Printer Friendly

Legal risks and responsibilities of physicians in the AIDS epidemic.

Legal Risks and Responsibilities of Physicians in the AIDS Epidemic

The refusal of some physicians to care for AIDS patients has been met with general condemnation. Surgeon General C. Everett Koop, for example, has labeled them a "fearful and irrational minority" who are guilty of "unprofessional conduct" that "threatens the very fabric of health care in this country." [1] And a pointed editorial in the New York Times insisted that physicians who think their responsibility to themselves is greater than to their patients "need a new profession." [2]

But it is one thing verbally to label such behavior inappropriate, reprehensible, or unprofessional; it is quite another to do something about it. The issue of proper treatment for AIDS and HIV-infected patients should be primarily addressed by the ethics of the medical profession. It is, after all, medical practitioners who have the primary right and obligation to define the standards of their profession. However, should the profession fail to respond adequately to the needs of patients in an unprecedented epidemic, the law will rightfully continue to set a standard of minimum conduct below which no physician may fall without confronting the possibility of losing a malpractice or discrimination suit or even his license to practice.

This article's primary concern is to summarize the existing law relating to physicians' obligations to care for AIDS, ARC, and HIV-infected patients. Secondarily, it identifies ways that current law can be strengthened to define more sharply physicians' obligations, so that this population of patients will be assured of continued access to the medical care they need and have a right to obtain. Although this analysis deals with physicians' responsibilities, it is likely that similar legal principles will be used to judge the conduct of dentists, optometrists, nurses, physician assistants, and other allied health professionals.

Legal Obligations to Treat

American common law is firmly grounded on notions of individual liberty and economic freedom that support the proposition that absent some special relationship, no citizen owes any other citizen anything. As applied to the practice of medicine, the general rule, sometimes denoted the "no duty rule," is that a physician is not obligated to treat any particular patient in the absence of a consensual doctor-patient relationship. [3] In the absence of a prior agreement or a statutory or regulatory prohibition, physicians (like other citizens) can, in deciding whether to accept patients, discriminate among them on the basis of all sorts of irrelevant and invidious criteria; from race to religion, to personal appearance and wealth, or by specific disease, like AIDS.

Over the years, there has been some erosion in the "no duty rule" in both common law and statutory law. Courts have affirmed both a duty to treat in limited emergency situations, and the continuing obligation of physicians once a consensual doctor-patient relationship is established. Statutes have been primarily directed toward articulating antidiscrimination principles. In addition, physicians may accept certain obligations to whole groups of patients by contract, such as employment contracts with hospitals and prepaid health plans (HMOs, for example) and agreements related to reimbursement by Medicare and Medicaid.

The Emergency Treatment Rule

Physicians working in emergency rooms must treat all patients who arrive with a medical emergency. Virtually every modern court has repudiated the ancient doctrine that an emergency room physician need treat only those patients the physician or hospital chooses. The relevant issue is not whether the person can pay, what color the person's skin is, or even if the person has reached the age of consent; the only legally relevant issue is whether the person is experiencing a medical emergency. If so, the individual has a legal right to be treated, and physicians, nurses, and others working in the emergency room have a legal obligation to provide this treatment. In case law, there is no suggestion of exceptions based on any specific virus (like HIV) the patient might also be harboring, or any specific disease (like AIDS) the patient may be suffering. [4]

Courts have reached this conclusion for a variety of reasons, including that citizens have a right to rely upon the expectation that care will be extended implicit in having an "emergency room"; that public hospitals have an obligation to treat all who apply for treatment; and that particular state statutes and regulations require emergency rooms to treat all emergency patients. Whatever the basis, this rule is essentially universal and noncontroversial. Of course, emergency ward personnel have the right to take reasonable precautions to protect themselves from harm, and their employers should comply with Centers for Disease Control (CDC) recommendations regarding appropriate protective procedures and clothing. [5] But protection does not include acts that would amount to refusing treatment, or would compromise good patient care.

