DQ1
1) N.L
Hi Class,
In 2023 we are will educate about STDs and be aware of how most of them can be transmitted. HIV or human immunodeficiency virus attacks the body’s immune system resulting in a compromised immune system and can result in AIDS or acquired immunodeficiency syndrome if untreated (Centers for Disease Control and Prevention, 2022). Mandating HIV screening can be tricky depending on where you are mandating people to get tested at. For example, In Urgent care or hospitals, it should be okay to mandate everyone to get tested as a precaution due to the atmosphere and environment one is in. Whereas in a job that doesn’t deal with any exposure it isn’t ethically fair to be exposed to this when there isn’t a reason to be. In my opinion, it should be offered during the other mandated vaccinations like the flu shots and Tuberculosis.
Reference:
Centers for Disease Control and Prevention. (2022, June 30). About HIV/AIDS. Centers for Disease Control and Prevention. Retrieved November 28, 2022, from https://www.cdc.gov/hiv/basics/whatishiv.html
2) E.P
Regarding HIV/AIDS specifically, the duty of confidentiality is nearly ubiquitous in professional codes of conduct. Patients’ right to privacy and the public’s need to be safe from contagions are in tension with one another. Presumably, only patients themselves will have a full understanding of how their disclosures to third parties will affect their personal, social, and professional life (Rennie et al 2006). Even more so than in other areas of life, the doctor-patient relationship is one in which a person living with HIV/AIDS has a right to confidentiality. Any intentional disclosure of protected information to a third party is a crime. One case in which a doctor divulged his patients’ HIV status to a coworker on the golf course without their permission resulted in a court awarding damages to the patients. Confidentiality, as a subset of information privacy, refers to the protection of information shared inside a trusting relationship from being shared outside of that relationship (Knight et al 2014). Only if the person (or institution) to whom confidential information was supplied fails to secure the information or knowingly exposes it to a third party without first party agreement does the right to confidentiality be violated. A breach of privacy, rather than confidentiality, occurs when an unauthorized person accesses patient records or other sensitive information stored in a computer system. No one other than the intended recipient in a confidential connection may be held liable for disclosure of the information.
Reference
Rennie, S., & Behets, F. (2006). Desperately seeking targets: the ethics of routine HIV testing in low-income countries. Bulletin of the World Health Organization, 84, 52-57.
Knight, R., Shoveller, J., Greyson, D., Kerr, T., Gilbert, M., & Shannon, K. (2014). Advancing population and public health ethics regarding HIV testing: a scoping review. Critical Public Health, 24(3), 283-295.
3) M.F
Hello Professor and Class,
HIV or human immunodeficiency virus attacks the body’s immune system resulting in a compromised immune system and can result to AIDS or acquired immunodeficiency syndrome if untreated (Centers for Disease Control and Prevention, 2022). When questioning if it is ethically justifiable to mandate HIV screening it is crucial to remember the general guidelines of medical ethics which are autonomy, justice, beneficence, and nonmaleficience (Singh & Banerjee, 2004). Challenges arise when justifying if screening for HIV should be mandated to include patient confidentiality and possible stigmatization and discrimination that a patient positive for HIV might experience. Certainly screenings for any health issue to include sexually transmitted diseases and HIV can not only improve early detection of these diseases but also increase opportunities for treatment of them. Acknowledging the justification questions when analyzing whether to mandate screening for HIV is also essential. Answering these questions of effectiveness, necessity, least infringement, proportionality, proportionality and public justification can help determine whether or not mandating screening protocols are ethical or not (Bernheim, Childress, Melnick, & Bonnie, 2013). The Centers for Disease Control and Prevention (2020), has concluded that routine, opt-out screening has been significantly effective for many reasons to include cost-effectiveness, minimizing risk of transmission, removing potential stigma associated with HIV testing, as well as supporting earlier diagnosis and treatment. Thank you for taking the time to read this.
Resources
Bernheim, R. G., Childress, J. F., Melnick, A., & Bonnie, R. J. (2013). Essentials of public health ethics. Jones & Bartlett Learning.
