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Utilitarian medical ethics
Utilitarian medical ethics
Utilitarian medical ethics
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This paper presents an ethical analysis of the mandatory newborn HIV testing law enacted in New York State. The law was passed as an effort to decrease maternal transmission of HIV, by treating infants born to HIV positive mothers immediately after birth with AZT. Newborn testing was promoted by the legislative and medical community following the overwhelmingly positive response from HIV infected pregnant women who were given AZT in the ACTG 076 clinical trials. Pregnant mothers who were given AZT had a markedly lower transmission rate than mothers who had not received it. This paper examines this newborn testing policy from a Utilitarian perspective to ascertain if the goals of the policy are feasible. The potential advantages, as well as the failures of using this policy are discussed. Implementations to improve the policy are also presented.
Ethical Dimensions of Mandatory HIV Testing of Newborns
in New York State: A Utilitarian Perspective
Description of Policy
In June of 1999 all hospitals in the state of New York were notified by the New York State Department of Health that beginning August first, 1999, a radical new approach to HIV screening was to be initiated. According to the policy, "for those women without prenatal HIV test results who decline HIV testing during delivery, hospitals are required to conduct expedited HIV testing of all newborns" (New York State Department of Health, June, 1999). This policy was the consequence of a heated debate in the legislature over the results of anonymous HIV screening performed on pregnant women in the state of New York (Cameron, 2002). New York State had been engaged in anonymous testing of newborns since the late 1980s, and this testing consistently reve...
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...d November 24, 2004, from http://www.philosophers.co.uk/cafe/phil_jul2001.htm
Turner, B. J., Newschaffer, C. J., Zhang, D., Fanning, T., & Hauck, W. W. (1999). Translating clinical trial results into practice. Annals of Internal Medicine, 130(12), 979-986.
West, H. R. (n.d.). Utilitarianism. Retrieved 11162004, from Encyclopedia Britannica Web Site: www.utilitarianism.com/utilitarianism.html
Wolf, L. E., Lo, B., Beckerman, K. P., Dorenbaum, A., Kilpatrick, S. J., Weintrub, P. S., et al. (2001). When parents reject interventions to reduce postnatal human immunodeficiency virus transmission. Archives of Pediatric and Adolescent Medicine, 155(8), 927-933.
Zulueta, P de (2000). The ethics of anonymised HIV testing of pregnant women: a reappraisal . Journal of Medical Ethics, 26, 16-21.
Ethical violations committed on underprivileged populations first surfaced close to 50 years ago with the discovery of the Tuskegee project. The location, a small rural town in Arkansas, and the population, consisting of black males with syphilis, would become a startling example of research gone wrong. The participants of the study were denied the available treatment in order further the goal of the research, a clear violation of the Belmont Report principle of beneficence. This same problem faces researchers today who looking for an intervention in the vertical transmission of HIV in Africa, as there is an effective protocol in industrialized nations, yet they chose to use a placebo-contro...
This case presents a very delicate situation that presents many legal and ethical questions. Do you tell your brother his partner has HIV? I would tell my brother, but the how and when, may vary based on circumstance. From a professional ethical standpoint, it would be unethical to disclose the patient’s HIV status without consent. It would violate the patient’s right to confidentiality, as it is the patient’s choice whom information may be shared with (Beemsterboer, 2010, p. 50). It could also be argued that it is a violation of the principle of nonmaleficence. By providing the patient’s HIV status to people unbound by HIPAA, you are putting the patient at risk of discrimination. This could cause mental anguish or psychological issues, therefore, in essence, inflicting harm on the patient. The most valued application of nonmaleficence is, “One ought to not inflict harm” (Beemsterboer, 2010, p. 42). This would outweigh the ethical argument that you are also preventing harm to your brother, another less important application of nonmaleficence (Beemsterboer, 2010, p. 42). There is one professional ethical principle that I would argue was being applied. This being the principle of paternalism, stating that healthcare providers should do what they deem best for the patient according to their ability and judgment (Beemsterboer, 2010, p. 47). If the patient had a sexual encounter with the brother, and did not inform him of her HIV status, she may be arrested for reckless endangerment according to Pennsylvania law. A case where an HIV-positive person did not disclose their status to their sexual partner was brought before the Pennsylvania Superior Court. According to Pennsylvania law, “Disclosure of HIV status is a defense ag...
beliefs of society. If society imposed a law that it was immoral to have children if you are extremely poor because u can not provide for them and the child’s life wont be satisfying, one could argue that with a little time the mother could move out of poverty and thus have a “good” life, or that the child may find life satisfying without much beyond basic necessities. The author claims that mandatory testing will be beneficial because it can help produce healthy children, yet assumes that all pregnant women at risk will get tested. If testing becomes mandatory many woman who avoid testing, either out of the fear of knowing if they have the disease or that they will pressured into terminating the pregnancy, many woman may avoid prenatal care all together, thus imposing more health risks on the fetus and the mother.
