The Meaning of AIDS: Implications for Medical Science, Clinical Practice, and Public Health Policy

Abstract

This first vol in the Studies in Health & Human Values series, presented in III PARTS & 18 Chpts with a Foreword by Albert R. Jonsen & an Introduction, offers essays by professionals in the humanities that are designed to shape & interpret the public knowledge & language about acquired immune deficiency syndrome (AIDS). Six different ways of considering AIDS are explored: a disease entity, an illness experience, a contagious infection, a fatal affliction, an epidemic, & a challenge to individual liberty. The interrelationships among these perspectives are examined, along with their implications for professional, personal, & social/political attitudes & responses to the AIDS problem. Introduction - Eric T. Juengst & Barbara A. Koenig -- The Many Meanings of AIDS. PART I - INTERPRETING OUR KNOWLEDGE OF A I D S - includes (1) Harold E. Varmus -- Naming the AIDS Virus; (2) Jana L. Armstrong -- Causal Explanations of AIDS -- uses Aristotle's typology of causation -- including material, formal, final, & efficient cause -- to demonstrate the importance of discourse in medical/biological science, & cautions against attributing causal rather than simply statistical significance to the AIDS virus; (3) Mary Ann Gardell Cutter -- Explaining AIDS: A Case Study -- employs a philosophical perspective to examine the stages involved in the construction of clinical explanations of AIDS that attempt to understand this problem both truly & effectively; (4) Judith Wilson Ross -- Ethics and the Language of AIDS -- discusses how metaphors for AIDS -- death, sin, crime, war, & civic division -- influence public policy, ethical judgments, & personal choices; (5) Joseph Cady & Kathryn Montgomery Hunter -- Making Contact: The AIDS Plays -- investigates how two well-known plays that opened in New York, NY, in 1985 -- William M. Hoffman's As Is, & Larry Kramer's The Normal Heart -- attempt to increase their audiences' awareness of the personal & social realities of AIDS; & (6) Julien S. Murphy -- The AIDS Epidemic: A Phenomenological Analysis of the Infectious Body -- examines the social construction of meanings attached to AIDS by the public, with focus on the fear of death & of the out-of-control body that underlies public panic. PART II - THE CLINICAL EXPERIENCE OF A I D S - continues with (7) Erich H. Loewy -- Duties, Fears, and Physicians -- describes the social contract that binds MDs to the community, & how MD fears affect their responsibilities to provide care to AIDS patients; (8) Barbara A. Koenig & Molly Cooke -- Physician Response to a New, Lethal, and Presumably Infectious Disease: Medical Residents and the AIDS Epidemic in San Francisco; (9) Bernard Lo -- Life-Sustaining Treatment in Patients with AIDS: Challenges to Traditional Decision Making; (10) Lawrence J. Nelson -- Law, Ethics, and Advance Directives Regarding the Medical Care of AIDS Patients; (11) Ray E. Moseley -- AIDS and the Allocation of Intensive Care Unit Beds; & (12) William J. Winslade -- AIDS and the Duty to Inform Others. PART III - A I D S AND THE PUBLIC HEALTH - offers (13) John C. Moskop -- Restrictive Public Health Measures and AIDS: An Ethical Analysis -- evaluates several potentially invasive or coercive public health measures against AIDS -- including screening, reporting, contact tracing, quarantining, & other restrictions on personal freedom -- & raises serious doubts about their justifiability; (14) Carol A. Tauer -- The Concept of Discrimination and the Treatment of People with AIDS -- summarizes two views on discrimination & responses to AIDS, argues that the notion is of little value for analyzing ethical issues, discusses society's legitimate interests in controlling the spread of AIDS, & describes several acceptable methods; (15) Timothy F. Murphy -- Quarantine in the AIDS Epidemic -- reviews previous attempts to deal with epidemics in the US through the use of quarantines or other exclusionary measures, & considers the practical & moral justifications behind recent proposals to enforce such measures in order to prevent the spread of AIDS; (16) Jacqueline J. Glover & Edward C. Starkeson -- Health Care Professionals and the Potential for Iatrogenic Transmission of AIDS: An Ethical Analysis -- presents evidence that the risks of iatrogenic AIDS transmission are low & argues against mandatory sreening, disclosure, & isolation measures, with focus on MDs who either work with AIDS patients or who have been diagnosed as having AIDS themselves; (17) Paul Carrick -- AIDS: Ethical, Legal, and Public Policy Implications -- discusses nine countermeasures that have been proposed or enacted by individuals, institutions, or US government agencies against AIDS, & refutes them on epidemiological, logical, & ethical grounds; & (18) Andrew R. Moss -- Coercive and Voluntary Policies in the AIDS Epidemic -- argues against the use of compulsory screening techniques in the battle against AIDS, describes how such coercive policy proposals are rooted in the stigma attached to homosexuality, & recommends voluntary public health methods, eg, education & testing. Chpt Notes include references. Bibliog of 40 items.