Ethical and Legal Aspects of AIDS Chapter Notes | Forensic Medicine and Toxicology (FMT) - NEET PG PDF Download

Introduction

• In 1981, a new disease called Acquired Immunodeficiency Syndrome (AIDS) was identified when there was a sudden increase in opportunistic infections and a severe form of Kaposi’s sarcoma among apparently healthy homosexual men and intravenous drug users. The main characteristic of AIDS is immunodeficiency, which means the immune system is weakened.
• Since its discovery, as the number of AIDS cases has risen and public awareness has increased, the ethical, legal, and regulatory frameworks have become more important. Balancing personal rights with public safety in the face of a deadly virus has introduced many new legal challenges related to various areas such as:
• Public health
• Education
• Employment
• Insurance
• Medical law
• Family law
• Civil rights

This document intends to briefly examine the ethical and legal aspects of AIDS in developed countries like the UK and the USA, as well as in a developing country like India.

English Law

In cases where public interests conflict, courts will only allow a breach of confidence if there is a valid reason or justification for doing so.

Disclosure of Information

• The obligation to disclose information about HIV-infected individuals and patients with contagious diseases is a limited defence in both the USA and the UK.
• In 1991, the British Medical Council determined that physicians should not carry out mandatory blood testing without the explicit consent of the patient.
• If a physician conducts such testing without consent, they may face disciplinary actions and must provide a justification for their decision.
• This issue is particularly pertinent considering the current unemployment challenges in England.
• Many companies in England require an HIV test certificate from their in-house doctors.
• The British Medical Council (BMC) aims to maintain the perspective of UK medical experts that there is minimal legal basis for disclosing an employee's HIV status or AIDS diagnosis to an employer.

US Position

In the United States, medical confidentiality is upheld by various federal laws that offer privacy protections for public health records containing HIV-related information. Recently, there has been a proposal to extend these protections to all medical records with HIV-related data, which has garnered significant attention in Congress.

Support for Extended Protections

• Health professionals and public health officials are in favor of this initiative.
• The proposal has been incorporated into the public health and welfare code concerning AIDS, ensuring strict confidentiality for all information related to HIV diseases and patients.

Legal Precedents and Public Health Concerns

• The Florida Supreme Court has recognized the detrimental impact of disclosing confidential HIV-related information on public health policy, as it discourages participation. This concern was highlighted in a case involving blood donation.
• The court emphasized that as the number of HIV-infected individuals rises, the need for confidentiality in legal and other contexts becomes increasingly important.
• While there has not been extensive focus on US case law due to the multitude of rulings in this area, several decisions by the US Supreme Court have reinforced the right to informational privacy.

Confidentiality in Legal Context

• A subpoena request for the identity of a school child with AIDS was denied partly due to state and city confidentiality laws.
• Health officials in the US recognise that safeguarding sensitive information collected during tracing promotes participation and cooperation by removing the fear of embarrassing disclosures.
• The main aim of contact tracing is to encourage testing and counselling, which offer substantial public health benefits.
• They understand that failing to provide appropriate protections for this information will likely deter volunteers.

Indian Position

The present AIDS legislation in India comprises State Amendments and a proposed Central Bill. In August 1989, the AIDS (Prevention) Bill was introduced in Parliament.

Main Features of the Bill

• Section 4: Requires registered physicians to report HIV positive cases to health authorities but lacks a confidentiality clause.
• Section 7: Mandates health authorities to provide counselling, health education, and specialized treatment, which is ineffective without guaranteed confidentiality.
• Section 5: Discusses precautionary measures to control the spread of the disease.
• Section 5(c): Suggests the removal of a patient to a hospital or another facility “for special care” as directed by health authorities, implying isolation as a proposed alternative. This provision faced strong opposition from Human Rights Groups and the WHO, leading to calls for the repeal of the legislation.

Local Regulations

• Local municipal laws, public health laws, and the Epidemic Disease Act of 1897 empower the State Government to implement necessary measures and temporary regulations to prevent outbreaks in case of a dangerous epidemic disease risk.
• States like Goa, Maharashtra, Orissa, and Karnataka have attempted to include provisions regarding AIDS within their local laws under this Central Legislation.

Instances from Different States

• In Maharashtra, Section 421 of the Mumbai Municipal Corporation Act requires doctors to report the presence of any dangerous diseases, which should be clearly defined according to local regulations.
• As per Section 53(1)(iv) of the Goa Public Health Act, individuals, including foreigners, cannot refuse a blood test if the Health Officer has reasonable grounds to suspect the presence of AIDS or other infectious diseases.
• In Karnataka, certain hospitals have isolation wards for patients who test positive for HIV. The local Public Health Act mandates testing for all women admitted to detention centres within the state.

Issues Raised

• Aids is a disease that spreads from one person to another in specific contexts only, i.e., by sexual contact or through blood.
• Aids is a communicable disease.
• Aids is classified as an epidemic disease in many contexts due to its significant public health impact.

Policy Responses
Policy responses prevalent in the world today that tackle the problem of Aids are:

• Isolationist response
• Integrationist response

Isolationist Response

The isolationist response is implemented by countries like Cuba and Romania and involves two primary actions:

• Mandatory testing
• Isolation of infected individuals

While these measures are positive steps, there are notable shortcomings:

• Mandatory testing is impractical and costly for a nation with over 900 million people.
• As a result, testing will primarily target high-risk groups.
• HIV is associated with unsafe sexual practices rather than sexual preferences, and focusing on these individuals may increase prejudice.
• This could drive the entire high-risk group underground, making them hesitant to disclose their condition due to fear of discrimination.
• Such outcomes undermine the objective of the approach.

Integrationist Response

The Integrationist response, put forth by the World Health Organization (WHO) and embraced by the United States and United Kingdom, encompasses three key features:

• No compulsory testing
• Protecting through confidentiality
• Ensuring nondiscrimination

Rights and Protections

• Right to Information: Individuals have the right to be informed about HIV tests being conducted and their implications.
• Right to Refuse: Individuals have the right to refuse to undergo an HIV test.
• Confidentiality: The HIV status of individuals who have undergone testing should be kept confidential.
• Right Against Discrimination: Individuals have the right to be free from discrimination in employment based on their HIV status.

Balancing Interests

• The response raises important questions about balancing private and societal interests.
• Protecting confidential information benefits both individual privacy and public interest.
• Safeguarding confidentiality is crucial for the well-being of individuals who are HIV -positive.

Previous Attempts and Current Status

• Previous attempts, such as the 1989 Bill, were withdrawn due to protests from human rights groups and the WHO, who oppose isolation practices.
• While India has not officially adopted the integrationist response in its policies, it has not supported this approach with legislation to date.