openly reject or surreptitiously evade this responsibility. It is because of these physicians that the question is so often raised about whether there is a duty to treat patients with HIV infection.

Although I have not attempted to respond to this question, I have suggested that an affirmative response does not help mitigate many of the problems that caused the question to be asked in the first place. While one can assert a duty to treat, one cannot argue coherently that there is a duty to be unafraid. Similarly, one cannot coerce empathy (or even sympathy) or any of the other feelings or attitudes that are essential to the development of caring relationships between physicians and patients.

AIDS has not only had extensive and troubling effects on what the physician-patient relationship is. It has also highlighted some of the shortcomings in our capacity to develop a stable social consensus about what it ought to be. 21


NOTES
1.
The central focus of this chapter is on the relationships of patients to primary care physicians such as family and general practitioners, many general pediatricians and internists, and some specialists in obstetrics and gynecology. Much of the discussion is, therefore, not applicable to physicians such as diagnostic radiologists, anesthesiologists, many surgeons, and others who typically have transient encounters rather than enduring relationships with patients.
2.
Actually, some physicians who have willingly assumed responsibility for the care of patients with HIV infection have asked if there is a duty to treat. In asking this question they are not seeking guidance for their own behavior. They are instead expressing a concern about the attitudes and behaviors of their reluctant colleagues.
3.
This is the motto of Alpha Omega Alpha, the leading medical honorary society.
4.
The validity of the Parsonian vision of the "sick role" has been subjected to serious challenges (e.g., Brody 1987: 68-73). The validity of these challenges is beyond the scope of this chapter. Renée Fox provides a critique of some of these challenges, as well as an argument for the continuing substantial validity of the "sick role" ( 1989:35ff).
5.
Reprinted in the Encyclopedia ofBioethics, p. 1731.
6.
This consideration of medical confidentiality as it relates to patients who have or who are at risk for HIV infection is necessarily superficial. For more extended discussions see Gostin ( 1989a), Dickens ( 1990), and Edgar and Sandomine ( 1990).
7.
Fully developed AIDS is reportable in all states and in the District of Columbia.
8.
Although public health officials do not tell "contacts" the name of the infected

-211-

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AIDS & Ethics
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Preface ix
  • Contributors xv
  • 1. Aids: the Relevance of Ethics 1
  • Note 22
  • References 23
  • 2. Aids, Public Health, and Civil Liberties: Consensus and Conflict in Policy 26
  • References 47
  • 3. Mandatory HIV Screening and Testing 50
  • References 73
  • 4. Aids and the Ethics of Human Subjects Research 77
  • Acknowledgments 101
  • References 102
  • 5. Aids and the Crisis of Health Insurance 105
  • References 124
  • 6. Ethical Issues in Aids Education 128
  • Acknowledgments 151
  • Notes 151
  • References 153
  • 7. Ethics and Militant Aids Activism 155
  • Notes 186
  • References 186
  • 8. Aids and the Physician-Patient Relationship 188
  • Notes 211
  • References 213
  • 9. Aids and the Obligations of Health Care Professionals 215
  • References 236
  • 10. Aids and Privacy 240
  • Acknowledgments 272
  • Notes 272
  • References 274
  • 11. Aids and the Law 277
  • References 305
  • SUGGESTED READINGS 306
  • Index 311
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