Centers for Disease Control and Prevention. (2022, June 30). About HIV/AIDS. Centers for Disease Control and Prevention. Retrieved November 28, 2022, from https://www.cdc.gov/hiv/basics/whatishiv.html
Centers for Disease Control and Prevention. (2020, March 4). Opt-Out Screening. Centers for Disease Control and Prevention. Retrieved November 28, 2022, from https://www.cdc.gov/hiv/clinicians/screening/opt-out.html
Singh Z, Banerjee A. HIV / AIDS : Social and Ethical Issues. Med J Armed Forces India. 2004 Apr;60(2):107-8. doi: 10.1016/S0377-1237(04)80096-0. Epub 2011 Jul 21. PMID: 27407599; PMCID: PMC4923030.
REPLY
4) B.M
Hello class,
Reading some of the responses by my classmates, I see that many of you are actively working in a healthcare setting and have had a great experience in this discussion topic. I have not yet worked in this setting; however, I did work in a retirement home during my senior year of high school, and part of the hiring process for all employees was a mandatory tuberculosis test to see if we were positive for TB. With this in mind, I believe that it is ethical for a mandatory HIV screening, for HIV can be an extremely life-threatening condition for various individuals, for it prevents your body’s ability to ward off infections. (HIV/AIDS – Symptoms and Causes, 2022). HIV is something that needs to be reported by law, which is a strong telling of the significance. (Bernheim et al., 2013). Mandatory screening is not only crucial for the health of others, but the health of the individual being tested as well for early diagnosis can have the earlier treatment and greater health outcomes. (Screening for HIV | Clinicians | HIV | CDC, n.d.). The conditions that need to be met are things such as if the condition poses a health threat to the greater population, and in that case, there is a duty to protect the health and safety of others. (Bernheim et al., 2013). With this in mind, I still believe that those screened are informed about why they are being tested, for everyone deserves the right to control their health.
References:
Bernheim, G. R., Childress, J. F., Melnick, A., & Bonnie, R. J. (2013). Essentials of Public Health Ethics (Essential Public Health) (1st ed.). Jones & Bartlett Learning.
HIV/AIDS – Symptoms and causes. (2022, July 29). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
Screening for HIV | Clinicians | HIV | CDC. (n.d.). https://www.cdc.gov/hiv/clinicians/screening/index.html
REPLY
DQ2
5) W.S
Hello Class!
I can see a lot of benefits to things such as vaccinations, screenings, and testings. Vaccines have allowed protection and prevented illness for not only the people vaccinated, but others around them, especially the immunocompromised. A good example of this is the Polio Vaccine. The US had many outbreaks from the years 1948-1955, averaging roughly 16,000 cases a year in the 20th century, the first vaccine for polio was made in 1955, 2020 was documented as zero cases of polio and is considered eradicated from north and south America. I can see how screenings and testings for genetics based diseases or alignments are positive and extremely helpful, especially when it comes to planning children, examples of this are down syndrome, cystic fibrosis, and the HER gene in breast cancer. Above all, as positive and informative and protective some of these abilities medicine has, I believe in bodily autonomy and having the choice in what you put in your body, and what you allow to be done on your body. I do not believe anything medical wise should be “mandated”. We live in a world where we preach and stand on beliefs such as free speech, but then turn around and force someone based on work policy, school policy, and pandemic issues to inject something into their body. I apply this every day at work. I have had patients who have refused life saving measures due to religious beliefs, personal beliefs, and would never try to force something on them, simply based on “this will help you so why not do it”, everyone has their own reasons and it’s not my place to judge.
