Medicolegal Aspects Of AIDS,

Doctors face various medicolegal and ethical questions regarding Acquired Immunodeficiency Syndrome (AIDS), as there is no legislation integrating all issues concerning Human Immunodeficiency Virus (HIV) and AIDS. Thus, it is essential for doctors to handle this sensitive issue with care as they play a central role maintaining patient dignity and providing compassionate care to HIV patients. This article provides medicolegal guidance to doctors regarding practice, confidentiality, HIV testing, etc. for AIDS patients.

Doctor’s Duty Of Care

It is unethical on part of a doctor to refuse treatment or investigation to a person infected with HIV. A doctor may be held guilty of professional misconduct for this unethical behavior.

Confidentiality

Doctors may have to face civil and criminal penalties for unlawful disclosure of HIV positive status. The physician should not reveal confidential communications or information without the consent of the patient unless provided for by law or due to the need to protect the welfare of individual or in public interest.

Medical Records

When patients have undergone tests for HIV, doctors must maintain separate records to prevent test results from being inadvertently disclosed with other records. They can be guided by existing regulations for medical termination of pregnancy concerning the custody of consent forms and maintenance of admission registers.

Informed Consent For HIV Testing

A physician must obtain an informed consent before performing any invasive procedure on a patient so that the patient has sufficient knowledge about the procedure to make an informed decision.

• Patients should be given full disclosure of the nature of HIV disease, nature of the proposed test, implications of a positive and a negative test result and the consequences of treatment prior to taking consent.
• The consent must be voluntary, and the patient must be competent to give consent or to refuse. Informed consent for testing and disclosure must be in writing.
• In case of marriage, if one of the partners insists on a test to check the HIV status of the other partner, such tests should be carried out by the contracting party to the satisfaction of the person concerned.

National AIDS Control Organization (NACO) Guidelines For Physicians

• HIV testing should be carried out on a voluntary basis with appropriate pre- and post-test counseling
• Disclosure of HIV status of the person should not affect his rights to employment, the position at the workplace, right to medical care and fundamental rights in any way.
• The result of HIV test must be kept confidential and even health care workers who are not directly involved in the care of the patient should not be told about the result.
• Surveillance of HIV positive cases in the country does not require reporting of the identification data of the patient.
• HIV positive woman should have complete choice to make decisions about pregnancy and childbirth.
• Women should be advised to avoid pregnancy as there are chances of infecting the child.
• There should be no forcible abortion or even sterilization.

Partner Notification (Partner Counseling/Contact Tracing)

It is necessary to notify and counsel the sexual partners of an HIV patient about their exposure to HIV. Approaches to partner notification are as follows:

• Patient referral: HIV positive person is encouraged to notify partners about their possible exposure to HIV, without the a direct involvement of health care providers.
• Provider referral: HIV positive person provide their partner’s names to health care providers who then confidentially notify the partners directly. There are again two approaches to informing third parties:
  • Contact tracing: It is based on patients’ voluntary cooperation in providing the names of contacts. It occurs during sexual disease awareness programs.
  • Duty to inform: This approach comes in a clinical situation where the physician knows the identity of the person at risk of exposure. Here, physician should disclose the endangered person without the consent of the patient due to his moral duty to warn.

Overall, the basic principle of ethics dictates that individuals with HIV should be treated with respect and their dignity should not be violated. It is the moral duty of physicians to provide compassionate care and maintain the dignity of HIV patients.

Reference

Mathiharan, K. HIV And AIDS: Some Legal And Ethical Implications For The Medical Profession. Issues In Medical Ethics 2002, 10 (4), 79-82.