Prison patients are never alone and never without supervision and rules, and the medical staff is always negotiating its power with the adminsitration. The patient-doctor relationship can become distorted in this setting.
The stigma associated with HIV has diminished with its spread among the heterosexual population and the development of effective treatments. This normalization may justify assuming a more traditional public health perspective about mandatory prenatal screening.
Those in prison are less healthy than the general population, are far more likely to have engaged in high-risk behaviors that can result in organ damage, disease and disability, and age more rapidly than nonincarcerated individuals do.
Gerald M. Oppenheimer, PhD, MPH and Ronald Bayer, PhD
The alarm generated by the AIDS epidemic left civil liberties proponents fearful that traditional public health responses might be imposed on newly susceptible or infected populations.
The greatest pressure to resuscitate the extremely low-birth-weight infant often results from successful marketing efforts that lead families to expect that their premature infants will be cute and healthy.
With heterosexual transmission the chief cause of global HIV spread, those without the power to select sexual partners, choose the timing of sexual encounters, or insist on safer sex practices are unable to protect themselves from infection.
Physicians new to a case might object to an established care plan. Practice variation, clinical momentum, and how value is assigned by different parties to acute care and comfort measures can each contribute to conflict in these cases.
AMA J Ethics. 2018;20(8):E699-707. doi:
10.1001/amajethics.2018.699.
Undocumented patients in the United States with end-stage renal disease receive “compassionate” dialysis. Such patients oscillate between being marginally well and “ill enough” to receive dialysis while clinicians wrestle with complicity in a system that both offers and withholds life-saving therapy.
AMA J Ethics. 2018;20(8):E778-779. doi:
10.1001/amajethics.2018.778.