Ethical Principles and HIV / AIDS Care - some challenges Anthony Mullings DM (O&G) MPH UWI

Approach Ethics and its cardinal principles 3 major aspects in HIV/AIDS care Guiding principles for ethical decision making

Objectives Identify aspects of ethical behaviour related to HIV /AIDS care Identify specific ethical concerns relating to HIV / AIDS care Develop a basic framework with which to approach ethical issues in HIV /AIDS care

Ethics Contemplation of moral issues Several types: Principle based ethics Virtue based ethics Care ethics Feminist ethics Communitarian ethics Case based ethics

Ethics Medical ethicists generally guided by a set of principles and value system of the society Professional ethics It is not the Law but needs to take the law into consideration

Principle based theory Four cardinal principles by which to approach ethical reasoning: Autonomy Beneficence Nonmaleficence Justice

Virtue Ethics Depends on individual’s character – trustworthiness- prudence – fairness- temperance – integrity- self-effacement – compassion All these are supposed to be present especially in health professionals

Other Theories Care ethics - depends on personal traits Feminist ethics - equality of women and men Communitarian - ? Personal autonomy Case based - precedence

Some areas of general application Diagnosis Care giving Research There has been concern in HIV/AIDS because of the stigma and hence confidentiality factor thus bringing more focus on the individual rights (autonomy) factor.

Diagnosis Identification of who to test - everyone or only admitted high risk? – Casting aspersion? Pre and post test counselling - mandatory? – who to do? – how: individual or group? – extent of?

Diagnosis Who to inform? – lab to who? – who to patient? How to inform? – lab to by paper, phone, fax, world wide web? – client? – caregiver to ?

Care Nature of: e.g. Inpatient vs. outpatient – Investigation – Treatment – Nursing – Medical – Other - disposal etc. – Other patients – Other staff

Care Caregivers – right to know vs. universal precautions – personal views (conscientious objectors or dereliction of responsibility) – level of risk – Individual state of health – Level of institutional support

Research For improvement in: – Prevention – Care – Cure Necessary to collect data – what level of data necessary – how to preserve the 3 principles

Collection of Data How to collect? – Face to face interview vs. self-completed questionnaire – Anonymous self-completed questionnaire vs. random screening and selection What to collect? – Often more is collected than actually needed

Research How to process after collection - confidentiality issue Data entry - – all of the information? – identifier or no? has implications for cross checking accuracy of entry Data analysis - – sensitivity to nature of problem? Has implications for objectivity

Research How to store? – hard copy – electronic copy – both Security issues

Research How to use? – treatment options – reporting academic policy related capacity building Ultimate benefit should be to participants

Ethical decision making Get all the facts as far as possible Consider all the options that any reasonable person may choose Fit this into the value system within which you function and see how they match Find out the legal implications

Decision making Find out if there are any previous documented cases similar to this one Develop a broad based group for support and advise Present the facts and options dispassionately to the interested party / parties and make a decision Obtain informed consent

Remember Do no harm Respect the individual (Autonomy) Maintain confidentiality