AIDS and the Exodus.

Few of the memories of my youth stand out as clearly as those of the Seder nights when my family gathered, much as Jews have for millennia, and read from the Haggadah, the book that retells the story of the Exodus from Egypt and the creation of the Passover holiday. Most of all, I remember the following passage from the Haggadah, a responsive reading between the leader and those assembled:

Leader: The struggle for freedom is a continuous struggle, for never does man reach total liberty and opportunity.

Assembled: In every age, some new freedom is won and established, adding to the advancement of human happiness and security.

Leader: Yet, each new age uncovers a formerly unrecognized servitude, requiring new liberation to set man's soul free.

Assembled: In every age, the concept of freedom grows broader, widening the horizons for finer and nobler living.

Leader: Each generation is duty-bound to contribut to this growth, else mankind's ideals become stagnant and stationary.

Assembled: The events in Egypt were but the beginning of a force in history which will forever continue.

Leader: In this spirit, we see ourselves as participants in the Exodus, for we must dedicate our energies to the cause there begun.

The antiquated use of the gender-specific word "man" in the old Haggadah reaffirms that we must indeed respond to formerly unrecognized forms of servitude. But the passage also emphasizes the dynamic nature of freedom and liberty. Elsewhere in the Haggadah there is talk of the essence of Passover and how Passover relates to the elimination of all tyrannies whether due to a Pharaoh or other causes. The Haggadah talks of the tyrannies of poverty, privation, wealth, war, power, despair, ignorance, color, time, and disease. Years after the Exodus and the first Passover celebration, Jesus would sit at the Last Supper, a Seder, his most recent days having been spent in his own affirmation of the Passover message -- and among those he would minister to were lepers, the most freedom-deprived and despised people of their day.

We have long since abandoned the practice of ostracizing patients who have Hansen's disease and of blaming them for their illnesses. We have also stopped looking upon people who have tuberculosis as members of an underclass with a social stigma. Yet, as Sim and Purtilo warn us elsewhere in this issue, we may not have changed as much as we think. All too often we cloak primitive fears in modern rationalizations when it comes to patients who have acquired immunodeficiency syndrome (AIDS) or the human immunodeficiency virus (HIV).

The attitudes too many health professionals bring to the care of patients with AIDS reveal that, with each new generation, there are indeed new freedoms to be obtained because new forms of servitude are revealed. AIDS frightens us all. It should. Patients with AIDS should not frighten us, however; when we cannot rationally dissociate the person from the disease, we have stopped practicing in an era of modern medicine and have instead returned to an era of exhortation and incantation. It is as though we have marched backward in time.

Sim and Purtilo ably discuss the arguments that can be put forth in opposition to physical therapists treating patients who have AIDS. Of all the arguments, the one with the most credibility relates to the therapists' fear of becoming infected. Yet when reasonable precautions are taken, the likelihood of infection renders the argument theoretical, rather than real. No one can argue against reasonable precautions, such as the use of appropriate sterile procedures, but reasonable precautions do not include viewing the patient who has AIDS as an invading pathogen. If we send subtle messages of fear and hatred, and if we cannot respect the humanity of our patients with AIDS and freely respond to their legitimate needs, we will be abrogating our responsibilities as health care professionals and our duty as members of a modern society.

The greatest disservice we can do to ourselves and our profession, let alone to patients with AIDS, is to surrender to fear based on ignorance and to willfully remain ignorant. Bertrand Russell observed that "Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom." In the case of AIDS, wisdom in the form of knowledge about the disease can help combat our fear.

In our generation, I hope we may fulfill the injunction of the Passover Haggadah and ensure through our treatment of people with AIDS that our civilization has moved beyond the time when fear of disease led to imprisonment of the ill. Each generation is indeed duty-bound to contribute to the growth of freedom and justice that began in Biblical times. AIDS provides us with a challenge to prove that in the face of a horrendous disease we can live in a spirit in which we see ourselves as participants in the Exodus. Freedom from fear and superstition never seems easy to the generation engaged in the struggle. When we overcome fear and provide just treatment for all of our patients, we have shown a dedication to the spirit described at the Passover Seder. In overcoming fear and accepting and treating all patients, we establish new freedoms that, in the words of the Haggadah, advance human happiness and security, even in the fact of the oppressiveness of AIDS.