Summary of Responses to: ethical question (LONG)

Summary of Responses to: ethical question (LONG)

Bill Lifford

7/8/1999

Hello everybody,

Thanks to all of you who weighed in on my rather unusual situation.
There were a lot of good replies... I have listed them here (at least
all the ones that have come in in the first 12 hours since I posted),
separated by lines ----.

My original post is at the end of the entire message, in case someone
missed it and wants to know just what this is all about.

I'm going to handle it (she has an appointment next week) like this:
1) tell her I am unable to give her any advice / information on how to
contact people who may be interested; 2) explain to her that I am
uncomfortable with her requests, and that if she cannot stop hounding me
to use my professional contacts to seek such information, that I would
recommend she seek another prosthetist; and 3) inquire with local law
enforcement (without mentioning any names) as to if they should know
anything about the situation and if so what action should be taken.

I hope it will all turn out well.



SUMMARY OF RESPONSES:
----------------------------------------------------------

I'm afraid you have one of the most perplexing dilema... patient
confidentiallity vs public health.

I do know that there have been cases where attempts to purposely infect
folks with HIV has been treated as assualt with a deadly weapon.

Are you associated with a teaching hospital? They often have have
pannels
who discuss medical ethics. You might be able to present your case with
them.

Baring this, you might want to discuss it, in the abstract, with your
local
health department. They are probably aware of the local laws...

The risk is that, once you begin to discuss it, you might be compelled
to
report it by law..

>From the sounds of your posting, you belive that she may be looking for

sexual contacts.. This sounds like intent and if you belive that
HIV transmission is assualt with a deadly weapon.. then you may be
an accessory to that crime...

I'm very glad I'm not faced with the same decisions you are..

(I wonder if posting it to machines that span many state jurisdictions
make you liable to all the laws that may be in effect in each of
those jurisdictions? GAD!.. I hope not!)

I think I'd talk to my own personal lawyer FIRST thing in the morning,
to
see what your risk is.. they pursue ethics type issues as you can.

Steve

---------------------------------------------------------

You sent a message which was forwarded to amputee-online.com about
you HIV+ former(?) hooker.

I am not in the business but I am former clergy so I think I know
something about ethics. I'll put my 2 cents in the pot.

It is not your responsible to serve as her procurer (which you would
be if you gave her the information she requested and, she acts on
that information to turn tricks).

If I were in your position (if she came to me at the church and gave
me the same information, and made the same request) I would be
ethically responsible if I gave her the information, she acted on it
and, by so doing, infected one of her clients.

I would encourage you to tell her That is not my job. My job is to
make limbs and braces. Maybe you should talk to someone in a
computer store, who might know of sites with the information you
asked for. By doing this 1) you remove yourself from the ethical
problem, 2) you do not abandon her with a flat No because you gave
her another possible source of the information.

If worse comes to worse and she will not accept that answer you need
to ask yourself the question Do I need her business enough to
compromise my ethics to keep it?

The law is changing all the time, if she infects a client because you
gave her information as to where to troll for clients you may be
opening yourself to being in court explaining why you should not
compensate the fellow for 6 digits, due to your liability.

Hope it helps.

Grew up in Park Slope,

Bill

------------------------------------------------------

dissassociate ASAP

-----------------------------------------------------

Yes you do have a dilemma here, but it may be more simply to handle by
explaining your concerns. Be honest with her. If she really wants to
locate this information she will, you at least expressed your valid
concerns.

Douglas Bourgoyne, CPO

-----------------------------------------------------

Bill I dealt with a few HIV+s at a county hospital. Please be objective,

this person came to you to get professional assistance to get prosthetic

services do what is right and stop at that point. You lifestyle excludes
your
knowledge of devotees. professionally respond that you don't have
information that answers a question clearly out of our realm of
expertise.
The fact she is attractive moderately clouds our judgement on when to
stop
extending our help. As P and O guys, we have a vulnerable predisposition
to
want to fix it all. Wocase would be that some family is devastated by
this
woman's actions and you were the only way they may have come to meet. Be

objective and your heart will be the better for it.