Physicians are not expected by the law to be heroes, but are obligated to act as other qualified physicians would act in the same or similar circumstances. Thus, if a patient threatened an emergency room physician with a gun or a knife, the substantial risk to health and life would provide legal warrant for the physician to refuse to treat such a patient. Likewise, if the patient's medical condition exposed a physician to great risk, and if it was the accepted practice of qualified physicians not to treat the person under the same or similar circumstances, the physician would be legally justified in refusing to treat the patient. Although AIDS is a fatal, infectious disease if acquired, it is not the currently accepted medical practice to refuse to treat HIV-infected patients because of the risk they pose to providers.

Still, the emergency treatment rule may have very limited application in requiring physicians to treat AIDS or HIV-infected patients. Only a minority of these individuals are likely to require urgent treatment in emergency rooms. And even then, the obligation to treat ends with the emergency. If the person can be treated better elsewhere, transfer to another facility is permitted (even encouraged), at least with the consent of the patient and the other facility. [6]

The obligation to treat in an emergency does not usually apply outside of the emergency room setting. Only one state, Massachusetts, has adopted licensing regulations that require its physicians to render emergency care to any person with a medical emergency, no matter where that emergency occurs. [7] Even under this rule, however, physicians who are not competent to treat in an emergency are required only to try to find another physician who can.

Thus, in the absence of some contractual or statutory right, AIDS and HIV-infected patients, like all other persons, have a legal right under common law to access to medical services in the United States only if they are suffering a medical emergency and are able to obtain emergency medical attention. That this situation is still tolerated in the United States is a national disgrace; but by refusing to grant universal access to health care and medical services to AIDS and HIV-infected patients, we are treating them no differently than anyone else.

Duty to Continue Treatment

A patient's right to treatment is greatly enhanced after the establishment of a voluntary relationship with a particular physician, for then the doctor has a duty not to abandon the patient. The general rule is that once a doctor-patient relationship is established, it continues until:

1. it is terminated by mutual consent;

2. it is terminated by the patient;

3. the physician's services are no longer needed; or

4. the physician withdraws after reasonable notice to the patient. [8]

The creation of a doctor-patient relationship, therefore, may be critical to the legal obligation of a physician to care for a particular patient. Such a relationship is always formed when the physician agrees to examine or treat the patient, which usually involves a face-to-face meeting. But at least one court has held that a doctor-patient relationship can be created when the physician accepts an appointment with the patient for an office visit, at least where the appointment relates to a specific condition mentioned by the patient over the telephone when seeking the appointment. [9]

The physician cannot abandon or refuse to treat a patient already under his or her care simply because that person is infected with HIV or has AIDS, at least not without reasonable notice. The distinction between an HIV-infected patient and one with AIDS or ARC should be underlined here. Treating an individual with AIDS or ARC involves the knowledge and skill needed to treat a specific disease; treating an HIV-infected patient involves knowing what precautions to take to avoid infection while treating a different, usually unrelated, condition. If the physician is unqualified to treat the patient, he or she usually has an obligation to refer the patient to a specialist or someone who is qualified to treat the patient's condition. Thus, a physician may be able (or even required) to transfer the care of the patient to another provider. Nonetheless, as long as the patient requires treatment for the condition that the physician is treating or attending (e.g., pregnancy), the physician cannot terminate the relationship without ensuring that the patient is able to obtain alternative care.

As with the emergency rule, the strength of the duty of nonabandonment is limited if there are alternative treatment sources available in the community. However, if alternatives do not exist, this principle may protect the individual from being left without a caregiver, albeit one who may be treating only because compelled by legal duty.

