10. AIDS and Privacy

FERDINAND SCHOEMAN

ISSUES OF PRIVACY surface in nearly every dimension of AIDS, from diagnosis, to treatment, to epidemiology, to prevention. A sampling of issues includes topics like reporting human immunodeficiency virus (HIV) infection to public health agencies, confidentiality of the therapist-patient relationship, and the duty, on the part of the individual or public health authorities, to disclose one's condition to a sexual partner, surgeon, employer, or insurance provider. No group in society is more vulnerable to both biological and social repercussions of a disease than those infected with HIV. Tragically, some aspects of protecting the privacy of those who are HIV infected have frightening potential for others who understandably wish to avoid contagion, as well as for those who recognize the social costs of the increasing numbers and changing profile of AIDS victims. AIDS, as we will see, is destined to have as much impact on the contours of our notion of privacy as computerization of records and the legalization of abortion did.

Conflict and the inevitability of unmet and haunting needs is nowhere more manifest than in the case of AIDS. AIDS is a lethal disease that is communicable in controllable ways. To think of it as a fatal disease invokes one pattern of normative responses: sympathetic and protecting attitudes. To think of it as a condition that is communicable in a controllable way invokes another set of normative responses: those attributing accountability for harming others. Being sick diminishes one's accountability for some things--things over which one has impaired capacity. The negligence or recklessness involved in infecting another with HIV is not, however typically the result of impaired capacity ( United States v. Sergeant Nathaniel Johnson, Jr.). 1 A person who deserves compassion for having a disease may also deserve admo-

-240-

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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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