HIV has had a dramatic effect on the history screening and testing of blood donations. Since May 1985 all blood donated in the United States received testing for HIV antibodies, p 354. Still there are cases of negligence when the collection of blood is done. In 1983, a blood center knowing that blood from homosexual and bisexual men should not be accepted. The blood center even had a written policy stating that donors who volunteer that they are gay should not be allowed to give. In the case of, J.K & Susie L. Wadley Research Inst. v. Beeson, Mr. B a patient received several units of blood from the blood center during his surgery. Mr. B later going back to the hospital for being sick tested positive for HIV and his wife tested positive. At trial, damages of $800,000 were awarded to Mr. B’s widow. Failing to follow their policy cost a significant amount of money. Patients...
Potter, J. E., White, K., Hopkins, K., Amastae, J., & Grossman, D. (2010). Clinic Versus Over-
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
(Allen et al., 2000) The Acquired Immune Deficiency Syndrome (AIDS) is a clinical situation that requires the ethical principle Justice to be implemented. AIDS can be transmitted by sexual activity, intravenous (IV) drug use, and passed from mother to child. Due to the judgments and fears from the general population and some healthcare professionals, patients who have this disease may find themselves suffering from discrimination in many ways of their lives. This discrimination comes from the stigma placed by the factors in which AIDS is mainly spread. These factors are poverty, homelessness, illiteracy, prostitution, human-trafficking, which create the labels like the “drug user” or “homosexual”.
Children with AIDS were prevented from going to school; infected adults lost their jobs, their families, and were shunned by a fearful society. Available testing for AIDS was underutilized by the gay population for fear of further social consequences. The government was finally forced to take action through media channels to manage the global threat to all people that AIDS not presented. Out of necessity to manage the virus and provide reassurance to those infected the government implemented privacy laws that protected the individuals who tested positive for the AIDS.
HIV is a devastating and deadly virus that affects 1.1 million Americans annually (CDC, 2010). The hardest hit group is that of gay or bisexual black males. The “Testing Makes Us Stronger” campaign was implemented August 15, 2011 by the Centers for Disease Control and Prevention (CDC) in response to this need for awareness and prevention in the black gay and bisexual male community. From 2006-2009, the number of infected black bisexual and gay men increased by 48% (CDC.gov, 2006-2009) showing an increased need for education and prevention as well access to HIV/AIDS testing in the community in order to reduce the occurrence of HIV among black gay and bisexual males.
“Clinically, the HIV infected adolescents present as physically stunted individuals, with delayed puberty and adrenarche. Mental illness and substance abuse are important co-morbidities” (Naswa, 2010). Naswa, 2010 also reports that adolescences with HIV have a higher susceptibility rate to contract STD’s that the average individual due to the thinner lining of mucus in the ovaries at this stage of their development. The stigma of living with HIV is also a factor for her psychosocial development. The fact that she contracted this disease from her father further contributes to emotional trauma.
Toal, Jean, and Lynn M. Paltrow. “Should a Pregnant Woman Be Punished for Exposing Her Fetus to Risk?” Bioethics. Issue 9. n.d.:144-61. n.d. PDF file. 18 Nov. 2013.
JAMA: Journal of the American Medical Association. 14 Nov. 2001: 2322. Academic Search Complete. Web.
Various articles examining the ethical and legal issues surrounding the disclosure of HIV status prior to sexual relationships make evident that the disadvantages of disclosure outweigh the benefits, making clear that disclosure is unnecessary.
No vaccine has proved successful in preventing HIV. So the epidemic continues to spread, mainly among underprivileged and marginalized populations: the poor, people of color, people in prison, injection drug users, and men who have sex with men. Many do not understand they are infected and innocently transmit the virus to others. Unawareness, prejudice, and lack of access to healthcare is fueling the outbreak. Therefore, health professionals have a critical role in screening, testing, and educating patients, families, and communities. Health professionals can also teach by example, through offering nonjudgmental, sympathetic care to those affected by this deadly virus.
There are many incidents in the healthcare field where a patient or a worker can be injured or their safety is at risk. This 32 year old nurse at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). She works towards the prevention of mother-to-child transmission of HIV. When she finished her studies in nursing, she was an intern at Kinshasa’s General Provincial Referral Hospital where she first contracted HIV. One day, she accidentally pricked herself with a needle used on a HIV positive patient. She was unaware that this patient was HIV positive, but she reported the incident to her nursing officer. When she told him what happened, he advised her to get get a blood test. Her results were negative. Her intern year was over and she