Download Session 8 - Teaching Slides

Ethical Issues
in the Care of PLHIV
HAIVN
Harvard Medical School AIDS
Initiatives in Vietnam
1
Learning Objectives
By the end of this session, participants
should be able to:
 List 4 common ethical challenges/duties in
the clinical care of PLHIV
 Explain benefits of universal precautions
that can protect patients from stigma and
discrimination
 Explain patients’ rights regarding HIV
testing
2
4 Duties in Caring PLHIV




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
3
Duty to Care


All patients should receive the best
possible care
All indicated procedures must be
performed
• Invasive diagnostic procedures
• Therapeutic procedures
• Hands-on care
4
Duty to Care: Dilemma
Resources are scarce :
 Medications
 Patient wards
 Devices
 Human
resources…
 Tools
Questions:
•Who should get medication first?
•Who decide this?
5
Reducing Fear of Personal Risk

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
6
Duty to Protect (1)


Protects health care workers from
acquiring infections in the course of
their work
Protects patients from acquiring
infections from health care workers
7
Duty to Protect (2)

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
8
Duty to Protect:
Universal Precautions

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
Universal Precautions are only effective
if implemented with all patients in all settings
9
Confidentiality (1)


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
10
Confidentiality (2)

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
11
Right to Autonomy(1)

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
12
Right to Autonomy (2)
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?
13
Ethical Obligations





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
14
Key Points




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
15
Thank you!
Questions?
16