s four-box model of ethical decision making. Jonsen’s four-box model looks at medical indications, patient preferences, quality of life, and contextual factors in ethically difficult and complex situations. This model will help providers be clearer about the ethical issues in the TAY case examples. As a result of this process, mental health providers will be able to better understand how to approach ethical dilemmas that arise in the care of TAY with HIV and find ways to come to ethically sensitive and appropriate decisions regarding the conflicts that arise. Child and adolescent mental healthcare providers will be confronted with multiple ethical issues in their work with this vulnerable group of TAY with HIV. Utilizing Jonsen’s model will help the clinician work through the complex ethical issues that arise in their treatment.