Antidiscrimination Statutes

Since private citizens can discriminate against their fellow citizens in the absence of prohibitory or antidiscrimination legislation, both the federal and state governments have enacted statutes to protect against some of the most offensive forms of discrimination. The most noteworthy federal effort is the Civil Rights Act of 1964. Among other things, the Act prohibits places of public accommodation involved in interstate commerce (such as transportation, food, and lodging establishments) from discriminating on the basis of race, religion or national origin. Subsequently, Congress passed the Rehabilitation Act of 1973, which prohibits discrimination in federally assisted programs on the basis of handicap when the individual is "otherwise qualified." The U.S. Supreme Court recently applied this law and the concept of "handicapped individual" to a person with tuberculosis, a potentially contagious disease. [10] The ruling mandated that such a person cannot be discriminated against in employment covered by the act if he or she is "otherwise qualified" for the position.

The same logic almost certainly applies to an individual with AIDS, but the court specifically declined to rule whether an individual who is infected with HIV is handicapped. Nevertheless, the ruling in the tuberculosis case supports the conclusion that an HIV-infected individual is handicapped. [11] Specifically, the Court noted that the purpose of the Rehabilitation Act was to protect "handicapped individuals from deprivations based on prejudice, stereotypes, or unfounded fear, while giving appropriate weight to such legitimate concerns of the grantees [recipients of federal funds] as avoiding exposing others to significant health and safety risks."

Whether an exposure is "significant" in the context of a contagious or infectious disease will be decided in the courts, but as the Supreme Court observed, "courts normally should defer to the reasonable medical judgments of public health officials." Thus, as long as public health officials reasonably continue to conclude that AIDS is not easily transmissible in specific settings and circumstances, those with AIDS and HIV infection should be protected from discrimination in federally assisted programs for which they are "otherwise qualified." Most states have enacted laws, modeled after the federal civil rights legislation, that prohibit "public accommodations" from discriminating against individuals on the basis of handicap. These laws, of course, will provide the broadest protection for individuals if they are construed (as I believe they should be) to include HIV-infected individuals.

The question of whether a physician or hospital can refuse to treat a patient solely because the patient is infected with HIV is very complex. This discrimination issue would be equivalent to refusing to treat a patient because the patient is black or gay, if there were no risk of transmission of the infection. The question, of course, is how great the risk to the physician should be before he or she could legitimately discriminate against HIV-infected individuals by denying them nonemergency treatment.

There is no easy answer, but a point of reference seems relevant. The risk of hepatitis B infection is real, and the disease is sometimes fatal, but this risk has never been seen as sufficiently high to justify discrimination against either infected patients or surgeons. Thus at least as long as scientific estimates place the chance of becoming infected with HIV and dying at less than the probability of becoming infected with hepatitis B and dying, there is no objective data to warrant discriminating against an HIV-infected individual.

A related point is that often the risks to patient and physician are similar (e.g., blood-to-blood contact during surgery). Accordingly, should we decide that it is reasonable for patients to be tested for HIV-infection prior to surgery (and this might make sense so long as the information could be kept confidential and would not affect the decision to operate, only the precautions taken during the operation), the same logic suggests routine testing of surgeons for HIV-infection as well, and informing prospective patients of the surgeon's HIV status.

Even under the most rigorously fair antidiscrimination law that could be devised, the extent of physicians' legal obligations would be limited to referring patients they are unqualified to care for to physicians and facilities qualified to provide care. In no case would an unqualified physician actually have a legal duty to render treatment (indeed, in the absence of medical emergency, it could be malpractice to attempt to treat a condition that a physician is unqualified to treat if alternate care is available).

It will also be difficult to define private doctors' offices as places of "public accommodation" for the purposes of antidiscrimination laws. Private physician offices are generally not open to the public without appointment; and even then access is generally limited to certain diseases or categories of patients that the physician is capable of treating and agrees to treat in advance. Thus, the duty of continuing treatment is likely to be much more helpful to AIDS or HIV-infected patients than antidiscrimination legislation.

