Distributive justice and HIV disease in intensive care

Human immunodeficiency virus (HIV) infection presents ethical dilemmas for health care professionals involved in critical care settings. Although critical care may prolong life for those with life-threatening illness or surgeries, the long-term outcome is still poor for those infected with HIV. Health care professionals have an obligation to provide quality care to prolong life. The requirement to prolong life in situations where the outcome is anticipated to be poor results in ethical conflict. The dilemmas created by the ethical principles that provide rational, systematic, critical, and principled thinking present multidimensional conflicts regarding how to live a moral life. The HIV epidemic has forced critical discussion about the allocation of health care dollars for the treatment of individuals who might not survive regardless of therapies. Allocation of care or distributive justice must be predicated on objective information that results in decisions that do not discriminate against a person with HIV infection. Ethically, sound decision making requires that all involved in the care and support of patients be a part of the process.