AIDS and the Duty to Treat Do physicians have a duty to treat HIV-infected patients? Must they subject themselves to the risk of becoming infected? physicians today are at minimal risk of contracting infectious diseases than they used to have at the pre antibiotic, antiseptic era.

The code of medical ethics started to revolve around the tradition that to be a physicians means willingness to take risk for the benefit of the patient. Epidemics of plague, influenza, yellow fever, are typical examples. AIDS era has compelled today's physicians to reopen the traditional inquiry into moral relationship between hazard and professional duty.

physicians view their response to treat AIDS patients as emanates from their oath to benefit the patient ( moral responsibility). Bioethicists question whether physicians still have their moral responsibility.

Bioethicists stress that patient-physicians relationship is a contract between free and equal moral agents. This view of voluntary relationship - reinforces that physicians have the right to choose who to treat. -failed to answer whether physicians has special duty to enter into contract with hazardous patients. If this the case then : Is voluntarism - as viewed by bioethicists- is an acceptable base for medical practice in the era of AIDS?

Protecting the vulnerable: Individual rights vs. professional obligations  HIV-infected patients are sick, in need for care.  As individuals they have right to receive care/ or at least the society have social duty to provide the care. The drawback of this argument: it exempts the physicians and put the responsibility squarely in the society through government.

Government can: - create a voluntaristic system and provide incentives, or - issue a social contract with health professionals In exchange for the performance of this service, physicians are granted monopoly over the practice of medicine (License).

This contract has established some sort of duty to treat. Thus improves upon the right-to-health care argument. This contract does not shoulder the responsibility on each physicians but on certain specialty and on level of care. Except in medical emergencies and physicians in public hospitals, still other licensed physicians can refer hazardous patients to others.

This contract (that is based on duty to treat) is compatible with voluntaristic system where professional is recognized to practice and the AIDS patient receive the care from those willing to serve. In theory every one seems to be satisfied (pts get decent care from willing physicians, unwilling physicians exempted from coercion, and willing physicians are rewarded) This is true with enough number of physicians willing to shoulder this responsibility. In practice, this contract put certain physicians under unfair pressure to treat AIDS patients and become exposed to higher risk of infection or burnout.

Other physicians, out of egalitarian response towards their colleagues may step forward to take their share of responsibility, but not to help the needy sick.(voluntary). If there is no enough number then voluntary system tend to harm patients.

Harm that come out of voluntaristic system can be expressed in several forms: 1. refusal to treat patients is in itself an insult. 2. delay in referring patients to those willing to treat result in significant harm. 3. the probability of lack of access or substandard level of care. 4. Even with enough physicians willing to treat, still the quality of care is open to question (AIDS=insane, criminal)

Results of 4100 dentists is a proof that professionals are not willing to treat HIV-infected patients. And if they do, it is a substandard level of care. If the system is unable to secure access and quality, this is the case then we have to go back and open the file of the traditional conceptions of the virtuous physicians.

Conceptions of the professional virtue.  The risk of contracting HIV from needle stick is 1 in 200 incidents. Although it is minimal but the risk is there.  This is an acceptable risk. However, certain physicians conclude that the risk is not worth running. How can this be explained? Is it voluntary or professional duty?

In refusing to treat AIDS, physicians seem to say “ I will risk my life for an innocent child but not for those who brought it upon themselves. Trying to sympathize with patient, physicians usually end with fear of what will happen to them and their families if they contracted the disease. If physicians are to be expected to put their lives in the line, the least the society can do is treat them and their families with gratitude and respect. Those who refuse to risk their lives for “e.g. homosexuals”, they are violating the basic duty: the duty to treat all patients with respect irrespective of their personal attributes, their social or economic status, or the nature of their disease.