Contractual Agreements

Duties can also be created by contract, and private contracts between physicians and health care institutions or insurance plans (like health maintenance organizations) may be one of the most effective protections for access to care. The employment contract will generally require employed physicians to render medical care to any patient in the plan who applies for care, or (in the case of medical students, interns and residents) to any patient on their service or to whom they are assigned. As employees, they have the right to work together to change employment conditions under standard collective bargaining procedures and laws. Unless it is the private employer's policy for nonemergency care, they do not, however, have the right to discriminate arbitrarily against any particular class or category of patient. [12]

As employees, physicians also have a right to protect themselves from dangerous exposures and to insist that their employers take steps to provide them with a healthful work environment. The Occupational Safety and Health Administration (OSHA) is in the process of developing guidelines to protect workers from HIV infection. Pending the announcement of these guidelines, OSHA has provisionally adopted the August, 1987 CDC guidelines to protect workers. [13] Employees can claim protection under these guidelines, and can refuse to work if their employers fail to comply. In addition, federal OSHA legislation protects workers who complain of an OSHA violation, prohibiting retaliation by the employer. The right not to work, however, may be constrained by a collective bargaining agreement that contains a no-strike clause prohibiting refusals to work for health or safety matters, or that contains a grievance mechanism as the exclusive method to present complaints. The only legally recognized exception to such restrictions is the general rule that both individual and concerted actions taken in "good faith because of abnormally dangerous conditions" will not be construed as violating a no-strike or collective bargaining agreement. Ultimately, however, without some "ascertainable, objective evidence" of an abnormally dangerous condition, the employee must follow the policy or he or she can be lawfully fired. [14] Current evidence of the danger of HIV infection to physicians and surgeons does not meet this risk standard. In the case of a medical student, the remedy is expulsion; interns and residents could be terminated from their training programs.

Standards Set by Medical Associations

Organized medicine has traditionally defended the right of individual practitioners to treat whomever they wish, except in an emergency. Ethical standards set by professional associations do not carry any formal sanctions other than loss of membership in the association. However, courts can use these standards as evidence of a duty of care, since a physician's legal duty is primarily defined by medical custom. Thus specific professional ethical standards can be used as evidence in a malpractice suit brought by a patient denied care by a physician, if the patient were harmed by the refusal. Perhaps more importantly, an ethical standard can help define the character of the profession, and if it is seen as reasonable most practitioners will adhere to it.

In late 1987, the Council on Ethical and Judicial Affairs of the American Medical Association issued a report to the AMA House of Delegates, which affirmed that a physician "may not ethically refuse to treat a patient whose condition is within the physician's current realm of competence" solely because the patient has AIDS or is infected with HIV:

A person who is afflicted with AIDS needs competent, compassionate treatment. Neither those who have the disease nor those who have been infected with the virus should be subjected to discrimination based on fear or prejudice, least of all by members of the health care community. Physicians should respond to the best of their ability in cases of emergency where first aid treatment is essential, and physicians should not abandon patients whose care they have undertaken. [15]

The report, which was accepted by the House of Delegates, stops short of saying that physicians must care for AIDS patients, but does make refusal to do so unethical if such care is within the physician's competence and refusal is based solely on the patient's disease status. Russell Patterson, the vice-chairman of the Council, explained the report with reference to Principle VI of the AMA's 1980 Principles of Medical Ethics: "A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate and the environment in which to provide medical services." Patterson maintained:

We never took that to mean that a physician could illegally or unethically discriminate against any group of patients, such as blacks, members of a religious group, or patients with AIDS. A physician doesn't have to care for AIDS if the disease process is out of his spectrum of knowledge but, for example, a surgeon should not refuse to operate because a patient has AIDS. [16]

Since the AMA has repeatedly supported the rights of its members to treat whomever they wanted (except in an emergency), this explanation seemed to indicate an astonishing reversal of position. The problem is that the AMA's top officials have made it clear they have no plans to enforce the Council's report; if doctors don't want to take care of AIDS and HIV-infected patients, the AMA will consider them "incompetent" to treat and excuse them. [17] According to AMA Executive Vice-president James Sammons, this exemption would include a physician with a "psychological hang-up" that interferes with his or her ability to treat AIDS patients. [18] In effect, this reduces the AMA's position to a statement that a doctor must treat an AIDS patient if the doctor wants to treat an AIDS patient.

