The right to know and the right to privacy: HIV testing and health care management

Balancing the rights of suspected or actual HIV-infected individuals versus the preferences of patients, customers, coworkers, and others requires a delicate balancing of individual rights and responsibilities in light of medical and epidemiological facts. It is undoubtedly the quintessential ethical and legal problem of our time for health care management to confront. The dilemmas and the ensuing debate will be intensifying in the nineties as the number of diagnosed AIDS cases and of HIV-positive individuals rapidly expands. Much of the literature in the management field, and unfortunately some in the area of AIDS, consists of writing that ends with such concepts as prescriptions, guidelines, battleplans, etc. for dealing with the problem being discussed. Certainly, excellent articles and books abound in this vein. There is an ever present desire, however, for deductive reasoning whereby, because the topic is management, the problem, whatever it may be, can be managed in the classical scientific method, with one best way to handle the situation. The typical conclusion to an article such as this would be a section subtitled the antithesis of reality, that is, something like "AIDS Made Easy" or "Ten Steps to Effectively Deal with AIDS For Health Care Providers." The foregoing review presents issues that are too complex to be reduced to simplistic action plans for health care management and providers. The legal and ethical problems of the use of HIV testing of health care providers are but one part of the myriad of difficulties brought on by the epidemic--among these being the complex social issues brought on by AIDS and the ramifications in the areas of hospital and health care service reimbursement, cost, capacity, and adequacy. The legal status and propriety of HIV testing will continue to be under debate and in flux for some time, as all available precedent and guidelines in this area are based on current epidemiological and medical knowledge. This is, of course, subject to change and reinterpretation as more is learned about AIDS and as the prevalence of HIV infection, ARC, and AIDS increases. Certainly, it is not an issue that has been resolved by Leckelt and Glover, but these cases have brought more insight into the proper role of HIV testing of health care workers in light of current medical and legal knowledge.(ABSTRACT TRUNCATED AT 400 WORDS)