Respectfully,
Tony Denson CO

----------------------------------------------------

Hi - Amp-L and the St. John's are certainly not the primary location of
devs and wans but a warning re this woman would be appreciated.....even
directly to the wannabe list, but somebody will probably forward this to

those people. In spite of what seems to be considerable antipathy there
is
a kind of cohesion between these groups. At any rate your concern is
well
taken and, with an HIV+ threat in the background, an exploitive
individual
is quite a threat. People will thank you. Cheers, George B.

-----------------------------------------------------

Bill:

Have this woman contact Jama Bennett at ASCOT.

She can be reached at the ASCOT Page at <URL Redacted>

Hope this helps.

For more info on devotees (from this amputees perspective) check out
the bottom of the page at
<URL Redacted>

BTW: Devotees are not allowed membership to the St Johns Amputee list.

Hope this helps.
=================================================
Ian Gregson ( <Email Address Redacted> )
Amputee WEB Site <> AMPUTATION Online Magazine
<URL Redacted>
Moderator Amputee & D-Sport Listservs
icq # 27356900
=================================================

------------------------------------------------------------------

Bill, I would treat her prosthetic needs as that is the nature of your
business. You don't know of any devotees for her to contact so that is
where it should stop. If you just tell her that in no uncertain terms I

suspect she will get the message. And she will probably just move on to

another prosthetist if seeking a devotee is her goal. At least she was
forthright in informing you of the HIV.

Joe

-----------------------------------------------------------------

Ethically it is your responsibility to provide prosthetic care and
treatment, anything beyond that is out of bounds! Keep your focus on
that
only, and if she wants to keep grilling you for more info or resources,
send
her packing. There is a very large and smelly can of worms that can come

open here, and you don't want to get any of it on you!
    Hope this helps!!! Good luck!

                    Kevin Hawkins CP

----------------------------------------------------------------

Bill,

 I would not help this patient in contacting the devotees group or our

mailing list. I too have heard of this very unusual situation.

I would help this patient with her prosthetic care, only. Actually, if
you
were to come aware of this HIV patient coming in contact with anyone,
where
the other person is in danger of being infected with HIV; you are
obligated
legally in contacting your local police department.

I would stay neutral if you can.

  Jake C.P.

-----------------------------------------------------

Bill,

  I'm truely
amazed on how this situation arose. In my opinion, there is no ethical
question. The organization she is looking for is not one of therapy,
and
hence the field has no ties to it. You should tell her your a
prosthetist,
not a dating service! The issue of AIDS is a different bag of worms.
This
is not an issue of helping her, but of self help. As far as her
dating,
let's hope she has enough sense to use protection as well as explain to
her
partner the implications.

Take care,

Rich

-------------------------------------------------------------------

=================================
MY ORIGINAL POST:
=================================

Hello everybody,

I have an extremely unusual situation here, and I was wondering if
anybody has encountered anything similar or can offer advice. Let me
explain:

A client/patient came to the office (walk-in, no prior appointment), and

I did an evaluation. The person is approx. 35 years old, left
transtibial amputee secondary to vascular disease. She is currently on
anti-depressive medication and experiences mood swings. She is also
HIV+.

She mentioned to me that she is HIV+ because she used to work as an
adult film star and call girl. She keeps asking me if I know of anyone
that can put her in touch with people called devotees. These devotees

are people who are attracted specifically to amputees. She has read
about them and, I think, heard about them on the Howard Stern radio
show.

I have told her several times that I don't know anyone of the sort and I

try to change the subject. She, however, persists upon asking again and

again. Judging from her recent background, I'm assuming she intends to
find these devotees for the purpose of making money off of them. I
really don't know that for sure, but given her past and her desire to
locate them I have to assume it's for some form of self-exploitation.

I am extremely uncomfortable with this whole situation. What she does
is her business, but I am concerned. I mean, even if she does locate
some people like that, will she disclose her HIV status??? At what
point and how should I disassociate myself from the whole thing? Should

I recommend she check out Amp-L and the St.-John's Listservers (just to
get her to stop asking me)? Is it ethical to recommend she go somewhere

else? Or is it unethical to not try to help her? The issue is
clouded... exactly what is my professional and ethical responsibility at

this point?

Frankly, I don't know what to do. Has anybody ever had a similar
patient? Please advise.

Bill Lifford, CP
ARIMED Orthotics, Prosthetics, and Pedorthics
Brooklyn, NY