Few state medical associations have addressed this issue, and at least in states with large HIV-infected populations, like New York, Massachusetts, Illinois, California and Florida, they should. The Texas Medical Association has adopted a standard that actively invites discrimination by giving the physician the option to treat or refer the patient, regardless of the physician's ability to treat the disease. Explaining this decision, James Mann, the chairman of TMA's Board of Counselors said:

We didn't agree that a physician who diagnoses AIDS is mandated to treat the patient. I don't think it can be called discrimination when it's a matter of a guy laying his health and career on the line. A young man may spend 15 years of his life getting medical training and risk his life treating disease. You must think of the potential dangers and risks.... All it takes is a slip of a needle or a splash of secretions. [19]

David Vanderpool, president of the Texas Medical Association, argued that physicians should continue to do business as usual in the face of the AIDS crisis, and that the "traditional freedom" physicians have to choose whom to serve should be maintained. He also implied this arrangement works to the benefit of patients: "You and I don't want to be treated by someone who doesn't want to treat us."

Strong and unequivocal statements on ethical standards from organized medicine can help patients obtain access to needed services. However, statements like that issued by the Texas Medical Association, and the "clarifying" remarks of Sammons on the AMA standards, perpetuate fear and prejudice and set up restrictions on access to care. Physicians should set their own ethical standards. But if they fail, or if the standards are too low, the law must operate to protect the public.

Medical Licensing Boards

Agencies in each state license physicians to practice medicine, a procedure that grants the profession a monopoly and makes the practice of medicine without a license a crime. Medical licensing boards have statutory authority to issue regulations that govern the practice of medicine and to define "unprofessional conduct." Unlike private medical organizations, like the AMA and the state medical associations, the regulations promulgated by these agencies have the force of law, and violation can lead to license suspension or revocation. [20] These potential sanctions make such standards much more powerful agents in affecting physician behavior.

Thus far, state licensing boards have displayed two different approaches to physician refusals to treat AIDS or HIV-infected patients. The Board of Medical Examiners in New Jersey, for example, issued an "AIDS Policy," on November 18, 1987:

A licensee of this Board may not categorically refuse to treat a patient who has AIDS or AIDS related complex, or an HIV positive blood test, when he or she possesses the skill and experience to treat the condition presented.....

In cases where the physician is unable to render care, "the licensee retains the responsibility to make alternative arrangements for the proper care of a patient." [21]

An opposite stance has been established by the Arizona Board of Medical Examiners. This Board stated that their licensees have the right to refuse continued treatment to AIDS patients.

The licensing boards of states that have a significant number of AIDS patients have a legal and ethical responsibility to clarify the legal obligation of their licensees to render care in a nondiscriminatory manner. They should do so now, before any "movement" develops to deny treatment or to adopt either the "Texas Solution" or the "Arizona Avoidance Strategy."

State Antidiscrimination Statutes and Private

Employment Contracts

AIDS and HIV-infected individuals would have a more compelling legal claim of access to care if antidiscrimination statutes in each state clearly included them in the category of handicapped individuals who could not be discriminated against in regard to employment, housing, and access to "public accommodations," including hospitals, clinics and physician and dental offices.

