Care of Persons with Communicable Diseases Integrity

1
Care of Persons with Communicable Diseases
Integrity
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Integrity

• Fundamental value underlying ethical behavior
• Unique among nursing values because it focuses on
  the moral agency of the nurse and not the duty
  owed to others

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Features of Integrity

• Moral Autonomy directing ones own moral life
  rather than being guided by others
• Fidelity to Promise actions guided by promises
  made
• Steadfastness unwillingness to yield values
  even under pressure
• Wholeness consistency across various dimensions
  of life

4
Integrity and Moral Distress

• Nurse knows right thing to do but institutional
  constraints make it difficult or impossible

5
Moral Distress

• Psychological disequilibrium and negative feeling
  experiences when a person makes a moral decision
  but does not follow through by performing the
  moral behaviour indicated by the decision

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Communicable Diseases Public Health Law

• Primary duties of medical health officers are
• Duty to report all known and suspected cases of
  communicable disease
• Duty of confidentiality not binding if third
  party in imminent danger of contracting
  life-threatening disease, contact notification

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Ethics and SARS Lessons from Toronto

• Health Care Providers persons most affected 40
  of those infected

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Ethics of Quarantine

• Health Protection Promotion Act (1990) gave
  power to enforce quarantine for non-compliant
  individuals

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Values assoc. with SARS/Quarantine

• Individual liberty
• Protection of public from harm
• Proportionality least restrictive methods
  reasonable, applied without discrimination

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SARS Values contd

• Transparency full information re risks and
  benefits
• Reciprocity persons quarantined must have
  adequate care and not suffer unfair economic
  penalties

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SARS Values contd

• Privacy of personal information and public need
  to know
• Duty of care - does obligation extend to risking
  life of nurses?
• Equity others denied care as SARS became
  priority
• Solidarity globalization includes duty beyond
  national boundaries

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HIV Infection in Canada

• Disproportionate number of persons infected are
  injection drug users and men who have sex with
  men
• Infection rate among women rising, usually as
  result of heterosexual contact
• Infection rate rising disproportionately among
  aboriginal population

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Canadian approach re HIV

• Voluntary behavior change
• Informed consent for testing
• Protection of confidentiality
• Voluntary partner notification

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2 Canadian law cases re HIV

• Cuerrier, 1998, Williams, 2003
• HIV persons now have legal duty to disclose to
  potential partners

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Should testing become mandatory?

• Professional Codes of Ethics and Canadian law
  both require informed consent
• HIV agencies advocating for more education, and
  widely-advertised, readily available, bias-free,
  quality testing options

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Can nurses refuse to care for persons with HIV?

• See Code of Ethics statement 1, Justice
• Moral objections? See Choice, statement 8

17
Should HIV testing be mandatory for nurses?

• Constitutes an invasion of privacy
• Nurses have right to decide for themselves, MARN
  position statement, 1994