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Ethical Issues in the Care of PLHIV

HAIVN Harvard Medical School AIDS

Initiatives in Vietnam

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By the end of this session, participants should be able to:List 4 common ethical challenges/duties in the clinical care of PLHIVExplain benefits of universal precautions that can protect patients from stigma and discriminationExplain patients’ rights regarding HIV testing

Learning Objectives

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Duty to care versus fear of personal risks

Duty to protect patients versus duty warn others

Duty to maintain patient confidentiality

Duty to protect patient autonomy

4 Duties in Caring PLHIV

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All patients should receive the best possible care

All indicated procedures must be performed• Invasive diagnostic procedures• Therapeutic procedures• Hands-on care

Duty to Care

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Medications Devices Tools

Patient wards Human

resources…

Duty to Care: Dilemma

Questions:•Who should get medication first?•Who decide this?

Resources are scarce :

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Educate health care workers about their rights to:• protect themselves and patients.• adequate equipment and supplies to

protect themselves Universal precautions should be

standard of practice for ALL patients and settings

Reducing Fear of Personal Risk

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Protects health care workers from acquiring infections in the course of their work

Protects patients from acquiring infections from health care workers

Duty to Protect (1)

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If there are HIV-infected Health Care Workers in health settings, the manage should consider:• The type of patient contact they have –

does it represent a true risk for transmission to patients or others

• Are patients exposed to the Health Care Worker’s blood or body secretions?

In most cases, there is no risk and the Health Care Worker is not ethically required to reveal his or her infection

Duty to Protect (2)

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Definitions:• Treat ALL blood and body fluids as if

they are potentially infectious Benefits:

• Do not identify any particular patient as HIV-infected -> Reduces stigma

• Protects everyone

Duty to Protect: Universal Precautions

Universal Precautions are only effectiveif implemented with all patients in all settings

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Maintaining the privacy of patient information is an ethical duty

Discussion about patients should be:• limited to those with a direct need to

know • and conducted in private areas

No signs on patient rooms or labels on outside of medical records

Confidentiality (1)

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Dilemma: Health care workers need to: • maintaining the privacy of the infected patient • inform people at risk

If the patient is putting another individual at risk for HIV infection:• Encourage the patient to:

inform the person at risk change his/her behavior

• Offer to help the patient inform the person at risk

• If possible, inform the person at risk without revealing the identity of the infected individual

Confidentiality (2)

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Patients have the right:• to decline HIV testing

Except for cases specified as per MOH guidelines

• to the information they need to make treatment choices

Results of HIV tests should be presented privately

It is unethical to give a patient a positive HIV test result without also providing emotional support and information

Right to Autonomy(1)

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End of life decisions: Whether or not to provide advanced

care • who decides? Physician? Family? Patient?

When to stop medications? Which medications to continue?

Is pain relief adequate? Is hands-on care adequate?

Choice of place of death?

Right to Autonomy (2)

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To provide the best possible care for all patients

To protect patient privacy To maintain patient autonomy To provide emotional support and

information to all patients To continue care until the end of life

Ethical Obligations

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All patients should receive the best possible care

Universal Precautions are used with ALL patients

Patients should never receive a positive HIV test result without also receiving information and psychological support

Health care workers must never abandon patients

Key Points

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Thank you!

Questions?