Yet, AIDS confronts us with a phenomenon much more complex than simple discrimination on the basis of disease, albeit an infectious, potentially lethal disease. As others have correctly noted, even if fear of contracting AIDS is given as the reason for discrimination, the underlying motivation may be much more complex. Additional reasons for discrimination may include homophobia or an aversion to IV drug users; an age similarity between providers and sufferers who are terminally ill because of the lack of an effective treatment; and that AIDS patients require intensive, expensive, and exhausting care. [22]

On of the most powerful ensurers of nondiscriminatory patient care can be the provisions in employment contrcts and hospital staff by-laws. These documents can bind physicians who are employees and physicians who have staff privileges to specific nondiscriminatory behavior regarding AIDS patients. The sanctions for noncompliance can also be spelled out, whether it be dismissal from employment, loss of staff privileges, dismissal of an intern or resident from a training program, or expulsion from school. Of course, those accused of discriminatory behavior must be given a fair hearing, including representation by legal counsel, prior to any punitive action against them. [23]

The Associated Medical Schools of New York, which represents the state's 13 medical schools, recently adopted a policy worthy of emulation. The Association decreed that physicians had a "most fundamental responsibility" to treat AIDS patients, and that any faculty member, hospital resident or medical student who refused to treat an AIDS patient would be dismissed. Although there have been no reported cases of such refusal in the medical school system, Dr. Richard Schwartz, the president of the Association, said he "felt it important to take a tough leadership position at a time of national crisis." [24]

Laws, Symbols, and Minimal Ethics

Discrimination and prejudice based on fear are difficult for the law to prevent. As Leonard Glantz put it when he and I did Pediatric Rounds on this subject at Boston City Hospital. "The law cannot make people courageous or virtuous." The law does, however, symbolically embody the minimal ethics of society, and thus helps both form and articulate society's basic values and expectations of its physicians. Physicians can relatively easily "beat" an antidiscrimination charge by developing a modus operandi that includes withdrawal from practicing in those specialities or training programs in which they might encounter AIDS patients, limiting their practice to certain types of diseases and disorders unlikely to include AIDS patients, or developing an efficient referral system to avoid direct contact with AIDS patients. There is little that can effectively counter such patterns of physician behavior short of actually lodging a charge of discriminatory conduct. But the fact that only a handful of physicians openly admit that they discriminate against AIDS and HIV-infected patients indicates that these practices are already viewed as unacceptable. Strong action on the part of organized medicine, state licensing boards, and others can ensure that discrimination against AIDS and HIV infected patients is acknowledged as unethical.

This analysis suggests that individual physicians have no legal duty to treat except in specific situations. Broad statements of ethical responsibility by organized medicine, state licensing boards, hospitals, and medical schools, however, can transform the "no-duty rule" into a "professional-duty-to-treat or locate-and-refer-for-appropriate-treatment rule." When such rules are promulgated, they should be followed by intense educational programs based in hospitals so that all physicians and health care workers can be kept fully informed regarding the meaning of AIDS, ARC and HIV infection, realistically assess the risk of transmission, and understand the steps that can reasonable be taken to minimize that risk. Hospitals and prepaid health plans also need responsive employee grievance mechanisms, competent safety personnel, available safety clothes and equipment, safe methods of dealing with blood and bodily fluids, and adequate disability coverage. Antidiscrimination standards should also be adopted. But there is no quick legal fix to guarantee access to medical care to AIDS and HIV-infected patients, because the basic problems of health care access in the United States are economic rather than legal in nature.

Physicians do have special legal obligations because they have been granted special privileges by society. Their continued practice of medicine is voluntary; and their conduct is properly judged by standards higher than those to which we hold others, even higher than those to which we hold firemen and policemen. Society could not tolerate firemen and policemen who refused ever to risk their lives in doing their jobs. Nor should it tolerate physicians who refuse to take risks in their practice. Nonetheless, if we want to be effective in motivating physicians to care for AIDS and HIV-infected patients, we must also take reasonable steps at the broader, societal level. Universal Health insurance coverage for all patients seems critical. Monetary and licensure suspension penalties for discrimination seem useful. And realistic methods to deal with prevention of HIV infection seem essential. Ultimately, only such a multifaceted approach, is likely to prove effective in assuring access to medical care for patients with AIDS or HIV infection.

References

[1] P.M. Boffey, "Doctors Who Shun AIDS Patients are Assailed by Surgeon General," New York Times (Sept. 10, 1987), 1.