Thank you for taking the time to read this,
Whitney
Mayo Foundation for Medical Education and Research. (n.d.). History of polio: Outbreaks and vaccine timeline. Mayo Clinic. Retrieved November 29, 2022, from https://www.mayoclinic.org/coronavirus-covid-19/history-disease-outbreaks-vaccine-timeline/polio
REPLY
6) I.M
Hello Class,
The importance of screening for any type of public health use is extremely vital to the community. I know this because in one aspect one of the jobs that I am tasked with is to test patients on a regular basis for any STDs / HIV And get the results back to them within about 24 to 48 hours. Not only do we do this but We keep track of this for our department and for the state department to keep track of numbers in the community. Screening is an important part of preventive medicine. Ideally, screening tools identify patients early enough to provide treatment and avoid or reduce symptoms and other consequences, improving health outcomes of the population at a reasonable cost. Cost-effectiveness analyses combine the expected benefits and costs of interventions and can be used to assess the value of screening tools. Screening represents a cornerstone of preventive medicine. Its rationale is to identify disease during an early and pre-symptomatic stage. With appropriate treatment, screening can result in disease prevention for those patients identified as at-risk. Early disease may be easier and less expensive to treat, which positions screening strategies as potentially sound investments for healthcare systems. Several countries have developed national screening programs that have led to increased disease detection rates and prevention. However, screening is not entirely risk-free and usually represents an immediate economic burden for systems with tight budget constraints. Some screening tools are associated with direct health risks (X-rays and radiation), and others might not provide a real additional value if, for instance, no follow-up treatment is available. Additionally, tests need to be sufficiently reliable and accurate, since high proportions of false negatives or false positives might represent worse health outcomes and unnecessary diagnostic costs. To maximize value, an economic evaluation is a useful tool to compare the potential benefits, risks, and costs of different strategies and to inform resource allocation decisions. All health systems have scarce resources and are faced with opportunity costs; this means that any investment in a screening tool will come at the cost of other health services to the detriment of those patients who would have been treated.
References:
Principles, methods, applications and organisation of screening for early detection, prevention, treatment and control of disease (no date) Principles, methods, applications and organisation of screening for early detection, prevention, treatment and control of disease | Health Knowledge. Available at: https://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2c-diagnosis-screening/principles-methods-applications (Accessed: November 28, 2022).
REPLY
7) B.M
Hello class,
I believe any testing should be voluntary and have the patient’s full consent. The patient should be informed about every aspect of the procedure by creating a mandatory screening; there will be individuals who avoid it free of cost and the possibility of illness. (New Survey Finds Large Number of People Skipping Necessary Medical Care Because of Cost | NORC.org, n.d.). Screenings, however, are a critical part of public health, for screenings allow medical professionals to detect cancer, viruses, and various diseases that impact the patient and the whole population. (Get Screened – MyHealthfinder | health.gov, 2021). Screenings allow for early detection and treatment of health issues before they can be unmanageable; therefore, it is crucial to ensure people are not forced into procedures and understand the test. (Get Screened – MyHealthfinder | health.gov, 2021). Before public health professionals mandate something, they must understand the risks and rewards of mandating a test or screening. (McKenzie et al., 2016).
References:
Compulsory and mandatory medical examinations. (n.d.). https://archive.unu.edu/unupress/unupbooks/uu08ie/uu08ie0t.htm
Get Screened – MyHealthfinder | health.gov. (2021, January 1). https://health.gov/myhealthfinder/doctor-visits/screening-tests/get-screened
New Survey Finds Large Number of People Skipping Necessary Medical Care Because of Cost | NORC.org. (n.d.). https://www.norc.org/NewsEventsPublications/PressReleases/Pages/survey-finds-large-number-of-people-skipping-necessary-medical-care-because-cost.aspx
McKenzie, J., Neiger, B., & Thackeray, R. (2016). Planning, Implementing & Evaluating Health Promotion Programs: A Primer (7th ed.). Pearson. BibliU – Reader
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8) N.L
Hi Class,
Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. HPV vaccines can prevent some of the health effects HPV causes. This fact sheet answers basic questions about HPV. (CDC, 2022) The testing for this disease is currently optional for all ages. It is known to be a higher risk in teens than in adults and studies have shown that about 3 million people a year are diagnosed with HPV. With that information having such high rates I think it should be mandatory during physicals for all ages. It is the easiest way to input this for all patients not to feel like they are being picked on due to age, sex or race. It is important to try to properly educate patients with this STI as it is so common and can cause many different side effects to the body from genital warts to cancer. As public health providers, it is our job to promote the importance of the testing of HPV and the continuation of getting yearly testing as it can be transmitted at any given time.
Reference:
Centers for Disease Control and Prevention. (2022, April 12). Std Facts – Human papillomavirus (HPV). Centers for Disease Control and Prevention. Retrieved November 29, 2022, from https://www.cdc.gov/std/hpv/stdfact-hpv.htm
