Questioning bioethnics: AIDS, sexual ethics, and the duty to warn

Hasting Center Report

Volumn 29, Issue 5, 1999, Pages 26-35

  Ainslie, Donald C ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ACQUIRED IMMUNE DEFICIENCY SYNDROME; ATTITUDE TO HEALTH; BIOETHICS; BIOETHICS AND PROFESSIONAL ETHICS; ETHICIST; FEMALE; HEALTH CARE AND PUBLIC HEALTH; HOMOSEXUALITY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS 1; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; IMMUNOLOGY; INFORMED CONSENT; INTERPERSONAL COMMUNICATION; MALE; MORALITY; PROFESSIONAL PATIENT RELATIONSHIP; PROFESSIONAL STANDARD; PSYCHOLOGICAL ASPECT; REVIEW; SEXUAL BEHAVIOR; SOCIAL PSYCHOLOGY; TRUST;

BIOETHICS AND PROFESSIONAL ETHICS; HEALTH CARE AND PUBLIC HEALTH; PROFESSIONAL PATIENT RELATIONSHIP;

ACQUIRED IMMUNODEFICIENCY SYNDROME; BIOETHICS; DISCLOSURE; DUTY TO WARN; ETHICISTS; FEMALE; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HIV SEROPOSITIVITY; HIV-1; HOMOSEXUALITY, MALE; HUMANS; MALE; MORAL OBLIGATIONS; PROFESSIONAL ROLE; SEXUAL BEHAVIOR; SOCIAL VALUES; TRUST;

EID: 0033183533     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: 10.2307/3527734     Document Type: Article

References (70)

