This assignment is a discussion on the topic of ethical issues on HIV/AIDS. Ethics can be defined as principles which govern the conduct and behavior of certain group of people in a given context. Ethics are found in various professions such as law, medicine, social work and counseling among others.
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Ethics comprise the code of conduct which practitioners in various professions should abide with so as to guard the public from unprofessional practice (Kizza, 2010). The discussion will look at a brief overview of AIDS and the ethical issues related to it. The issues to be discussed include ethical issues related to research and counseling for AIDS patients, discrimination, and intentional transmission of the disease and the protection of vulnerable groups in the society.
Brief Overview of AIDS
Since its discovery in early 1980s, the disease has remained a big challenge to many nations of the world. When it was discovered, the virus was a very serious global issue. This is because it affected both the rich and poor nations alike. The perception by then was that AIDS was like a death sentence and that is why there was a lot of stigmatization on the victims (World health organization, 2011).
There were a lot of myths about HIV/ AIDS such as the argument that it could be spread through shaking of hands, kissing, sharing clothes or cooking utensils. Those who contracted the disease were also perceived as sexually irresponsible and immoral and this led to high levels of stigmatization.
The sigma took the forms of discrimination in social and economic terms. Socially, the AIDS patients were treated as social outcasts in that many people avoided mixing or interacting with them. Economically, those who were infected were sometimes denied employment, or even sacked if they were found to be HIV positive. This stigmatization had a lot of negative impacts on the patients, key among them being that many patients actually died earlier as a result of stress and lack of proper medication (World health organization, 2011).
The increasing trends of deaths due to HIV/AIDS triggered a lot of research on the disease, with many researchers wanting to get a cure for AIDS without much success. However, researchers led by the World Health Organization (WHO) and the Center for Disease Control (CDC) managed to make some progress by discovering some mitigation measures in form of anti-retroviral drugs, which are given to the AIDS patients so that they may prolong their lifespans.
A Lot of campaign was also done especially in the 1990s to educate people on how to protect themselves from HIV and also to separate the myths and facts about HIV/AIDS. The results of this were a reduction in new infections, prolonged lifespans, reduced stigma and discrimination, and reduction of parent to child transmission during pregnancy (World health organization, 2011).
One thing to note about AIDS is that it has been described as a disease of the poor. The reason is that the disease is mostly attributed to poverty just like many other diseases such as malaria, marasmus, cancer and kwashiorkor. This is because poor people are not able to access reproductive health information and services or afford proper diet. Most of the poor people do not care about their health but care more about their survival (World health organization, 2011).
In the sub-Saharan Africa for example, the number of people living with the disease in 2007 accounted for 68% of the tool population of people living with AIDS worldwide. In this region also, a 1.7 million new infection record was noted as well as 78% of deaths resulting from AIDS (Nyika, 2007.pp. 25-34).
The region also comprised of over 1.4 million children who were orphaned as a result of the disease while the adult prevalence was estimated somewhere around 5%. Similarly, most of the AIDS patients were women, who accounted for 60% of all people infected with the disease. These statistics do confirm that the disease is actually a disease of the poor and marginalized in the society (Nyika, 2007.pp. 25-34).
Ethical Issues Related To Research on HIV/AIDS
There are three basic ethical principles in the research on HIV/AIDS as well as on other sexually transmitted infections, cancer and mental illness. The three principles include; respect of persons, beneficence and justice.
Respect of persons
Respect for persons is a basic ethical principle which is twofold in nature. One, it covers two ethical convictions, that is, individuals should be treated as autonomous agents, and that persons with diminished autonomy are entitled to protection respectively.
In addition, it has two moral requirements, that is, to acknowledge the human subjects’ autonomy, as well as protect those with diminished autonomy. According to this principle, an autonomous person is capable of making deliberations about his or her personal targets and act under the set direction of those deliberations.
In some instances the subject in the research may lose the ability to determine the course of their life during the research due to illness, mental incapacitation, immaturity, or circumstances that severely restrict their liberty like imprisonment.The incapacitation to self-determination can be either short lived or permanent.
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This principle insists on treating all individuals as autonomous agents ensuring that individuals with immature or incapacitated self-determination are given extensive protection depending on their risk of harm and likelihood of benefit (Biggs, 2010).
In researches involving human subjects, this principle demands that the subjects enter into the research voluntarily and adequately informed. However, there are certain cases in which the application of the principle faces challenges. For example, the fact that prisoners are dependents exposes them to risks of coercion to participate than volunteer in research on AIDS despite the provisions of the principle to protect them.
