Health Professions, Codes, and the Right to Refuse to Treat HIV-Infectious Patients

Abstract

Health Professions, Codes, and the Right to Refuse to Treat HIV-Infectious Patients The phenomenon of AIDS has not raised new ethical issues. It has, however, given a new slant and poignancy to many familiar issues, such as confidentiality, triage, and the right to refuse treatment. It has, as well, revived some issues that had lain dormant throughout recent medical experience: in particular, whether health professionals are obligated to subject themselves to the risks of treating those with communicable disease. (*1) It is worth emphasizing that this question may well be a temporary artifact of changing perception. Some degree of risk to health professionals in the conduct of their work (for example, exposure to hepatitis) has always been present as a background datum. The background danger of old familiar risks may remain greater than the new risk introduced by HIV. But perception, rather than reality, controls the generation and resolution of ethical issues, and the perception is that now, because of the new HIV factor, health care is potentially a risky occupation. In canvassing the reaction of professional associations to this newly recurring question, the executive director of an association of laboratory technicians gave me this informal but not unusual response: Dealing with this is part of the job. You take the job, you take the good with the bad. If, in five years, the AIDS problem is not under control, this response will be entirely apt, as applied, for example, to new blood technicians. Then, occupational exposure to HIV infection will have been subsumed within the background of risks and normal expectations of those entering and remaining within the profession. At the current point of transition, however, this answer is not fully responsive to the concerns of currently licensed professionals. HIV exposure was not part of the expected deal they had cut in entering a health care profession. We have then a renewed--and probably brief--opportunity to discuss the substantive question of ethics and the occupational risk of health care workers. We have also the opportunity to reopen a procedural question: the relationship between morality and professional associations of health care workers, as expressed in codes of ethics and other statements of professional moral obligation. The examination of these professional materials has recently become the exception rather than the rule. As Robert Veatch put it, in typically vigorous fashion: The most important event in medical ethics in the past fifteen years has probably been the challenging of the assumption that the codes of organized medical professionals are the definitive summary of ethical norms governing medicine. When the Hastings Center Report began publishing it was widely assumed that, if one wanted to know whether a medical practice was ethical, one would consult the Hippocratic Oath or the principles of the American Medical Association. Now that assumption is rejected by the courts, by critical commentators, and even by many medical professionals. [1] A proper rejection of the definitive status of professional materials does not imply, however, that they are of no interest or use. On a descriptive level, they may represent an expression of the profession's own conception of the ethical obligations of its members, which may be useful in creating realistic public expectations of professional conduct. Within the profession, the broad ethical principles contained in codes are occasionally of persuasive value in evaluating and amending conduct. Codes and ethical statements may, depending upon their provenance and context, be of prescriptive value as well. An ethical statement may be taken as a solemn means of self-binding on the part of professionals, a public form of promise or commitment to abide by certain norms. Changes in the bioethical climate of the last fifteen years have affected professional associations as well, and this has been reflected in their increasing attention to codes and statements concerning ethics. …