1. See, for example, Morton E. Winston, "AIDS and a Duty to Protect," Hastings Center Report 17, no. 1 (1987): 22-23;
2. Richard L. North and Karen H. Rothenberg, "The Duty to Warn 'Dilemma': A Framework for Resolution," AIDS and Public Policy Journal 4 (1989): 133-41;
3. Ferdinand Schoeman, "AIDS and Privacy," in AIDS and Ethics, ed. Frederick G. Reamer (New York: Columbia University Press, 1991), pp. 240-76.
4. Patton calls this the "dont-ask-don't-tell strategy": Cindy Patton, Fatal Advice: How Safe-Sex Education Went Wrong (Durham, N.C.: Duke University Press, 1996), p. 29.
5. For discussions of the development of the safer sex ethic within the gay community, see also Douglas Crimp, "How to Have Promiscuity in an Epidem-ic," in AIDS: Cultural Analysis, Cultural Activism, ed. Douglas Crimp (Cambridge, Mass.: MIT Press, 1988), pp. 237-71;
6. Cindy Patton, Inventing AIDS (New York: Routledge, 1990);
7. David L. Chambers, "Gay Men, AIDS, and the Code of the Condom," Harvard Civil Rights-Civil Liberties Law Review 29 (1994): 353-85.
8. Bayer also points to a neglect of the sexual responsibility question, Ronald Bayer, "AIDS Prevention - Sexual Ethics and Responsibility," NEJM 334 (1996): 1540-42.
9. One of the few discussions of sexual responsibility in the AIDS context is Michael Yeo, "Sexual Ethics and AIDS: A Liberal View," in Perspectives on AIDS: Ethical and Social Issues, ed. Christine Overall and W. P. Zion (Toronto: Oxford University Press, 1991), pp. 75-90.
10. See especially Larry Kramer's 1978 novel Faggots (New York: Plume)
11. and the response it engendered in the gay press, discussed in S. Seidman, Embattled Eros: Sexual Politics and Ethics in Contemporary America (New York: Routledge, 1994), ch. 4.
12. People with AIDS Coalition, "Founding Statement (The Denver Principles)," in AIDS: Cultural Analysis, Cultural Activism, ed. Douglas Crimp (Cambridge, Mass.: MIT Press, 1988), pp. 148-49.
13. For empirical studies of the sexual behavior of people with HIV and the frequency of disclosure of HIV status, see: Gary Marks, Jean L. Richardson, Norma Maldonado, "Self-Disclosure of HIV Infection to Sexual Partners," American Journal of Public Health 81 (1991): 3321-22;
14. Neil S. Wenger, Francoise S. Kusseling, Keith Beck et al., "Sexual Behavior of Individuals Infected with the Human Immunodeficiency Virus," Archives of Internal Medicine 154 (1994): 1849-54.
15. Daniel C. Berrios, Norman J. Hearst, Thomas J. Coates et al., "HIV Antibody Testing among Those at Risk for Infection," JAMA 270 (1993): 1576-80.
16. Ronald Bayer, Private Acts, Social Consequences: AIDS and the Politics of Public Health (New Brunswick, N.J.: Rutgers University Press, 1989), p. 190.
17. Patricia Illingworth, AIDS and the Good Society (London: Routledge, 1990), p. 32.
18. Walt Odets, In the Shadow of the Epidemic: Being HIV Negative in the Age of AIDS (Durham, N.C.: Duke University Press, 1995), pp. 99-122.
19. Sheila R. Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History (New York: Basic Books, 1994).
20. Chalmers, "Gay Men," p. 362.
21. See also: Gabriel Rotello, Sexual Ecology: AIDS and the Destiny of Gay Men (New York: Plume, 1998), p. 155.
22. See Robert Padgug and Gerald M. Oppenheimer, "Riding the Tiger: AIDS and the Gay Community," in AIDS: The Making of a Chronic Disease, ed. Elizabeth Fee and Daniel Fox (Berkeley: University of California Press, 1992), pp. 245-78.
23. Odets, In the Shadow of the Epidemic, pp. 166, 179.
24. Odets, In the Shadow of the Epidemic, pp. 71-73;
25. Patton, Inventing AIDS, p. 9.
26. People with AIDS Coalition, "Founding Statement," p. 149.
27. David Feinberg, Queer and Loathing: Rants and Raves of a Raging AIDS Clone (New York: Viking, 1994), p. 67.
28. Charles Barber, "AIDS Apartheid," NYQ 2 (3 November 1991): 42-45.
29. Tarasoff, Vitaly v. The Regents of the University of California, 17 Cal.3d 425.
30. See the seminal Special Supplements to the Hastings Center Report: Carol Levine and Joyce Bermel, eds., "AIDS: The Emerging Ethical Dilemmas," Hastings Center Report 15, no. 4 (1985);
31. Carol Levine and Joyce Bermel, eds., "AIDS: Public Health and Civil Liberties," Hastings Center Report 16, no. 6 (1986);
32. Kathleen Nolan and Ronald Bayer, eds., "AIDS: The Responsibilities of Health Professionals," Hastings Center Report 18, no. 2 (1988).
33. Sheldon H. Landesman, "AIDS and a Duty to Protect" [Case Commentary], Hastings Center Report 17, no. 1 (1987): 23.
34. See North and Rothenberg, "The Duty to Warn 'Dilemma'," p. 134. A somewhat similar concern animated a dissent in Tarasoff 1974, J. Clark (dissent), J. McComb concurring. 1976, J. Clark (dissent), J. McComb concurring.
