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PubMed1990

A seroprevalence survey for human immunodeficiency virus antibody in mentally retarded adults.

The prevalence of human immunodeficiency virus (HIV) infection among adults who are mentally retarded is not known. Policies for those in residential settings are being established despite incomplete information. Knowledge regarding HIV seroprevalence would enable administrators to make more effective policy decisions concerning testing and HIV prevention. Discarded sera from mentally retarded adults were anonymously tested for HIV antibody. Sera were collected from a health facility in Westchester County, NY, that provides care to developmentally disabled adults. After identifications were removed, sera were coded and linked to demographic and clinical variables from hospital and laboratory records. Sera came from individuals living in both institutional and less restrictive community settings in metropolitan New York City and more distant locations in New York State, all of whom were seen by the above facility. No HIV antibody was detected in sera from 241 mentally retarded adults. This study suggests that the prevalence of HIV antibody in mentally retarded adults is not high. Mandatory screening programs may not be appropriate for these individuals. Monies might be better spent on educational programs directed at AIDS prevention, and further development of ethical and safe policies for those who are mentally retarded.

Adolescent↗
PubMed1990

Ethical concerns about AIDS.

The HIV/ARC/AIDS story continues to unfold. It is both the old, sadly familiar experience of plague and disease, of lepers isolated as unclean, of smallpox decimating the American Indians, of a Black Death sweeping medieval Europe, of the 1918 influenza. It is also a new story, one in which medical scientists rather quickly identified the causative infectious agent but, as yet, have been unable to cure the infection, although some amelioration of the basic course of the illness appear possible if treatment with AZT is begun relatively early. The ethical problems are numerous and constantly change as the understanding of the disease and its potency evolves. The social answers have, after initial delay, received positive action on an official level. On the more personal level of the average American there remains animosity, prejudice, and a deeply rooted fear, the ancient fear of the leper, of the plague victim. The health professionals have also officially responded well to the challenge of AIDS. Personally, as in society generally, there has been a mixed response. We believe that the ethical concerns enumerated in this article will be resolved in favor of persons with AIDS. Nevertheless, the personal, spiritual, emotional, and economic isolation experienced by persons with AIDS and their families challenge us about what kind of society we wish to be. We will ultimately be measured as a civilization by the way in which we treated the least fortunate. America's track record in this regard has been mixed. AIDS presents us with a chance to change.

Acquired Immunodeficiency Syndrome↗
PubMed1990

A survey of exposures, practices and recommendations of surgeons in the care of patients with human immunodeficiency virus.

Policy makers face a conflict between satisfying concerns of health care workers (HCW) about the occupational risk of human immunodeficiency virus (HIV) infection and ensuring adequate care for patients. This conflict is particularly severe in the field of surgery. We mailed a questionnaire on the surgical care of patients infected with HIV to 1,461 surgeons in New York City and Philadelphia, and 551 (37.7 per cent) responded. Although 1.9 per cent currently were testing all patients for HIV, 42.6 per cent of surgeons believed that all patients in their hospital should be tested. Of the surgeons who responded, 6.3 per cent refused to treat any patient infected with HIV. Less than 50 per cent recommended the use of barrier precautions on all patients in their hospital. Surgeons in New York City were significantly more likely than those in Philadelphia to favor separate facilities for HIV-infected patients. Surgeons considering themselves at higher occupational risk were more likely than those at lower risk to favor widespread testing, separate facilities and use of precautions. Surgeons reported a wide range of opinions. Their approach to the use of barrier precautions differs from the Centers for Disease Control recommendations. The patterns observed suggest that distinct policies may be appropriate for different hospitals.

Female↗
PubMed1989

The ethics of statutory coercion in the treatment of chemical substance abuse/dependence (addiction).

Many countries, including the Republic of South Africa, have introduced legislation providing for statutory treatment in cases of chemical substance dependence (addiction). Many more countries, including Canada and the United States of America, have made various attempts at the introduction of similar legislation in the face of an escalating drug abuse problem, only to have such legislation successfully challenged by various civil rights groups protesting about the "infringement of individual rights." This paper will examine some of the practical implications of coercive treatment of chemical addiction against the background of the principles of the rights of the individual. It will examine the feasibility of legal protection for such individual rights with simultaneous insistence on constructive treatment intervention. It will also raise many topics for discussion in terms of the role of the "helping professions", the well-worn tenet of "Am I my brother's keeper?" and the sociological poser of "the benefit of the community."

