HIV / AIDS Course > Chapter 5 - Legal and Ethical Issues

Chapter 5: Legal and Ethical Issues

V. Legal and Ethical Issues

There are significant ethical issues surrounding the treatment of HIV patients. The issues addressed here are competence in treating HIV and issues of confidentiality versus the duty to warn.

A. Competence in treating

Courses in HIV/AIDS are required in many states for the professional healthcare professional. Suggesting the fact that it is the responsibility of all social workers to be able to treat those with HIV, the NASW (New York Chapter) in 1993 provided the following in their recommendations for Social Workers regarding the treatment of individuals with HIV:

"All persons diagnosed with HIV infection or the presumption of HIV shall have access to services offered by professional social workers. The obligation of all social workers to provide necessary services to the above people is comparable to the ethical obligation to provide service to people regardless of their sexual orientation, race, color, country of origin, creed, gender, age and disability.

Social workers in all practice settings and different levels of authority are obligated to become knowledgeable about transmission of HIV and the disease process and be prepared to educate and counsel peers, other professionals and clients.

All social workers are obligated to update continually both their scientific knowledge about HIV disease and their skills in effectively working with people with HIV infection, their family members, friends and others." (NASW. 1993)

Although it is important for the healthcare professionals to make themselves competent and knowledgeable so they can be a resource with those that have HIV, it is important not to treat if this knowledge or competence has not been obtained. If this is the case, then the practitioner should seek consultation with an experienced person or refer the client to somebody with the expertise.

B. Confidentiality and Reporting Issues

As with all clients, those who are HIV positive have the right to confidentiality and privacy. The right to privacy of those who are HIV, or even take an HIV test, is strictly enforced. This is due in large part to the stigma associated with the disease. However, issues of when to break confidentiality can come up if the HIV positive person continues to have unprotected sexual relations with others who are not aware of the disease. The clients refusal to inform sexual partners creates a dilemma between their right to privacy and their actions which place the safety of the public at risk.

In 1988 the American Medical Association issued the following statement to doctors who are treating people with AIDS:

" We are saying for the first time that, because of the danger to the public health and danger to unknowing partners who may be contaminated with this lethal disease, the physician may be required to violate patient confidentiality. The physician has a responsibility to inform the spouse or known partners. This is more than an option. This is a professional responsibility." (Wilkerson, 1988)

The following addresses the issues of confidentiality further in regards to HIV/AIDS:

Exceptions to the legal and ethical obligation to maintain the confidentiality of HIV-related information exist. For example, health care providers in the U.S. have a duty to report HIV infections and AIDS cases to public health authorities. The benefits to the public health of this reporting are felt to outweigh the risk to individuals.(Lo, 2000) Reporting of AIDS cases has always included the patient's name and other identifying information. Although reporting of HIV infections initially was not done by name, there has been a recent and controversial movement in the U.S. toward name-based reporting of HIV infection.(Gostin et al. 1997) The debate over name-based reporting has focused on the need for more accurate epidemiological information regarding the spread of the epidemic-especially as antiretroviral therapies have proven successful in delaying progression to AIDS-versus concerns about deterring testing and the risk of discrimination. The Centers for Disease Control and Prevention (CDC) has made specific recommendations for keeping reporting confidential. (Guidelines€1997) However, because HIV testing carries the risk of discrimination if confidentiality is breached, the CDC and commentators on this issue have recommended that anonymous testing, from which name reporting is not possible, continue to be offered.

It is important to consult with an attorney regarding laws that have to do with the duty to warn. It is best if the healthcare practitioner can persuade the client to inform their partners.

C. Counter-Transferences

Working with HIV patience can be very emotionally draining and time consuming.

Support providers often experience anxiety and turmoil when they have ongoing interactions with someone who is under stress, chronically ill, or bereaved (Greene, Derlega, Yep, and Petronio p. 130)

As a result of the different issues that the AIDS patients are dealing with, often times they may lash out at the therapist because they are conveniently present, or they feel it is safe to be there. Sometimes there is a lot of complaining about situations out of the therapist's control whether it be present circumstances, family relationships or even transference causing the client to have angry feelings towards the therapist. The therapist who becomes too emotionally involved or wants to be always pleasing can be taken for an emotional roller coaster and get "burned out."

Other issues that may cause counter transference is the therapists sexual orientation versus that of the client. A heterosexual therapist needs to be aware of his or her feelings towards a person who has same sex attraction and who has participated in homosexual behaviors which have resulted in the contracting of the disease. The therapist must maintain an awareness of whatever feelings that might be brought into the therapeutic relationship.

Another source of potential emotional overload for the therapist is for those who work with AIDS who are close to dying and eventually die while still meeting with the therapist. This clientele can be both challenging and draining. Engaging clients and allowing them to express their feelings at their pace is important. Being with them and supporting that expression of feeling, and working with their families can be a very difficult, but also uplifting experience. When a client and their loved ones are able to move through the steps of dying, and find acceptance of death and peace. Again, it is difficult to keep that balance of engaging and supporting the client through the process, and maintaining appropriate emotional detachment or renewal to continue working with this clientele. Not every process will go well. In fact if they are seeing a therapist, chances are there will be quite a roller coaster of emotions.

One help mentioned earlier to to help the patient grow their positive support system. This way there will be others the patient can go to for support.

HIV / AIDS Course > Chapter 5 - Legal and Ethical Issues
Page Last Modified On: April 29, 2015, 01:12 PM