The Critical Calling: Reflections on Moral Dilemmas Since Vatican II

18. AIDS: The Shape of the Ethical Challenge

Chapter 18 AIDS: The Shape of the Ethical Challenge Californian Artie Wallace, 32, was diagnosed with AIDS (Acquired Immune Deficiency Syndrome) duringJuly 1986. On August 3, 1987, his ex-wife fled with their nine-year-old son Shawn, who wanted to live with his father.1 She feared their son would get AIDS and disapproved of Wallace's living with another man. This human tragedy—involving lawyers, judgesand a private investigator—could easily be a symbol of the sufferings of thousands throughout the country. It has all the dimensions we have come to associate with AIDS: ignorance, fear, separation, loneliness , alienation, stigma, judgment, pain and death. It is not surprising, therefore, that the AIDS epidemic casts up ethical problems at virtually every stage of its relentless onslaught. If we are to face these problems in a humanly compassionate and thoroughly Christian way, we must first be in control of some rudimentary facts. The moral obligations and policy decisions surrounding AIDS are synthetic. They are a synthesis or mixture ofprinciples with empirical data. Obligations defined and decisions made without benefitoffacts are likely to be nothing more than the promulgation ofpersonal or cultural biases. Such method by incantation only intensifies the problem by wrapping it in moral confusion. First, then, some facts. As of September 1976, the Centers for Disease Control (CDC) reported 42,354 diagnosed cases of AIDS in the United States. As I write, the number is well over 50,000. More than 25,000 have already died and the numbers change daily. The CDC estimates that 1.5 million are now infected with HIV (Human Immunodeficiency Virus). It projects that by 1991 270,000 will have AIDS, that 179,000 will havedied from AIDS, and that in 1991 alone 54,000 will succumb to the dread dis- 316 / Richard A. McCormick, S.J. ease.2 1 qualify these figures by "as I write." When this book appears, the figure could well have doubled. Thejetrovirus responsible for AIDS infects and leads to the death of T helper cells, with resultant dysfunction of the immune system. It was originally referred to as "Human T-cell Lymphotrophic Virus Type III (TLV-III) and more cumbersomely as HLTV-III-LAV (lymphadenopathyassociated virus).Now most literature follows the usage ofthe International Committee on the Taxonomy of Viruses: "Human immunodeficiency virus" (HIV). There are several technical and complicated ways of classifying the stages of HIV infection (whose diagnosis is referred to as "HIV positive," "antibody positive" and "seropositive"). They need not detain us here. For purposes of simplicity, I note the following: —HIV positive or antibody positive: the individual's blood shows antibodies stimulated by the HIV virus, indicating exposure to HIV. The individual is said to be "seropositive." A large proportion (perhaps between 30-50%) will develop full-blown AIDS but may remain asymptomatic for five to ten years. —ARC (AIDS-related complex): this refers to a group of less severe symptoms such as chronic diarrhea, recurrent fevers, fatigue, weight loss, lymphadenopathy (persistent swellingofthe lymph nodes). In May 1987, the CDC proposed dementia and emaciation as confirming AIDS, thus enlarging the number of those eligible for public health benefits. —AIDS: this refers to the most severe clinical manifestation of the HIV infection. It includes opportunistic infections, and above all, the relatively rare pneumocystis carinii pneumonia and neoplasms such as Kaposi's sarcoma. Figures for those with AIDS vary slightly (not substantially), depending on the source. A representative breakdown is the following: —73% in homosexual or bisexual men —17% in IV drug users —6% in those without a well-defined risk factor —1% in children —1.6% from prior blood transfusions —1% in hemophiliacs —1% in heterosexuals exposed to those in risk categories From this it isclear that HIV infection is transmitted above all in three ways: (1) sexual contact (exchange of body fluids); (2) parenteral exposure (needle-sharing for drugs, blood transfusions); (3) perinatal exposure (transplacental and/or intrapartum transmission). All HIV infected persons are potentiallyinfectious,and probablysofor AIDS: The Shape of the Ethical Challenge / 317 life. At present there is no known cure for AIDS although various antiviral agents and immunomodulators are being developed. AIDS is quite simply fatal. AZT (azidothymidine) can prolong life and improve performance status; but it cannot cure. These are some of the bare facts. It is clear that there are many ethical problems associated with the phenomenon ofAIDS. For instance, is it ethical for a physician...