Public Health Ethics Reflection Paper



Public Health Ethics Reflection Paper

Crystal J. Bendele

Ferris State University

Abstract

Health policy and ethical issues surrounded the topic of the HIV infection in the early 1980s. Before much was known about this deadly disease, ethical issues regarding the rights of heterosexuals and homosexuals broke out in a rampage. As health policymakers struggled to make ethical decisions based on CDC recommendations to control the potential harm caused from this epidemic, it was difficult for particular social groups not to feel discriminated against. This paper explores a major issue in health policy that was identified in the movie, And the Band Played On. It identifies with an ethical framework best suited for implementing policy during a crucial time in history as the HIV virus emerged and became an epidemic.

Public Health Ethics Reflection Paper

The ethical issue chosen to explore and link with health policy deals with controlling the AIDS epidemic without discriminating against gays or infringing on others’ rights (Walters, 1988). While watching the movie, And the Band Played On, the health policy issue identified was the attempt of the CDC to control the epidemic and prevent further spread of the disease. The fact that little was known about the disease and initially there was not any proof that the disease was spread through sexual contact made it difficult to implement health policies that public health officials believed would help prevent the spread of the disease and protect the population. Because this disease was initially believed to be a disease among men who have sexual relations with other men, ethical issues surrounding the disease and the stigma of the hosts were many. The focus here reflects on the earliest days of the HIV infection and AIDS and the collision of health policies and ethical issues surrounding the disease.

Past Challenges with the AIDS Epidemic

In the 1980s, public health officials were forced to confront the challenge of the AIDS epidemic (Bayer, 1991). Little information was known about this disease that was killing members of a specific population. The CDC worked to identify the disease and mode of transmission, but, nothing was for certain in the early days. They did however, believe that the disease was spread through sexual activities between men. One of the health policies identified because of their studies included closing of bathhouses in an attempt to prevent the spread of this disease. The attempt to prevent the spread of what we now know as HIV resulted in closing the cities’ bathhouses. Because sexual encounters happened onsite at bathhouses and the CDC believed the infection was spread sexually, bathhouses posed a significant danger to public health. According to Kelley, an even more significant concern regarding the bathhouses was not just that sexual encounters occurred but the number of sexual encounters with multiple partners in which an infected person could engage (1992). Because the disease was linked to homosexual men and believed to be sexually transmitted, the CDC had a valid argument that closing bathhouses could potentially prevent the spread of the disease. However, this gesture would not prevent men from participating in sexual acts with other men. It would however, hopefully decrease the number of partners and decrease the incidence (Kelley, 1992). This suggestion left homosexuals feeling discriminated against and tension was built between public health and individuals’ rights.

Ethical Aspect and Public Health

Kelley stated that bioethical issues to be considered from a public health aspect include: a public versus individual health, public versus individual rights, and seriousness of disease issues (1992). Issues that must be weighed include benefits versus harm of policies, rights or freedom of those affected by the policies and distribution of the outcomes within the population (Kelley, 1992). There was no question that the government had the power to close bathhouses for the sake of public health, but, was this the morally right thing to do? This becomes an ethical issue in that it may not respect the rights of all parties at stake. However, the Rights Approach to this ethical dilemma may not be the best choice when people’s lives are at risk. Perhaps, using the Utilitarian Approach would be the best choice of framework in which to base the decision on whether or not to close the bathhouses. The argument here is that if men choose to participate in sexual activity with other men they will find another place other than a bathhouse. However, closing the bathhouses might have reduced the rate of spread of infection. On the side of public health, since the belief of the CDC was that the disease was transmitted sexually and most cases were among homosexual men the correct action was to close the bathhouses. This was the best decision for the greater good of this high risk population.

From an ethical standpoint, implementing a policy to close bathhouses did not cause harm to men that frequented them. Harm was prevented because multiple sexual partners increase the risk of infection and closing bathhouses affected the source of partners (Frankena, 1973). Frankena recognized that psychological harm may have been caused due to disruption of social networks (1993). The issue was ethnically problematic however, the outcome was supposed to decrease physical harm even though there may be sufferers of psychological harm. In the absence of vaccine, effective treatment, or cure, it became evident almost immediately that the only weapon against AIDS was a preventive measure: education (Silverman & Silverman, 1985).