Behavior Control↗
PubMed1989

Legal and ethical issues in the use of antiandrogens in treating sex offenders.

Antiandrogen treatment of sexual offenders raises serious legal and ethical considerations in both the medical profession and in the courts. Discussion is offered on the use of antiandrogens in both an involuntary and voluntary context. The potential negative impact of this treatment modality on such constitutional issues as privacy interests, right to procreative freedom, freedom of speech and communication, and freedom from cruel and unusual punishment is explored and notable, germane court cases are presented. The need for clear ethical guidelines for the administration of this treatment is stressed.

Androgen Antagonists↗
PubMed1989

The paraphilias and Depo-Provera: some medical, ethical and legal considerations.

Paraphilic disorders are Axis I psychiatric afflictions. They are not acquired by volitional decision, but are manifested by the association of erotic arousal with unacceptable behavior or stimulae (e.g., children). Because paraphilic behavior occurs in the service of a biological drive, use of medication to suppress sexual appetite may constitute an adjunct in treatment. Medroxyprogesterone can be used to decrease unacceptable erotic urges and fantasies, with the intent of increasing self-control. Such treatment should not be forced upon an unwilling person. Conversely, persons should not be denied access to treatment by laws which deter seeking help, or because of incarceration, parole, or probation.

Androgen Antagonists↗
PubMed1989

Involuntary administration of medication in the community: the judicial opportunity.

In a state in which patient refusal of antipsychotic medication in all nonemergency situations must be respected, lawyers and psychiatrists in western Massachusetts have employed probate court decisions as involuntary outpatient treatment orders. The legal, administrative, and clinical issues in sustaining court-ordered outpatient treatment are discussed by focusing on case examples demonstrating some successes, some challenges, and some failures. Judicially sanctioned involuntary outpatient treatment presents an alternative model to statutorily based outpatient commitment.

Adult↗
PubMed1989

The impact of AIDS on state public health legislation in the United States: a critical review.

This article reviews and analyzes the current public health legislation in 17 states and the District of Columbia in the United States. These states were selected and grouped into high, medium, and low incidence based on their annual AIDS incidence rates. Data were collected through a combination of library research and direct communications with the various state health departments. Four major areas of legislation were reviewed: HIV antibody testing and reporting; confidentiality and partner notification; personal control measures: and AIDS antidiscrimination laws. In general, majority of the states have treated the AIDS epidemic as a public health problem and not as a moral or criminal issue. Some states with higher incidence such as New York and California have developed the least restrictive laws and responded with stronger AIDS antidiscrimination legislation. The states with medium incidence have more restrictive measures and the low incidence states have less legislation and fewer regulations related to AIDS. AIDS educators should be aware of the implications of the varied legislation and regulations on AIDS education and prevention. They should play a strong advocacy role in promoting the development and application of measures that will facilitate the prevention and control of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Screening for HIV.

Explore the source record for details and available documents.

AIDS Serodiagnosis↗
PubMed1989

AIDS: social, legal, and ethical issues of the "third epidemic".

The "first" and "second" epidemics of AIDS are considered to be the spread of HIV infection and subsequent development of AIDS cases; what has been termed the "third epidemic" is the widespread economic, social, and cultural reaction to the disease, raising crucial social, humanitarian, and legal issues. This article deals with four questions arising from these issues: (1) What is the best public health approach to people with HIV/AIDS, and what rights should they have? (2) Who should be subjected to mandatory testing? (3) Who has a right to know or be warned if someone has HIV/AIDS? and (4) How can society be protected against people who irresponsibly or deliberately set out to infect others? It is concluded that, as recommended by the World Health Organization, policies which balance concern for public health with respect for individual rights are both the most humane and the most effective ways to control the spread of AIDS.

AIDS Serodiagnosis↗