Apart from respecting the decisions of subjects and protecting them from harm, making efforts to secure their wellbeing under the principle of beneficence is necessary. Beneficence provides a strong sense of obligation. Just like the respect for persons, this principle is two-fold. The two rules for beneficent actions include; do not harm, and possible benefit to minimize possible harms.
The two rules are part and parcel of those already existing in medical ethics, which requires physicians to benefit their patients according to their best judgment, and justification to seek benefits despite the risks. The obligation of this principle stretches from individual, society, particular research projects, and entire research enterprise shifting its target.
This situation presents an ethical dilemma in researches with low risk; lack of direct benefit prospects to the subjects with its key targets as minimal risk and great benefit to subjects. Lastly, claims recognized by this principle come to conflict and force difficult choices (Dickenson, Huxtable & Parker, 2010).
The principle of Justice
The principle of justice ensures fairness in distribution of the benefits and costs of researches among the stakeholders. An injustice occurs when some benefit is withdrawn or persons with diminished autonomy are denied protection just like the rules in the Nuremberg code which makes the quality informed consent essential both to the individuals and research enterprises.
On the contrary, some of these rules have been found wanting when applied in diverse situations as they show some signs of conflict amongst them and difficulty in interpretation. The ethical principles are not generalized enough to form a strong ground for formulating and criticizing specific rules (Chat bum, 2009).
The above three general principles form the basis for informed consent, risk/benefit assessment and selection of subjects of research requirement when conducting research. The informed consent requires that subjects in a research be allowed, depending on their ability to dictate what is to happen or not to happen to them. A research can be allowed to proceed only if it fulfills the standards of this regulation. However, there are chances that nature may not allow for the fulfillment of this requirement easily (Chat bum, 2009).
Getting the consent of a subject for research is a process which includes information, comprehension and voluntaries. Informed consent insist on researches providing an opportunity for clients to exercise their choice while those opposing argue that telling some information to the subjects can interfere with the validity of research.
Instead, they propose that some information should be revealed at the end of research contravening the principle of justice which says that people should be treated equally, according to their needs, individual effort, societal contribution and their merit (Chat bum, 2009).
In informed consent, the principle require that information be given to the client depending on his or her intelligence, rationality, maturity and language so as to provide them with an opportunity for questioning and withdrawing at any stage in the research. Comprehensions tests, use of third party in case where the subject is a child, extend of risk are other things that need to be considered. In this process, it becomes difficult to rule out on information (Morrison, 2009).
Incomplete informed consent for fear of interference with validity of the research, patient’s inability to make the choice makes the decision on the information to deliver to the subject a difficult issue to resolve. Informed consent involves voluntary without any form of intimidation and incentives like improper rewards in exchange for compliance (Chat bum, 2009).
Assessment of risk and benefits
This application requires that research designs be reviewed by credible committees to weigh the potential risks versus the benefits presented to subjects by the research. This is aimed at helping the subjects to choose whether to participate or not.
It is difficult to make precise documents since the assessments of all aspects of research should be rigorous and precise which can easily result to misinterpretation, misinformation and conflicting judgments. In assessment of brutal or inhuman treatment, risk reduction, research with significant risks of impairments for vulnerable population, the method of determining risk should be precisely explicit, reasonable as judged by other facts or available studies (Biggs, 2010).
Selection of subjects
The Principle of respect for persons is displayed in the requirement of consent while the principle of beneficence is displayed in risk benefits assessment. On the other hand, the principle of justice gives moral requirement that there be fair procedures and outcomes in the selection of subjects. Justice helps at individual and societal level by ensuring a representative sample in selection and treatment (Biggs, 2010).
Ethical Issues Related To Counseling for HIV/AIDS
In counseling for HIV/AIDS, ethics can be described as principles which govern the relationship between clients (AIDS patients) and counselors or doctors. Ethics direct the counselors on how to conduct themselves in a professional manner and with dignity so as to enhance a good relationship with their clients and create a conducive environment for an effective therapeutic relationship.
Some of the ethical issues in counseling include confidentiality, putting the client’s needs before those of the counselor, ethical issues regarding diagnosis, nonjudgmental attitude among others (Corey, 2009).
The ethical issue of putting the client’s needs before the needs of the counselor is a very important one in counseling for HIV/ AIDS. Counselors are required to separate their personal issues with their profession, so as to be able to work conveniently, efficiently and effectively.