Education as an Alternative

A principle function of public health agencies has always been to inform the community about disease and to promote health, placing much of the responsibility on individuals to act in the light of facts presented (Silverman & Silverman, 1985). Silverman & Silverman also stated that the task of formulating appropriate recommendations for behavior to reduce the risk of contracting AIDS was hampered by initial confusion about the exact mechanism of transmission and what constituted safe sexual practices (1985). The recommendations from the CDC to close the bathhouses may have been the most rapid measure for the greater good of the at risk population. However, according to Kelley, education programs would have been a less restrictive alternative than closing the bathhouses (1992). Leroy Walters later argued that imaginative public health education would be moral education in the sense that it helped the hearer see clearly the possible effects of his or her behavior on others (1988). This argument could be beneficial, however, after the identification of the virus and the certainty of it being a sexually transmitted disease. Ethically, Walters suggests, promotion of legal prohibition of discrimination against people who engage in private homosexual acts (1988). To reduce the fears about being stigmatized would encourage homosexual and bisexual males to disclose their patterns of sexual activities and could lead to discussions of risk reducing practice (Walters, 1988). At the time, because little was known about the virus, a discrimination free environment for homosexuals may have provided information for a more rapid identification of the virus and transmission routes. This information would have provided possible insight into measures that could prevent disease. The incidence rate may have been decreased had gays not felt stigmatized and discriminated against and allowed to express their position from the beginning. However, on the defense of the gays, it may be difficult to open up and discuss a topic with such high stigmatism.

Blood Donation Stance

A second public health issue that was tied to an ethical dilemma identified in the movie included the prevention of blood donations from the at risk population. Once the virus was identified in blood, vulnerable populations such as hemophiliacs were at risk if health policies were not in place to protect them. Homosexuals argued that because this was initially identified as a gay disease, they were being discriminated against. The ethical argument is placing the entire population at risk of death by not applying a policy to prevent high risk individuals from donating blood. This infringed on individuals’ right to live. Once again, this issue is best approached using the Utilitarian Approach. It can be argued that dying from an unknown disease that is spread through blood products is less harmful than dealing with emotional effects suffered from discrimination.

Ethical Framework

When implementing health policies, it is crucial to utilize an ethical framework from which to draw ideas. According to Santa Clara University, after recognizing the ethical issue by asking the question, ‘could this decision or situation be damaging to someone’ (2009). They also recommended obtaining all of the facts prior to making decisions. Perhaps, this is why there was difficulty in implementing health policies regarding closure of bathhouses. It was initially difficult to prove that the disease was spread sexually. That made it difficult for the at risk population to accept. The ethical issues presented by AIDS as a public health event will be pondered by health professionals, bioethicists, and sociologists for years to come (Silverman & Silverman, 1985). The ethical standpoint from which the conclusion is drawn is that at the time of the first recognition of the disease, public health officials made the correct decision for the greater good of the population.

References

Bayer, R. (1991). Public health policy and the aids epidemic-an end to hiv exceptionalism. The New England Journal of Medicine, 324.

Frankena, W. (1973). Ethics. Englewood Cliffs, NJ: Prentice Hall.

Kelley, J. (1992). Community health and ethical theory: implications for holistic nursing. Journal of Holistic Nursing, 10(3), doi: 10.1177/089801019201000307

Sandford, M., & Pillsbury, S. (Producers), & Spottiswoode, R. (Director). (2010). And The Band Played On [Motion picture]. USA: Warner Brothers.

Silverman, M.F., & Silverman, D.B. (1985). AIDS and the Threat to Public Health. The hastings center report. Retrieved November 24, 2010, from

Velasquez, M., Moberg, D., Meyer, M.J., Shanks, T., & McLean, M.R. (1988). A framework for thinking ethically. Informally published manuscript, Markkula Center for Applied Ethics, Santa Clara University, Santa Clara, California. Retrieved from

Walters, L. (1988). Ethical issues in the prevention and treatment of hiv and aids. Science, 239(4840), doi: 10.1126/science.3340846

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