f. Distancing Behavior. The only consolation left for an isolated and dying
AIDS patient is the kind word, tender look, or comforting touch that sometimes only a
primary care giver can offer. When nurses execute their duties with a detached and
guarded concern for the risks of their own exposure, they cannot provide the caring that
is so crucial at the very point when the technology side of medicine cannot do much
more.
(1) Immediate family members who care for dying AIDS patients in the
home have not contracted AIDS, even though they handle soiled bed sheets and come
in close contact with the patient.
(2) When health care providers drastically minimize all contact, even those
that would benefit the patient without involving risk to themselves, they are not living up
to their code of ethics. Fear that distances the health care provider from the AIDS
patient to that extent gets in the way of fulfilling the ethical requirements of the job.
g. Acquired Immunodeficiency/Human Immunodeficiency Virus--Related
Bias Growing Faster than the Disease. A review of 13,000 reported cases of AIDS
discrimination, performed by Nan D. Hunter for the American Civil Liberties Union in
1990, revealed that discrimination against people with AIDS has steadily increased.
This is the case, even though most people realize that the disease cannot be spread by
casual contact. The study revealed that even people who know that the disease is not
spread casually will sometimes prevent people with AIDS from keeping jobs, getting
housing, insurance coverage, or medical care. About 30 percent of the cases of
discrimination were not against those already infected, but against those perceived to
be at risk, or those who cared for AIDS patients. The cases varied from a dentist who
overcharged AIDS patients, to doctors and dentists who would not treat AIDS patients
at all, to a woman who lost her job because she volunteered to be a 'buddy" at an AIDS
clinic.30 The number of cases reported increased from less than 400 in 1984 to 92,548
in 1988, the last year for which data were available. The greatest number of reported
cases (37 percent) occurred in employment, though no instances of transmission in the
workplace (outside the health care setting) have been reported.31
(1) Discrimination in health care services accounted for 9.9 percent of all
reported discrimination in this study. Health care discrimination included doctors and
nurses who refused to treat AIDS patients. The high number of discrimination
complaints in health care, especially by dentists and nursing homes, is particularly
alarming since health care is an essential service. The report described cases in 25
states and the District of Columbia, including several states in which doctors flatly
refused to care for people infected with the virus. Larry Gostin, Head of the American
Society of Law and Medicine, says that discrimination in health care can be much more
sophisticated, taking the form of "systematic attempts to transfer people to other doctors
or hospitals, especially to public hospitals."33
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