The ethical approach to AIDS: a bibliographical review

Ethical decision making in dental education: a preliminary study

BACKGROUND

In terms of ethical decision making, every clinical case, when seen as an ethical problem, may be analyzed by means of four topics: medical indications, patient preferences, quality of life, contextual features. The aim of this study was to compare the performance of 4th year dental students on Ethical Decision Making before and after a course on ethics.

METHODS

Fourth year dental students (n = 37) from academic year 2013-2014 participated in the study. A 3-h lecture, which was about four topics approach to clinical ethical case analysis, was given to the students. The lecture was based on case scenarios related with dental ethics. After the completion of lectures,a case scenario was presented to the students to assess their ethical decision making abilities. At the end of the exam, four topics and ethical judgment were evaluated. Their performances on this examination were evaluated before and after lectures. Statistical evaluation was performed with the significance level set at p < 0.05.

RESULTS

A statistically significant difference was found between the means of four topics (p < 0.05). There was no statistically significant difference between the mean scores of judgment of ethical decision (p > 0.05). The mean total score of the students after the course was significantly higher than before course (67.5 and 54.4, respectively; p < 0.05).

CONCLUSION

More lectures should be implemented to the curriculum to increase the student awareness of ethical issues and to reach the ultimate goals of dental education.

HIV/AIDS and bioethics: historical perspective, personal retrospective

Problems posed by HIV/AIDS differ from those of past epidemics by virtue of unique properties of the causative agent, dramatic societal changes of the late 20th century, and the transition of medical practice from a professional ethic to a technology-dependent business ethic. HIV/AIDS struck during the coming-of-age of molecular biology and also of bioethics, and the epidemic stimulated the growth of both disciplines. The number of articles published about AIDS and ethics (as identified by a MEDLINE search) peaked in 1990, just before the peak incidence of AIDS in the United States. The character of ethical dialogue has now shifted from familiar moral quandaries such as civil liberty versus public welfare to concerns about vaccine trials and public policy toward the developing world. Physicians and other health care workers who were involved from the onset endured something of an emotional roller coaster. Their compassion-based work ethic was to a large extent replaced by a competence-based work ethic after the introduction in 1996 of highly active antiretroviral therapy. The abundant recent literature on "professionalism" in medicine makes scant mention of AIDS/HIV. The disruptive effect of AIDS/HIV on society would have been substantially greater had relevant technology such as the ability to isolate retroviruses and potent therapy against tuberculosis not been in place. This sobering consideration, along with such recent events as the use of bioterrorism against civilian populations, suggests new relevance for Potter's definition of "bioethics" as a science of survival in which the biology of ecosystems must be taken into account.

Politics of monitoring and evaluation: Lessons from the AIDS epidemic

Monitoring and evaluation programs must strike a balance between generating meaningful tactical information for program managers while taking steps to ensure that public data use does not worsen discrimination and stigma toward people who are positive for the human immunodeficiency virus.

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

The bioethics tabloids: how professional ethicists have fallen for the myth of tertiary transmitted heterosexual AIDS

The hysteria and misconceptions about AIDS which are fostered and held by the popular press have been accepted uncritically by many bioethicists, who have not bothered to explore popular empirical claims in sufficient depth. As a result, and because ethicists attempt to sell moral problems in a manner not much different from the way the popular press attempt to sell newspapers, artificial dilemmas have been produced in professional journals. We concentrate on just one popular misconception about AIDS--that the heterosexual incidence of the syndrome is widespread--and show how bioethicists' unreflective acceptance of this myth has led them to make conceptual and practical errors.

The competing discourses of HIV/AIDS in sub-Saharan Africa: discourses of rights and empowerment vs discourses of control and exclusion

The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.

HIV/AIDS: the ethical and legal dilemmas

Regardless of personal feelings and fears, all healthcare practitioners have a duty to uphold the rights of HIV/AIDS patients. Dilemmas arise when the practitioner's responsibilities are split between upholding these rights and enforcing those of other at-risk individuals.

Ethical problems raised by anti-HIV vaccination

At present questions are being asked world-wide about the risk of the AIDS epidemic. The discovery of an anti-HIV vaccine has become an urgent priority, but it also raises a number of sensitive questions. Ethical problems in this field are particularly delicate, since the perspectives of individual health and public health do not seem to coincide. Our research team conducted a review of more than 400 articles on the ethical problems raised by AIDS. We concentrated particularly on the ethical and legal issues raised by research on anti-HIV vaccine. These problems fall into three main categories: therapeutic assays, which must be controlled by a strict agreement defined by international norms; manufacture of the future vaccine, raising legal difficulties which must be faced and solved now; distribution of the vaccine to the population, which should be conducted on a general basis, i.e. it should be offered to all individuals and not only to risk groups.

AIDS, a social dilemma: detection of seropositives

At present, we can observe an evolution in ideas about the detection of HIV seropositivity through a qualitative analysis of specialised literature on the ethical aspects of AIDS. In the case of this disease, systematic screening of the population does not correspond to epidemiological criteria: it is wasteful, troublesome and costly. Whether it is voluntary, and therefore biased, or compulsory, and therefore controversial, systematic screening seems an unlikely option. This situation has prompted many versions of target-group screening, which correspond to two options: systematic screening of known risk-groups, discriminatory, confidential and anonymous; target-group screening linked to particular circumstances: recognised as necessary by blood-donors and well-accepted by pregnant mothers. This method can be institutionalised and applied in the armed forces and in prisons,.... Lastly, we consider measures taken by different countries and organisations.