Ethics in actual surgery. The surgeon and HIV seropositive and AIDS patients

Surgeons feel threatened by the risk of contamination when operating on HIV-seropositive or AIDS patients. Observations on the likelihood of contamination in literature are most divergent due to variables in seropositive prevalence, in frequency of contamination risk and in distinction between HIV seropositive and AIDS patients. Except in emergency the surgeon may refuse to treat a patient. Screening seropositively for selection is hampered by the inconsistency of false positives and false negatives depending on the method used and on costs appropriate to large scale controls. Exclusion of patients from treatment is unethical. Referring them to other colleagues on ground of contamination risk is ethically unjustified. Denial of care to a HIV infected patient may be justified when the operative risk is considered too high and the expected benefit too low because of the precarious condition of the patient and his shortened life expectancy. However the surgeon and his team need not to expose themselves to even a limited but real risk of contamination. Therefore the surgeons have to reconsider their surgical strategy and technique in order to keep chances of contamination as low as possible. A search for safer working methods for all operations and without any discrimination with regard to the patient is needed and should be taught to the surgical team.