Obligation to Treat

By Tom Smith, Ph.D.

 

As has been already mentioned, even after over 30 years and global public education programs, people are still misinformed regarding many aspects of HIV and fear the disease; this includes treatment providers. The current pending case against Western Dental cited above (see article 2C2) is a case in point. We are all vulnerable to our fears, biases, stereotypes and distorted thinking. Nevertheless, practitioners are still ethically obligated to provide treatment to this group of clients. No physician, social worker, dentist, physician’s assistant, nurse, counselor or psychologist can refuse treatment to an entire class of people including those infected with HIV. This does not mean, however, that one must work in an area within which one lacks the expertise or when countertransference problems interfere with appropriate treatment.

Knowledge defeats fear, clarifies the situation and offers avenues of treatment. The treatment provider is obligated to competently practice within the boundaries of their education, training, certification, license, supervision and consultation. In many states, problems regarding the obligation to treat are expected to be overcome through mandated education to keep one’s license to practice. It is no longer acceptable, ethical or legal to practice without being informed about HIV, including transmission, infection, treatment, prevention, special population and attendant psychosocial issues.

Ethics in the allied health fields require action to prevent and eliminate exploitation and discrimination of any person, group or class on the customary basis of race, ethnicity, national origin, physical characteristics, gender, sexual orientation, age, marital status, political or religious beliefs, mental or physical disability. One does not have to be at ease in working with these groups and their associated values and behavior; just educated, supervised and supported when working in uncharted territory. To the point: It is unethical to discriminate against anyone solely due to HIV infection. The Americans with Disabilities Act prohibits discrimination against HIV positive persons and prohibits any policy that denies or limits a person’s access to care.

Best Practices regarding duty to treat

The treatment provider must have an intimate knowledge of their own feelings about working with people who have HIV/AIDS, about sexual orientation, sexual behavior, drug and alcohol use, poverty and lack of education and how that may affect treatment. The provider must have a plan, guidelines or philosophy about treating HIV issues and adequate supervisory or collaborative support.

Be fully knowledgeable, at least as the state requires and at best comprehensively, regarding all aspects of HIV/AIDS: transmission including sexual practices (anal and vaginal intercourse or bizarre sexual behaviors), bodily fluids, needle sharing; prevention, including safe sex, use of condoms and informing partners of one’s status; and treatment modalities (which are in constant change).

If the provider is HIV negative, be aware of unfounded fears regarding infection and working with HIV positive people and if the provider is positive, what personal disclosure situations might arise and how they may be dealt with; i.e., for what reasons one might disclose or not one’s status.

Know and network with local HIV service organizations. Know what services are available. Have printed materials available. Be aware of government services from the local, state to federal level; for example, AIDS Drug Assistance Programs (ADAP) and Ryan White Care Initiatives. Find out where others are getting help in your local area.

References

Adler, G., Beckett, A., Psychotherapy with the patient with an HIV infection: Some ethical and therapeutic dilemmas. Psychosomatics. (30) Spring 1989.

Hayes, J. A., & Gelso, C. J. (1993). Male counselors’ discomfort with gay and HIV-infected clients. Journal of Counseling Psychology, 40(1), 86-93.

Nelson, J. B. (1981). Religious and moral issues in working with homosexual clients. Journal of Homosexuality, 7(2-3), 163-175.

Ryan, C., Rowe, M. (1988) AIDS: Legal and Ethical Issues. Social Casework, June.

Wood, G., Marks, R., and Dilley, J. (1992) AIDS Law for Mental Health Professionals. Berkeley, Celestial Arts. 626 Words