AIDS and the human community

This paper examines ethical behavior in the face of the threat posed by the AIDS epidemic from the vantage point of: (1) different ways of looking at communal structure; (2) notions of justice and of 'rights' which develop from different ways of looking at community; and (3) views of the 'natural lottery' and of self-causation linked to attitudes towards community, justice and 'rights'. Possibilities of resolution are then examined briefly addressing problems of: (1) nonvoluntary testing of persons, and of reporting and restricting those believed to be infected; (2) professional responsibility towards the infected; and (3) communal responsibilities to those infected with AIDS. Communities which hold freedom (and its corollary autonomy) to be an absolute and which see beneficence as a 'nice' but nonmoral quality, will refrain from nonvoluntary testing, reporting and restricting. Professionals in such communities will view themselves as bureaucrats of health, their obligations restricted by explicit contract. Such communities will hold the 'natural lottery' (strengthened by notions of self-causation) to be at fault for all illness. It, therefore, would perceive no obligation to aid patients afflicted by AIDS or other misfortune. Communities of this sort, it is argued, when they feel sufficiently threatened by epidemics may (when they finally abrogate their principles or redefine the problem by excluding patients as members of the community) resort to extreme and no longer limited measures. The paper concludes that most look at community as constituted by more than the minimal obligations of refraining from harm to one another and include beneficence among the moral obligations. The incompatibility of freedom as a moral absolute with a viewpoint which sees beneficence as a moral obligation is stressed. Such communities, it is concluded, may consider the testing of population groups, as well as reporting and restricting of the infected, to be legitimately possible within their vision of morality. On the other hand, professionals will be constrained by other than explicit contract. The medical community bears a special obligation for dispassionate examination of the facts in light of its special training, as well as for a compassionate analysis in light of its tradition of compassion towards the ill. It must serve as advisor to the greater community as well as serving as advocate for patients and for their suffering. Communities and their professionals, therefore, will feel compelled to help what they, more likely, perceive as the victims of complicated causality and not merely the scapegoats of blind fate.