NEW YORK (Jun. 17)
A man complains to his physician of poor health and requests an AIDS test. The test is positive and the doctor advises the man to bring in his wife for a test, too. The man warns the physician to stay away from the wife.
Does the physician have the obligation to respect the confidentiality and privacy of his patient or protect the life of the man’s wife and any unborn children?
This was one of many ethical dilemmas pondered by health professionals attending the Second International Congress on Ethics in Medicine here last week, co-sponsored by Ben-Gurion University of the Negev, Beth Israel Medical Center of New York and The Karolinska Institute of Sweden.
Participants presented papers on and debated the plethora of ethical, legal, social and economic dilemmas which the modern age has presented to health professionals.
They included Dr. Lechaim Naggan of Ben-Gurion University, who spoke at the Third International Conference on AIDS in Washington earlier this month. He captivated the conference with a discussion on the ethics of mandatory testing for the AIDS virus.
ACCEPTANCE OF GENETIC MANIPULATION
In a session Thursday on the religious implications of genetic engineering, Rabbi Charles Knoll of New York and Sister Corrine Bayley of California presented Jewish and Catholic positions on genetic manipulation of plants, animals and people.
Knoll, Bayley and a discussion group of about 20 participants reached a tentative consensus that genetic manipulation would be religiously acceptable by both faiths for the purpose of curing disease.
But genetic experimentation for other purposes, especially in humans, raises moral and spiritual dilemmas that religious groups have yet to resolve.
Rabbi David Feldman of Teaneck, N.J., said under Jewish law there is a “mandate to heal which is unconditional.” He said the debates over genetic manipulation for healing are reminiscent of the debates in earlier days over medicine. “It is a traditional problem,” Feldman said. “Can you intervene in nature … If God wants you sick, should man intervene?”
The answer, according to Jewish tradition, is unequivocally yes, he said. But in other faiths, such as Christian Science, the use of medicine is prohibited for precisely this reason, Feldman said.
Bayley said that in the Catholic tradition, human life and human dignity are sacred. Each case should be evaluated on its merits under these principles, she said.
Much like the technology to produce nuclear power for peaceful purposes has been used to create nuclear weapons, it would be difficult at best to control the knowledge used to genetically cure disease and prevent experiments to produce a perfect child or something more sinister, participants noted.
Knoll, who is also a physician, raised the multi-faceted problem of keeping track of the identity of the parents in genetic engineering of humans and in surrogate mothering.
The spread of the deadly AIDS virus throughout the world has generated a different set of ethical dilemmas apparently as complex and troubling as those surrounding genetic engineering.
Naggan, a professor of epidemiology, said the issue pits the civil and human rights of the high-risk groups (homosexuals, intravenous drug users and their sexual partners) against the obligation to protect the healthy public.
Preventing the spread of the disease means first identifying the infected people and then curbing their activity that passes on the disease–sexual contact, sharing needles or blood donations.
But Naggan said mandatory testing is difficult to institute. The stigma and widespread discrimination against AIDS victims and the high-risk groups is a disincentive to voluntary testing, he noted. A person in the high-risk groups faces discrimination in schools, jobs and a host of personal problems if he voluntarily takes the test and the results are positive.
On the other hand, a member of the high-risk group gains nothing by submitting voluntarily to an AIDS test because there is no known cure, even with early detection, Naggan said.
URGES SOME MANDATORY TESTS
Mandatory screening for all is the most democratic method, Naggan said, and it reduces the stigma of the high-risk groups, but the cost is prohibitive. Mandatory screening for the high-risk groups makes more sense economically, Naggan said, followed up by contact with the sexual partners of those who test positive.
“Privacy issues should not interfere in trying to prevent the spread of the disease to the healthy population,” Naggan said.
The current methods of piecemeal testing of blood donors, military conscripts and federal prisoners are seriously deficient, Naggan said. “The price for not screening is much greater than the risk of personal discrimination,” he said.
Naggan warned that if governments do not adopt the needed legislation immediately, extremist views ruled by paranoia and the advocacy of “concentration camp” for AIDS victims may prevail in politics and threaten human rights and democratic values.
SCOPE OF PROBLEM UNKNOWN
The scope of the problem in the U.S. is impossible for health workers to gauge, he said, as there is no program of organized testing. AIDS statistics are based largely on unreliable estimates and samples of small and probably unrepresentative segments of society such as blood donors, he added. Compounding the problem, he contended, is the government’s inaction on AIDS legislation, due to the public’s fear, panic and irrationality surrounding AIDS.