One advantage of this is that the counselors are able to focus on the needs of the clients with undivided attention, which gives them an opportunity to fully understand the problems of their clients and do the correct diagnosis or do referrals if they are not in a position to handle the problems facing their clients.
The other advantage is that the clients and the counselors are able to focus on the real issues regarding the problems facing the clients. This gives the clients an opportunity to open up and volunteer as much information as possible. The clients are also able to pass their transference to the counselor, which serves a therapeutic purpose in the counseling process with the correct countertransference (Cottone & Tarvydas, 2003).
The other side of this ethical issue is that it may sometimes become difficult for counselors to separate their issues with those of the counseling process especially those who have just started counseling. Even those who are experienced may find themselves unable to separate their unfinished businesses with the counseling process (Corey, Schneider, & Callanan, 2010).
This leads to burn out in the counselors as a result of trying to balance their own lives with the burden of the problems of their clients, which may make them to go and seek the services of other counselor, thereby becoming clients themselves.
The key ethical issues in counseling for HIV/AIDS are confidentiality and judgmental attitude. Some counselors and doctors are known to abuse the right of their patients to confidentiality, especially after testing of the patients for HIV/AIDS. Some are known to disclose the HIV status of the patients to their close friends or relatives without the consent of the patients.
This is illegal because the only time when a counselor or doctor can reveal the results of HIV patients is when the results are required by a medical practitioner for treatment purposes only (World health organization, 2011).
Other counselors are also known to have what is called judgmental attitudes towards the clients who are infected by HIV/AIDS. Some are known to go astray and pass the blame to the patients, especially commercial sex workers. When this happens, the therapeutic relationship does not produce good results because the patients end up blaming themselves for contracting the virus instead of gathering courage to face life in a bold manner (World health organization, 2011).
Discrimination is the biased treatment of people based on their HIV status. People with AIDS are discriminated against in employment as well as in interaction with others. There are some institutions (educational and career institutions) which don’t admit people who are infected with AIDS.
This has been described as an unethical practice and it is actually prohibited by many laws, including the universal declaration of human rights, which stipulate that all persons have the right to be treated fairly irrespective of their health status (Elbe, 2006.pp.119-144).
Intentional transmission of the disease
As I mentioned earlier, there are many myths about HIV/AIDS. It is also worth noting that HIV/AIDS is a collection of syndromes which come as a result of weakened immunity. The symptoms of AIDS are mostly known by many people and this can lead to stigmatization.
There have been very intensive campaigns worldwide for the people to know their HIV status. The reason why there is emphasis on knowing ones HIV status is that the earlier one knows his or her status, the more the chances of minimizing the chances of early death due to the disease (Elbe, 2006.pp.119-144).
Many people have embraced this which has seen many infected people enroll of ART treatment as early as possible, thus making them live longer. However, there is the ethical issue which comes along with knowing ones HIV status. The issue is that of intentional transmission of the disease.
Some people who know they are HIV positive are known to infect others intentionally. This is not only unethical but also illegal. Many governments, in partnership with the Word Heath Organization and the Center for Disease Control have recommended some penalties for intentionally infecting others with the HIV virus (Hanefeld, 2005).
People with the virus are supposed to declare their status to their partners before any sexual encounter. The person who gets infected with the virus by another person has the right to sue for damages. This ethical issue is very sensitive because it extends even to marriages. Many couples especially in the developed world are now being required by the law to have protected sex with their spouses, unless they want to have children and when one spouse suspects the other of infidelity (Hanefeld, 2005).
Protection of vulnerable groups as an ethical issue
Vulnerable groups in the society in the context of AIDS include commercial sex workers, refugees and internally displaced persons, people in war-torn countries and those living in abject poverty. These groups are vulnerable because they are most likely to be infected with the virus, not because they want but due to the environment in which they live in.
Taking the example of internally displaced persons and especially women, they are most likely to be raped or being lured for unprotected sex for the exchange of money, which they greatly need. This makes them have very little bargaining power when it comes to the protection from the disease.
The same applies to commercial sex workers. Some of them put money ahead of their health and go to the extent of engaging in unprotected sex especially if their customers are willing to pay more for unprotected sex than for protected sex (Hanefeld, 2005).
Governments therefore need to put up polices which guard the vulnerable groups from being exposed to the dangers of contracting the virus. However, this rarely happens and that is why most of the new infections are found in the poor countries and more specifically, among women and children in difficult situations.
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