[2] Editorial "When Doctors Refuse to Treat AIDS," New York Times (August 3, 1987), A16.

[3] T.L. Banks, "The Right to Medical Treatment," in H. Dalton, S. Burris, and the Yale AIDS Project, eds., AIDS and the Law (New Haven: Yale University Press, 1987), 176.

[4] George J. Annas, "Your Money or Your Life: 'Dumping' Uninsured Patients from Hospital Emergency Wards," American Journal of Public Health 76:1 (1986), 74-77.

[5] Centers for Disease Control, "Recommendations for Prevention of HIV Transmission in Health-Care Settings," Morbidity and Mortality Weekly Report, 36-2S (August 21, 1987), 3S-18S.

[6] Annas, "Your Money or Your Life."

[7] Mass. Bd. of Registration in Medicine, 243 CMR 2.06 (10).

[8] George J. Annas, The Rights of Hospital Patients (New York: Avon Books, 1975), 95.

[9] Lyons v. Grether, 239 S.E.2d 103 (Virginia 1977). (Patient abandoned when doctor refused to see her for vaginal infection because she brought her seeing-eye dog with her).

[10] School Board of Nassau Co. v. Arline, 107 Sup. Ct. 1123 (1987).

[11] Wendy E. Parmet, "AIDS and the Limits of Discrimination Law," Law Medicine and Health Care 15 (1987), 61. The statute defines as handicapped one who: "(i) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (ii) has a record of such impairment, or (iii) is regarded as having such an impairment."

[12] See A.S. Leonard, "AIDS in the Workplace," in Dalton, et al. eds., AIDS and the Law, Yale University Press, 1987.

[13] Occupational Safety and Health Administration, "Occupational Exposure to Hepatitis B Virus and Human Immunodeficiency Virus; Advance Notice of Proposed Rulemaking," 52 Fed. Reg. 45438 et seq., Nov. 27, 1987.

[14] Gateway Coal Co. v. United Mine Workers of America, 414 U.S. 368 (1974).

[15] Council on Ethical and Judicial Affairs, "Ethical Issues Involved in the Growing AIDS Crisis," Journal of the American Medical Association, 259 (March 4, 1988), 1360-61.

[16] "Unethical to Refuse to Treat HIV-Infected Patients, AMA says" American Medical News, Nov. 20, 1987 43.

[17] "Refusing Care of AIDS Patients: New Policies and Admissions Emerge," Hospital Ethics (January/February 1988), 5.

[18] AMA Delegates Vote on AIDS Care Ethics," Medical World News (December 28, 1987), 16.

[19] "TMA policy lets MDs refuse AIDS patients if they refer," American Medical News 30:45 (December 4, 1987), 3.

[20] George J. Annas, Leonard H. Glantz, and B.F. Katz, The Rights of Doctors, Nurses & Allied Health Professionals (Cambridge, MA: Ballinger, 1981), 3-15.

[21] See R. Pear, "What would Hippocrates have said about AIDS?," New York Times (January 3, 1988), E7.

[22] Abigail Zuger, "AIDS on the Wards: A Residency in Medical Ethics," Hastings Center Report 17:3 (June 1987), 16-20.

[23] See Annas, et al., The Rights of Doctors, Nurses, & Allied Health Professionals.

[24] R. Sullivan, "13 Medical Colleges say Staffs Must Treat AIDS," New York Times (December 9, 1987), B3.

George J. Annas is Utley Professor of Health Law, and Chief, Health Law Section, Boston U. Schools of Medicine and Public Health
COPYRIGHT 1988 Hastings Center
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1988 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Annas, George J.
Publication:The Hastings Center Report
Date:Apr 1, 1988
Words:5334
Previous Article:Health professions, codes, and the right to refuse to treat HIV-infectious patients.
Next Article:Required request for organ donation: moral, clinical, and legal problems.
Topics:

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters