Ethical Decision-Making of Health Professionals Caring for HIV-Infected People in Hunan, China: A Qualitative Study

doi:10.21203/rs.3.rs-36067/v1

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Ethical Decision-Making of Health Professionals Caring for HIV-Infected People in Hunan, China: A Qualitative Study

https://doi.org/10.21203/rs.3.rs-36067/v1

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Background: Numerous ethical issues surged the moment AIDS was discovered. As advocates of HIV-infected people, health professionals encounter many ethical dilemmas in clinical practice. However, it remains unclear how health professionals solve these issues. To explore the ethical decision-making experiences of health professionals who care for HIV-infected people in Hunan Province, China, and to discuss the strategies for enhancing ethical decision-making competence in AIDS care.

Methods: This descriptive qualitative research adopted semi-structured, in-depth interview and thematic analysis. Participants were recruited by purposive sampling. In total, twenty-two participants completed the interview.

Results: Three themes emerged from data analyses of the interviews: (1) common ethical dilemma experienced by health professionals, (2) factors influencing ethical judgment, (3) ethical motivations.

Conclusion: About two thirds of informants failed to recall ethical dilemmas experienced in their clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence the ethical judgments of health professionals. In the ethical decision-making process, most informants took other people’s interests into consideration and conformed to law and professional codes of conduct. However, negative attitudes towards HIV-infected people still exist among a few professionals. Furthermore, some informants showed a misunderstanding of ethical principles. And the fear of medical disputes (conflicts with families and others) was experienced by many informants, influencing their ethical behaviors. Hence, more efforts are needed to eliminate negative attitudes towards HIV-infected patients. This study underscores the importance of continuing ethical education for HIV/AIDS-related professionals to enhance their ethical decision-making competence. Moreover, sound governmental laws may promote ethical behavior in AIDS care.

Medical Ethics

Ethical decision-making

Health professional

HIV

Qualitative descriptive study

Acquired immunodeficiency syndrome (AIDS) is a severe immunological disorder caused by the human immunodeficiency virus (HIV), resulting in a defect in cell-mediated immunity that is manifested by increased susceptibility to opportunistic infections and to certain rare cancers. Although the HIV infection rate has been reduced since its peak in 1997, the global population of people living with HIV/AIDS (PLWHA) is still huge and was as many as 37.9 million in 2018 according to the data from the official website of the Joint United Nations Programme on HIV/AIDS [1]. Due to its large population, China’s PLWHA must not be overlooked. According to a 2018 report from China’s Center for Disease Control (CDC), about 841,478 people were living with HIV in September 2018 [2], bringing medical as well as ethical challenges to AIDS care in China.

Ethical challenges in AIDS care arise for several reasons. First, some high-risk behaviors associated with HIV infection, like prostitution and drug abuse, infringe on traditional morality and thus draw condemnation, resulting in discrimination and stigma towards PLWHA. Worsely, healthcare workers is not free from such attitude in spite of the fact that they gain more acquaintance of HIV than ordinary people. Studies have been done in different countries to explore healthcare workers’ HIV-related stigma and discrimination and the results showed that healthcare providers showed high levels of stigma and discrimination against PLWHA [3, 4]. Second, the increasing life expectancy of HIV-infected people who receive appropriate treatment increases the possibility of health professionals experiencing a variety of ethical challenges and dilemmas over time [5].

As a result, numerous ethical issues are present in AIDS care. It is reported that HIV service providers encountered ethical challenges with regard to patients’ autonomy, beneficence, justice, and non-maleficence in the US [6]. Ghanaian scholars Dapaah and Senah also noticed an overt and covert violation of patient confidentiality by healthcare workers in HIV clinics [7]. In the same vein, the research team of Kaposy has determined some prominently discussed ethical issues are occurring in HIV clinics, such as conflicts between client autonomy and public health priorities, difficulties associated with the criminalization of nondisclosure of HIV positive status, etc [8]. Facing numerous ethical issues in AIDS care, the way health professionals deal with these issues becomes critical.

To evaluate the ability to solve ethical issues, ethical decision-making (EDM) competence has drawn considerable attention. It refers to an analytical process in which the optimal alternative is chosen in an ethical dilemma [9]. According to Rest’s Four Components model [10], ethical behaviors result from four reciprocal determinants: ethical sensitivity, ethical judgment, ethical motivation, and ethical character. Ethical sensitivity is the ability to perceive and interpret the moral situation that affects the welfare of someone else. Ethical judgment, also called ethical reasoning, is the ability to judge and analyze alternative actions for the ethical situation. Ethical motivation refers to evaluating how alternative actions serve ethical or unethical values and deciding which action to pursue. And ethical character is a person’s ability to overcome fatigue and difficulties when implementing ethical actions [10]. Insufficient EDM competence can not only result in undesired outcomes, but also trap the decision-makers into ethical conflicts [11].

The EDM competence of various health professionals has attracted researchers’ attention worldwide. For instance, Bužgová and Sikorová have determined that nursing students had a low level of such competence, and the competence was influenced by age and whether they were part-time students [12](Bužgová & Sikorová, 2013). Although EDM competence has been assessed among a variety of health care providers, including dentists [13](İlgüy, İlgüy, & Oktay, 2015), physicians and nurses [14](Pettersson, Hedström, & Höglund, 2018), health professionals in AIDS care rarely receive such attention. The team of Kaposy briefly outlined how Canadian health care providers and clients in HIV care manage different ethical issues [8], but without further exploration of why.

Chinese scholars Huang et al. have explored the ethical sensitivity of Chinese health professionals caring for HIV-infected people in Hunan province, and found that the majority of the participants could recognize the ethical issues that might happen in their line of work [15]. Nevertheless, how these health professionals behave ethically in clinical practice remains unclear in China. Furthermore, medical ethics education in China is still in an early stage [16]. The shortcomings of ethics curricula include limited course hours and topics, small faculty teams [16], outdated information and dull teaching methods [17]. Under these circumstances, the EDM competence of these professionals is still in doubt.

The present study aims to identify how health professionals (in this study, referring to physicians and nurses as prominent patient care providers in China) solve ethical issues in HIV/AIDS clinical practice. Furthermore, this study summarizes the characteristics of the respondents’ ethical decision-making and discusses strategies to promote ethical behaviors and improve the quality of AIDS health care.

Design

To develop an in-depth understanding of the EDM process of health professionals, we conducted a qualitative, descriptive study by one-on-one, face-to-face interviews.

Settings and Participants Sample

This study was conducted from May until August of 2018 in hospitals designated by the Hunan Center of Disease Control (CDC) as HIV/AIDS care facilities. We purposely selected five facilities that serve the majority of HIV-infected people in Hunan.

Participants were recruited by purposive sampling-recruitment. The inclusion criteria were as follows: 1) employed as a licensed physician or nurse); 2) provider of direct care for HIV-infected people and 3) willing to participate in the study. Nurses and physicians engaged in research or management of services for HIV-infected individuals were excluded. We recruited at least two informants from each hospital. Eligible participants were recruited and interviewed until data saturation (no new themes were found) [18].

Measures

The semi-structured interview was guided by Rest’s model on the development of ethical behavior: ethical issue — ethical judgment — ethical motivation — ethical decision — ethical behavior. Starting with the question, “Can you tell me some ethical dilemmas experienced in your daily work?”, the interview proceeded according to the model. Five self-compiled reality-based ethical dilemmas were given to the interviewee if he/she failed to recall any ethical experience in their daily work. The five reality-based ethical dilemmas were compiled based on consultation with two experienced health professionals (one doctor and one nurse) in AIDS care, and the dilemmas were revised in accordance with clinical practice after five pilot interviews (see Appendix 1).

Data Collection Procedures

All interviews were conducted by a nurse scientist with specialization in AIDS care and qualitative research, who has a PhD in bioethics. After introducing the purpose of this study and giving guarantee of confidentiality, informants were requested to give oral informed consent. Interviews were conducted in Mandarin (the required language in working environments in China). The interviews were audio recorded, and the gestures and facial expressions of the respondents were synchronously noted down. When the informant’s response deviated too far from the ethical topic, the interviewer guided him/her back by asking about his/her consideration about how alternative actions serve ethical or unethical values.

Analysis

Data were analyzed immediately after the interview. The audio recordings and notes were transcribed verbatim in Mandarin by two researchers of the team. Additional visits to some informants with equivocal responses were made to give them opportunities to clarify their meanings and ensure content accuracy. The numbered transcripts were anonymous to ensure interviewee’s confidentiality and were analyzed by inductive thematic analysis. After data immersion, two researchers respectively coded the transcripts to identify the main themes with NVIVO11.0 software. When discrepancies in coding and generalizing occurred, the research team and two invited experts in qualitative research met to discuss and find agreement. Lastly, the senior researcher of the team reviewed the audio-recordings and transcripts to ensure the themes were representative and finalized the themes. The analysis was performed inductively, without pre-set categories. However, with respect to the aim of the study, the analysis was focused on identifying the EDM of health professional. In this sense, the analysis was purposive.

In total, twenty-seven respondents were recruited, but five out of 27 asked to withdraw from interviews halfway because they failed to give thoughts of ethical topics. The AIDS-related working experience of the remaining 22 informants ranged from 0.5 to 14 years (Mean = 6.61, SD = 3.91), and the duration of interview ranged from 14 to 66 minutes (Mean = 24.62, SD = 12.48). Among the 22 participants, five were physicians while 17 were nurses. Coincidentally, all the physicians were male, and nurses were female. The AIDS-related working experience of the physician participants ranged from 2.5 to 12 years (Mean = 6.40, SD= 3.63) and their interview duration ranged from 16 to 66 minutes (Mean = 35.06, SD = 18.79). The AIDS-related working experience of the nurse participants ranged from 0.5 to 14 years (Mean = 6.68, SD= 4,12) and their interview duration ranged from 14 to 35 minutes (Mean = 21.55, SD = 8.50). The average interview duration of physicians (male) was longer than that of nurses (females) (t=2.345, P=0.029).

Three themes were identified: (1) common ethical dilemmas experienced by health professionals; (2) factors influencing ethical judgment: emotion, gender, occupation and difficulty in balancing different roles; and (3) ethical motivations, with three sub-themes identified.

Common ethical dilemmas experienced by health professionals

Only three out of 22 respondents described the ethical dilemmas they encountered in clinical practice. The common ethical dilemma described was about the contradiction between the patient’s right to keep confidentiality and relatives’ right to know the truth. One participant expressed her quandary as follows:

It’s a special disease, so patients usually hold the infection status back from their relatives. So many relatives will come and ask us about the patients’ disease and question why it takes so long to recover. We really feel embarrassed about these questions. ... Because keeping patient’s confidentiality may be detrimental to public prevention, while disclosing the patient’s condition indicates disrespect for the patient. (Participant 23, nurse)

Factors influencing ethical judgment

Based on the interviews, participants’ ethical judgment was found to be influenced by four factors: difficulty in balancing different roles, emotion, occupation and gender.

Emotion

The phenomenon that individual emotion overrode professional ethics appeared among several interviewees. For example, when given a scenario about encountering a friend dating an HIV-infected patient (Dilemma 1, Appendix), an informant discussed an intentional violation of patient confidentiality in order to keep personal loyalty to friends. She said

I will tell my friend about the patient’s condition immediately (with an embarrassing laugh), and restrain their intimacy with each other. Being friends is allowed, but sexual relationship is banned. After all, I don’t want my friends to get infected. (Participant 18, nurse)

Moreover, emotion played a key role in ethical judgement in some situations. For example, some informants demonstrated an unwillingness or preference to distribute limited medical resources to some specific HIV-infected patients (Dilemma 2, Appendix) because of individual attitudes towards those patients. One informant stated:

I sympathize with the children infected with HIV via mother-fetus transmission because they have no choice. Drug addicts really repel me for their immorality. ... I prefer to distribute the bed to the teenager because he’s younger and there is hope and significance in treating him. And I am completely unwilling to distribute it to the drug addict because he deserves what he gets. (Participant 2, doctor)

Occupation and gender

Due to the complete overlap between the participant gender and occupation (where all males were doctors and all females were nurses), it is difficult to distinguish the influence of occupation from gender. In the interviews, physician (male) respondents make ethical judgement from the perspective of ethical principles, whereas nurse (female) respondents from the perspective of emotion. For instance, considering the dilemma in which relatives require physicians/nurses to conceal the patient’s critical condition from the patient (Dilemma 4, Appendix), physician respondents took the patient’s right into consideration while nurses paid attention to the patient’s feelings. The distinction was demonstrated below:

We hope not to conceal the patient from his/her condition. Life should be held by the patient’s own hand; if we discuss therapies with his/her relatives, his/her life will be controlled by others. (Participant 27, doctor)

If we tell the patient about his/her real condition, he/she may be so stressed that he/she could die earlier. (Participant 16, nurse)

Furthermore, compared to doctor respondents, many nurses demonstrated a preference for shifting the ethical-decision making responsibility to doctors. They attributed this behavior to the traditional impressions of nurses (nurses just follow doctors’ instructions) in China. One nurse expressed her quandary as follows:

We will turn to doctors when facing any difficulties in decision-making. Because patients always think we nurses just obey the doctor’s advice to give injection or urge them to pay fees. They trust doctors more. (Participant 5, nurse)

Difficulty in balancing different roles

Health professionals are not only advocates for their patients but also guardians of public health. At the same time, they are also individual people. These roles will inevitably conflict with one another in clinical practice, increasing the difficulty of making ethical decisions. When confronting ethical dilemmas, they have to strike the right balance. For example, interviewees were asked what they would do about the following scenario (Dilemma 1, Appendix), “You have suggested that a patient in your ward disclose himself/herself to his/her relatives and partners, but you often come across the patient hanging out with different young girls/boys, and they look intimate. One day you encounter the patient dating a girl/boy again. What will you do?” One informant said:

It’s illegal for HIV-positive people to spread disease on purpose. So if I come across that kind of patient hanging out with a girl, I will privately remind him of his duty to prevent HIV transmission and the ways of prevention (by phone or by an online chatting tool or face to face talking if possible). Because if you talk with the patient in public, you will break the regulation of patient confidentiality according to the professional codes of conduct. We health professionals are not supposed to judge the patient, but are responsible to inform him of his responsibility to protect others from infection. (Participant 25, nurse)

Although 2/3 of respondents struggled to find a balance among those roles, some of them unintentionally violated ethical principles. For example, a nurse who misunderstood the principle of patient confidentiality thought that she obeyed the rule as long as she kept the patient’s HIV-infection status confidential. When being asked what to do if she was encountering one of her friends dating an HIV-positive patient (Dilemma 1, Appendix), she made such a reaction:

It violates professional codes of conduct if I disclose the patient’s infection. However, if it’s my friend who hangs out with the patient, I will advise her to keep away from him by sharing or tampering some of the patient’s private information. For example, (I may) deceive her by identifying another contagious disease like tuberculosis (that her partner has). (Participant 23, nurse)

Ethical motivations

Informants demonstrated three kinds of ethical motivations in the interviews: to protect their own interests; to safeguard others’ interests; and to obey ethical principles, regulations or professional conduct of codes.

To protect health professionals’ interests

In the interviews, a few informants showed concern about their own interests in the EDM process. The rationale for this motivation was to protect themselves from medical conflicts. This could be implied from their answers to different scenarios.

When presented with the dilemma about what to do when visitors ask questions about the patient’s diagnosis, one participant stated:

(I would like) To protect the patient’s privacy. And it’s also to protect ourselves. Out of the mouth comes evil. (Participant 16, nurse)

When asked about what to do if a dying patient’s relatives required all the health professionals to conceal the patient’s terminal condition from the patient even if the patient looks optimistic, (Dilemma 4, Appendix), several informants pointed out the irrationality of ignoring patients’ autonomy, but they chose to keep secrets from patients to avoid medical conflicts (the ownership of a dying patient’s autonomy is a common cause of medical conflicts in China; according to Chinese tradition, the caregiver’s voice should be mainly taken into consideration). They said:

It is absolutely improper for the doctor to conceal information from the patient. He has the right to know his condition. However, we did defer to the relatives’ request to keep the secret from the patient (with a forced smile). But anyway, the treatment will still be as usual. (Participant 24, doctor; Participant 27, doctor)

Also worth noting, for this scenario, one participant said:

It’s unnecessary to tell the patient his/her condition if their relatives demand that it be concealed. Because if the patient knows his/her condition, he/she will be too depressed to cooperate with us. (Participant 10, nurse)

To safeguard others’ interests

This ethical motivation was frequently expressed by the interviewees. They took other people into consideration in the EDM process, such as their patients, the clients’ families, or all of society. For example, when presented with a scenario in which the caregiver for an end-of-life HIV-infected patient insists on the use of ineffective treatment (Dilemma 5, Appendix), participants’ considerations were:

Treatment for a terminal patient is necessary. While the treatment may be futile for him/her, it can comfort his/her family. (Participant 20, nurse; Participant 26, nurse)

To obey ethical principles or professional conduct of codes (rule guided)

Rule-guided motivation was widely mentioned in the interviews. Informants with rule-guided motivation gave priority to professional codes of conduct or regulations in the EDM process. For instance, when asked what to do if beds are limited (Dilemma 2, Appendix), one participant said:

I will distribute the limited beds according to the urgency of the case or the order of arrival. (Participant 5, nurse) (Essentially this is triage, which is part of the responsibility of many health professionals)

When participants were asked what they would do if visitors want to know the patients’ diagnosis (Dilemma 4, Appendix), one participant expressed:

I won’t tell any visitors the patient’s condition. Regulations on AIDS Prevention and Treatment stipulate that all units and individuals should never disclose patients’ disease. (Participant 3, doctor)

The findings demonstrated some characteristics of the EDM process for health professionals in AIDS care in China, such as obedience to the rules and gender and occupational differences in ethical judgment. Moreover, several noteworthy phenomena were observed, like negative attitudes towards HIV-infected people; health professionals vacillating between personal and professional roles and misunderstanding ethical principles; and the effect of fear of medical dispute on ethical behavior.

Obedience to the rules

In light of the results, only several professionals narrated ethical dilemmas they had experienced, whilst the majority of interviewees failed to recall any ethical dilemma experienced in their daily work. However, Chinese scholars Huang et al. have investigated the same population and found that the majority of professionals can sensitively perceive when presented ethical issues [15]. The discrepancy between the two studies may result from a lack of individual ethical reasoning among the professionals. Huang’s study found that many professionals solved ethical issues by blindly conforming to relevant laws and regulations, rather than based on ethical reasoning [15]. Rule-guided motivation was also discovered in this study. As a result, health professionals may forget ethical dilemma experiences soon after they occur because they handled the problem easily without any confusion. However, as the survival rate of PLWHA improves, new ethical issues related to HIV/AIDS will inevitably arise, such as an appropriate age for HIV-positive children to know their conditions, the proper circumstances to perform mandatory HIV-testing, etc. It is important for health professionals to make ethical decisions based on correct ethical reasoning in order to maintain a harmonious doctor/nurse-patient relationship. Improvement in ethics education is conducive to the development of ethical reasoning skills.

Gender and occupation difference in ethical judgment

Our results revealed that doctors (males) made ethical judgment based on laws and regulations, while nurses (females) by care. In line with our results, Friesdorf et al. have also discovered that males engage more in cognitive processing while females prefer an ethics of care in their ethical reasoning processes [19]. However, whether gender differences in ethical judgment exist is still open to debate; research suggests different methods of data collection and types of dilemmas can lead to conflicting results [20]. Rigorous study designs are suggested to obtain more cogent evidence.

Occupational differences in ethical judgement might be interpreted from two aspects. Firstly, the responsibilities associated with participants’ occupations differ: nurses are supposed to pay attention to care, while physicians are responsible for curing [21]. Secondly, in Chinese culture, doctors are the dominant decision-makers in clinical practice, whereas nurses just function under physician orders [22]. As a result, some nurses might be indifferent in EMD or be unwilling to express their concerns about EMD. Furthermore, nurses in this study showed a preference to pass ethical decisions on to doctors; consequently, they might be less experienced in ethical decision-making, possibly reflected by their shorter interview duration compared to doctors’ (males’). These findings highlight the need to underscore the importance of nurses’ role in ethical decision making in nursing ethics education. Likewise, increased physician-nurse communication is suggested in order to promote multidisciplinary cooperation and enhance the quality of healthcare in AIDS care.

Negative attitudes towards HIV-infected people

Unfortunately, although UNAIDS has called for the elimination of stigma and discrimination towards PLWHA, it is a still widespread phenomenon. In this study, negative attitudes towards HIV-infected people were expressed by one informant. The attitudes arose from the denunciation of drug abusers for immoral behaviors like swindling family members out of money. Many scholars believe that ethical behavior is related to both a rational process and non-rational components like intuition and emotion [23]. In this case, health professionals’ behaviors may be affected by their attitudes. Comprehensive HIV-related knowledge education should be implemented to change the attitude of healthcare providers.

Vacillating between personal and professional roles and misunderstanding ethical principles

In this study, many professionals were vacillating between different roles the in EDM process, and professional role was subordinate to other roles for several informants. Moreover, some informants misunderstood ethical principles in the interviews. These findings may imply some deficiencies in medical ethics education. First, the team of Thoma has claimed that the role one takes in an ethical issue could influence how people identify moral problems, influencing ethical behaviors [24]. There is no doubt that medical ethics is based on the role of health professionals. Without determined role-taking and specified responsibilities, professionals are less likely to be ethically behave in clinical practice. Second, ethical principles are guidelines for ethical behavior. Misunderstanding of the principles can impair ethical behaviors, leading to unwanted results. Therefore, it may be helpful to stress the importance of the role of health professional and specify the responsibilities of this population. Continued ethics training is needed to help clarify ethical principles for health professionals. All in all, a lot of work is necessary to improve medical ethics education.

Effects of the fear of medical dispute on ethical behavior

Several informants implemented a sub-optimal ethical behavior due to the fear of medical dispute. Medical disputes do exist, but may be exaggerated by the mass media in China [25]. As a result, the fear of medical disputes arose among health professionals [26], motivating them to avoid conflicts rather than make ethically sound decisions. Legal literacy enables health professionals to defend themselves against medical dispute but it was widely lacking among health professionals while patients had a strong grasp of health law [27], exacerbating health professionals’ fear. Therefore, not only should the mass media more responsibly cover news regarding medical conflicts, but medical educators and hospital administrators should also promote healthcare providers’ legal literacy in order to reduce their fear of medical disputes. Besides, effective communication with patients is a good way to avoid medical conflicts.

Limitation

This study gave an outlook of EDM experience among health professionals and shed a new light on promoting ethical behavior in AIDS care. However, there are several limitations. First, this study was conducted in Hunan province, so the results cannot be easily generalized to the rest of the country. Separately, due to the same ratio of female to male and nurses to doctors, the influence of gender and occupation on ethical decision making could not be distinguished.

Overall, the majority of informants failed to recall ethical dilemmas experienced in clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence ethical judgment of health professionals. In the EDM process, most informants took other people’s interests into consideration and conformed to law and professional codes of conduct. However, the misunderstanding of ethical principles and the tendency that some health professionals had to vacillate between professional and personal roles implied some limitations of medical ethics education. There is an urgent need to promote medical ethics education for health professionals in China.

AIDS: Acquired immunodeficiency syndrome; HIV: Human immunodeficiency virus; PLWHA: People living with HIV/AIDS; UNAIDS: The joint united nations programme on HIV/AIDS; CDC: Center for disease control and prevention; EDM: ethical decision making

Ethical Statement

This study was approved by the Institutional Review Board of behavioral and nursing research at the School of Nursing of Central South University (Ethics code: 2017040).

Consent for publication

Not applicable.

Data and material availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was supported by the Fundamental Research Funds for the Central Universities of Central South University (Grant number: 2018zzts882) and the Fogarty grant of NIH (Grant number: D43TW009579). The funders had no role in study design, collection and analysis of data, manuscript preparation, or in the decision to submit the manuscript for publication.

Authors’ contribution

HH made contributions to the collection, analysis and interpretation of data, she have drafted and substantively revised the work. DK-G was involve in the design of the work, giving advice on the conduct of interview and reviewing the manuscript. HW was involved in the interpretation of data and the writing of the work; MY made a significant contributions to the design of the work, and she conducted and helped transcribe the interviews. All authors read and approved the final manuscript.

Acknowledgement

The authors would like to thank all informants who participated in this study.

Dilemma 1: Encounter a patient’s date

You have suggested that a patient in your ward disclose himself/herself to his/her relatives and partners but you often come across the patient hanging out with different young girls/boys, and they look intimate. One day you encounter the patient dating a girl/boy again. What would you do? And what if the girl/boy is one of your friends?

Dilemma 2: Source distribution

One day, 3 clients in serious condition come to your ward to register at the same time. However, there is only one bed available in the ward. Background data on the individual clients reveal the following: (a) a middle-school student infected with HIV through blood transfusion, (b) a middle-age female infected with HIV via her husband, and (c) a young man who is an injection drug abuser. Who would you distribute the limited bed to, and why?

Dilemma 3: The patient’s confidentiality

A visitor claiming to be a relative of a patient come to the ward. He/she ask you about the diagnosis of the patient. What would you do? Do you think it is necessary for PLWHA to disclose his/her condition to his/her relatives and friends?

Dilemma 4: The requirement to conceal

A patient is dying, his/her relatives require all the health professionals to conceal his terminal condition from the patient even if the patient looks optimistic. What would you do?

Dilemma 5: The requirement to treat

A HIV-infected patient is terminally ill. Although the treatment is ineffective, his relatives still insist on the treatment. Do you agree with the relative’s decision? Why?

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Ethical Decision-Making of Health Professionals Caring for HIV-Infected People in Hunan, China: A Qualitative Study

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