Friday, March 16, 2007

Stigma in the Lives of HIV+ Healthcare Workers

I'm Pete Levandoski

Advances in HIV related pharmacology have given HIV patients extended lifetimes, turning them from dead men walking to living individuals with a debilitating condition. In treating any patient, HIV status not withstanding, the American Dental Association states that dentists should practice, “high ethical standards which have the benefit of the patient as their primary goal” (Rhode Island Dental Association, 2006). If the maxim is adhered to, dentists should have no problems treating HIV positive individuals who come to them seeking care. The fear of exposure to the virus however, has led some dentists to refuse treatment. In these instances, the Supreme Court has stepped in, ordering treatment and protecting the rights of patients. However, in jumping to the aid of patients, the High Court may have inadvertently aided efforts to discriminate against those living with HIV.

A landmark case for HIV patients was the 1998 affirmation of the ruling in Abbott vs. Bragdon. Sidney Abbott, an HIV positive individual, successfully argued that in refusing to treat him because he was HIV positive, Dr. Rondon Bragdon had violated the Americans with Disabilities Act. Bragdon’s unsuccessful defense was that Abbott’s HIV represented a “direct threat” to his own health (Sfikas, 2002).

In May of 2002, the “direct threat” defense was again used, this time in the case of Waddell vs. Valley Forge. The Court ruled that Spencer Waddell, an HIV positive dental hygienist, could be removed from his job because his disease was a “direct threat” to the health of his patients (Sfikas, 2002). The sum of these two decisions is that the idea of “direct threat” can legally be used to protect patients but not to protect dentists.

The same code of ethics that puts patients first also claims that this goal has lead to, “…society affording to the profession the privilege and obligation of self-government” (Rhode Island Dental Association, 2006). Above all, dentists want to retain autonomy and self regulation. In the process of trying to protect patients, these two court decisions have reduced the autonomy of dentists. Decisions in the cases of Waddell and Abbott should have been made by dental professionals, argues Peter Sfikas in his article in the March 2002 Journal of the American Dental Association (Sfikas, 2002).

In the Abbott case, the procedure being performed was a cavity filling, which involves little to no blood. In the Waddell case, root planning, which involves a large amount of blood, was being done. The courts made the correct decision in siding with the patient when looking at the evidence in each specific case (Sfikas, 2002). However, instead of maintaining a case by case system, the courts have set precedents which issue blanket statements without regard for case specifics. This has lead to the reality that the only way a dentist can refuse treatment is by preemptively providing evidence of a “direct threat” to his or her health from the patient (Sfikas, 2002).

These two court cases have gone a long way to advancing the rights of HIV positive patients. The Supreme Court stepped in and set a precedent to prevent HIV positive individuals from being denied healthcare. The Waddell case however, could be spun to deny rights to HIV positive individuals (Sfikas, 2002). The Court gave Spencer Waddell’s employer the right to fire him because he was HIV positive. In trying to protect the rights of patients, the court system has set a legal precedent which discriminates against HIV positive workers if they pose a “direct threat” to the health of their customers (Sfikas, 2002).
Waddell’s case was denied writ of certiorari by the Supreme Court, so it will be up to future cases to decide whether or not firing an employee because they have HIV is legal (Waddell v. Valley Forge Dental Assocs. 2002). Whatever decisions are made in future cases; these two examples highlight the complex interplay between human rights and stigma that HIV positive individuals still face in the United States today.

Sfikas PM. “HIV and discrimination: A review of the Waddell case and its implications for health care professionals”. The Journal of the American Dental Association. Vol. 133, March 2002. (pp. 372-374).
Rhode Island Dental Association. “Principles of Ethics & Code of Professional Conduct”. 2006.<>. (29 November 2006).
Waddell v. Valley Forge Dental Assocs. 535 U.S. 1096. US Supreme Court. 2002.

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