Rights and duties of HIV infected health care professionals

Protecting patients from harm: design and implementation of an institutional bloodborne pathogen protocol

BACKGROUND

Patients are sometimes exposed to the blood of health care workers (HCWs) while receiving medical care. No national guidelines exist that authoritatively articulate the responsibility of HCWs infected with a potentially transmissible bloodborne pathogen (BBP). Geisinger Health System crafted and implemented a policy delineating the responsibilities of an HCW in the event of accidental blood exposure of a patient, specifically addressing HCWs known to be infected with a BBP.

METHODS

In 2008, a multidisciplinary group convened to review available published resources from the American Medical Association, specialty society positions, state and national guidelines, Centers for Disease Control and Prevention, and Society for Healthcare Epidemiology, as well as selected commentaries.

RESULTS

A policy was crafted and enacted within a large integrated heath care system that provided clear guidelines and responsibilities for HCWs who are either infected with a BBP or expose patients to blood in the course of providing medical care. This policy balances the rights of both patients and providers.

CONCLUSIONS

The resources to devise policies regarding BBP exposure to patients are available but require distillation of complex scientific data and social and/or legal opinion or precedent. We offer Geisinger Health System's policy as a workable and readily accessible model that defines the obligations of providers to protect patients in the event of a BBP exposure.

The ethics of HIV testing and disclosure for healthcare professionals: what do our future doctors think?

AIM

This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure.

METHOD

A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author.

RESULTS

Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals.

CONCLUSION

This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.

Law, and Public Health Policy

Two of the most important tools that assist states in protecting their populations against threats to health are public health policy and public health law. Policy can exist without recourse to law, but where policy has been designed for a long-term purpose, and where voluntary compliance has not proved successful, policy may need the heavier hand of law for implementation. However, law is not always an appropriate mechanism for achieving public health objectives. This article explores the boundaries of public health policy and public health law, and examines how they might work as dual mechanisms for public health.