Ethics Opinions

Routine universal screening of adult patients for HIV helps promote the welfare of individual patients, avoid injury to third parties, and protect public health. Nonetheless, physicians must continue to seek patients’ informed consent, including informed refusal of HIV testing.

Due to their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters. However, physicians also have an obligation to evaluate the risks of providing care to individual patients in the present versus the need to be available to provide care in the future.

In the context of infectious disease, physicians’ public health responsibility may include the use of quarantine and isolation to reduce the transmission of disease and protect the health of the public. They also have an obligation to protect their own health. In such situations, these obligations may conflict with patients’ rights of self-determination and with physicians’ duty to advocate for the best interests of individual patients.

Differences in treatment that are not directly related to differences in individual patients’ clinical needs or preferences constitute inappropriate variations in health care. Such variations may contribute to health outcomes that are considerably worse in marginalized populations. Physicians ethically are called on to provide the same quality of care to all patients without regard to medically irrelevant personal characteristics.

In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues, or threatens the availability of the health care workforce, and for which there is an available, safe, and effective vaccine, physicians have a responsibility to accept immunization absent a recognized medical contraindication or when a specific vaccine would pose a significant risk to the physician’s patients.

Expedited partner therapy seeks to increase the rate of treatment for partners of patients with sexually transmitted infections through patient-delivered therapy without the partner receiving a medical evaluation or professional prevention counseling. However, expedited partner therapy potentially abrogates the standard informed consent process, compromises continuity of care for patients’ partners, encroaches upon the privacy of patients and their partners, increases the possibility of harm by a medical or allergic reaction, leaves other diseases or complications undiagnosed, and may violate state practice laws.

Health promotion should be a collaborative, patient-centered process that promotes trust and recognizes patients’ self-directed roles and responsibilities in maintaining health. Effective elements of this process may include educating and motivating patients regarding healthy lifestyle, helping patients by assessing their needs, preferences, and readiness for change, and recommending appropriate preventive care measures.

Short-term global health clinical encounters provide needed care to individual patients in under-resourced settings and address global health inequities. Physicians engaging in short-term global health clinical encounters have an ethical obligation to prioritize benefits for the host community and ensure quality care while maintaining awareness for cultural differences. Sponsors of short-term global health clinical encounters should ensure the provision of resources, that team members practice within the limits of their skills, and that a mechanism for meaningful data collection is in place.