Good Decision Making in Real Time: Practical Public Health Ethics for Local Health Officials
Smith - - Public Health Ethics 8 2 Broadening the Bioethics Agenda. Dan W. Brock - - Kennedy Institute of Ethics Journal 10 1 The Concern for Equity in Health.
Oxford University Press. Efficiency and Equity in Health: Philosophical Considerations. Amartya Sen , S. Anand , F. Equity and Conflicting Perspectives on Health Evaluation. McLachlan - - Journal of Medical Ethics 31 7 Weinstock - - Journal of Medicine and Philosophy 36 4 Gavin Mooney - - Health Care Analysis 8 3 Health Inequalities and Why They Matter.
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Public Health, Ethics, and Equity
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Challenging Inequities in Health: From Ethics to Action - Oxford Scholarship
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HIV became the exception to the historical public health approach of using contact tracing to control sexually transmitted infections. The legal duty to warn has rarely been applied to transmission of HIV infection. In tort law the concept of a duty to warn has been applied to a number of circumstances where a party may be held liable for injuries caused to another or where a party had the opportunity to warn the other of a hazard but failed to do so. The difficulty is that transmission of HIV infection is most often not viewed as an injury or hazard but rather as a consequence of consensual sexual intercourse.
However it is apparent that the injury caused by HIV infection is as devastating as physical injury but occurs over a longer period of time as the complications of HIV infection progress and, without treatment, results in death. Numerous recent studies now show a clear association of HIV infection and violence against women. An ethical duty to warn has not been fully applied to HIV transmission and partner notification.
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In Tarasoff v. Regents of the University of California, the Supreme Court of California held that mental health professionals had a duty to protect individuals who are being threatened with harm by a patient.
The decision has received considerable discussion and debate as to the circumstances to which the Tarasoff principle can be applied. It has not been applied to HIV but, health care professionals are certainly aware that when they diagnose HIV infection, there are others at risk of harm and even death if HIV infection is not prevented or treated. It is possible therefore that the principle of a duty to warn could a be interpreted as duty to employ contact tracing as a means of avoiding irreversible harm to sexual partners who are exposed to or already are infected with HIV.
The risk-benefit ratio in favor of contact tracing has changed significantly — millions of HIV infections could be prevented and individuals who were already infected could be identified, treated and lead long and productive lives. An estimated 10 million individuals do not know they are infected and are likely, without treatment, to progress to AIDS and transmit HIV infection to sexual partners were unaware of their risk.