35. Interestingly, professional organizations and governments have sometimes opted for policies involving only a permission to warn, not a duty to warn. See, for example, American Psychiatric Association, Ad Hoc Committee on AIDS Policy, "AIDS Policy: Confidentiality and Disclosure," American Journal of Psychiatry 145 (1988): 541-42;
36. Commonwealth of Pennsylvania, Confidentiality of HIV-Related Information Act, 1990, P.L. 585, No. 148; §7609;
37. American Medical Association Board of Trustees, "Prevention and Control of Acquired Immune Deficiency Syndrome: An Interim Report," JAMA 258 (1987): 2097-2103, at 2103. Whether the common law duty to warn doctrine formulated in Tarasoff would override these policies is unclear.
38. Winston, "AIDS and a Duty to Protect," p. 22.
39. Landesman, "AIDS and a Duty to Protect," p. 23.
40. Jeffrey Kelly, "Counseling HIV-Positive Patients Who May Still Practice Unsafe Sex," in A Portfolio of AIDS/STD Behavioral Interventions and Research, ed. L. S. Bond (Washington, D.C.: Pan American Health Organization, 1992), pp. 156-60, at 157.
41. AMA Board of Trustees, "Prevention and Control," p. 2103.
42. Morton E. Winston, "AIDS, Confidentiality and the Right to Know," Public Affairs Quarterly 2 (1988): 91-104, at 97.
43. People with AIDS Coalition, "Founding Statement," p. 148.
44. See also Rotello, Sexual Ecology, pp. 229-32.
45. C. Everett Koop, "Physician Leadership in Preventing AIDS," JAMA 258 (1987): 2111.
46. Antonia Novello, Surgeon General's Report to the American Public on HIV Infection and AIDS (Washington, D.C.: Office of the Surgeon General, 1993).
47. AMA Board of Trustees, "Prevention and Control," p. 2098.
48. Lawrence Gostin, "The AIDS Litigation Project. A National Review of Court and Human Rights Commission Decisions, Part I: The Social Impact of AIDS," JAMA 263 (1990): 1961-70.
49. See also Chalmers, "Gay Men," pp. 380-85. In a judgment issued too late to be taken into account in this essay, Canadian Supreme Court recently ruled that someone who fails to disclose his HIV-positive status in order to influence another to consent to unsafe sex with him commits aggravated assault (R. v. Guerrier [1998], File No. 25738).
50. Tom L. Beauchamp and James S. Childress, Principles of Biomedical Ethics, 4th ed. (New York: Oxford University Press, 1994), p. 3, emphasis added.
51. Gilbert Meilaender has recently documented how contemporary bioethics has been dominated by a social policy-professional ethics approach. Gilbert C. Meilaender, Body, Soul, and Bioethics (Notre Dame, Ind.: University of Notre Dame Press, 1995), pp. 1-36.
52. Rotello, Sexual Ecology, pp. 135-62.
53. See also: D. C. Turner, Risky Sex: Gay Men and HIV Prevention (New York: Columbia Press, 1997);
54. R. Stall, M. L. Ekstrand et al., "Relapse from Safer Sex: The Next Challenge for AIDS Prevention Efforts," Journal of Acquired Immune Deficiency Syndrome 3 (1990): 1181-87.
55. Michelangelo Signorile, "HIV-Positive and Careless," New York Times, 26 February 1995;
56. Michael Warner, "Why Gay Men are Having Risky Sex," The Village Voice, 31 January 1995.
57. Rotello, Sexual Ecology, pp. 124-26.
58. Michelangelo Signorile, Life Outside: The Signorile Report on Gay Men: Sex, Drugs, Muscles, and the Passages of Life (New York: Harper Perennial, 1998), pp. 208-65.
59. For example, see the articles in Dangerous Bedfellows (Ephen G. Colter, Wayne Hoffman, Eva Pendleton et al.), eds., Policing Public Sex: Queer Politics and the Future of AIDS Activism (Boston: Sound End Press, 1996).
60. See also: Michael Warner, "Media Gays: A New Stone Wall," The Nation, 14 July 1997, pp. 15-19
61. and the letters to the editor in The Nation, 29 September 1997, pp. 31-32.
62. The Sex Panic! manifesto can be found at: http://www.cruisingforsex.com/ manifesto.html. For descriptions of the debate Sex Panic! has engendered see Caleb Crain, "Pleasure Principles," Lingua Franca, October 1997, pp. 26-37;
63. Sheryl G. Stolberg, "Gay Culture Weighs Sense and Sexuality," New York Times, 23 November 1997.
64. See, for example, Eve K. Sedgwick, The Epistemology of the Closet (Berkeley: University of California Press, 1990);
65. Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990);
66. Michael Warner, ed., Fear of a Queer Planet: Queer Politics and Social Theory (Minneapolis, Minn.: University of Minnesota Press, 1993).
67. Odets, In the Shadow of the Epidemic.
68. Signorile, Life Outside, pp. 323-25.
69. See Odets, In the Shadow of the Epidemic, p. 256.
70. Peter D. Kramer, "The Anatomy of Melancholy," New York Times Book Review, 7 April 1996.