Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations

Abstract

The profound reluctance of some physicians to care for patients with acquired immunodeficiency syndrome prompted us to review medical responses to other historic plagues. No consistent professional tradition emerged. Many physicians, including Galen and Sydenham, fled from patients with contagious epidemic diseases. Many of their colleagues, at considerable personal risk, remained behind to care for plague victims. This inconsistency suggests that an ethic stressing traditional professional duties may not be ideal for defining the optimal relation of the medical profession to patients with acquired immunodeficiency syndrome. A new professional ethic to guide physicians in the acquired immunodeficiency syndrome pandemic is needed. This ethic cannot be entirely derived from these patients' right to health care, which is primarily a claim against society rather than individual practitioners. Civil and professional proscriptions against negligence or abandonment apply only to therapeutic relationships after they are contracted. However, a professional duty to treat human immunodeficiency virus-infected persons could be based on the understanding of medicine as a moral enterprise. In this context, treating human immunodeficiency virus-infected persons is a virtuous act, which meets both patients' and society's health needs and affirms the moral mission of health care.

KIE: The authors review the ambiguous history of physicians and of codes of medical ethics regarding the care owed to patients with contagious epidemic diseases. They argue that a new professional ethic is needed to define the physician patient relationship, especially now when some physicians are reluctant to treat AIDS patients. Zuger and Miles reject as incomplete both ethics based on patients' rights to health care, which are primarily a claim on the profession, and ethics based on a contractual relationship, which permit the physician to refuse to enter the relationship. They propose to add an ethic of virtue which sustains the moral purpose of medicine and mandates that, in voluntarily committing themselves to the profession of healing, physicians are obligated to undertake the treatment of persons presenting themselves for care.