Health Care: Refusal to Treat

Pages63-65

Page 63

The Issue

Gaining access to health care is one of the most successful methods for controlling the HIV epidemic. However, around the world PLHIV and those perceived as being infected with HIV continue to face discrimination in the health care sector. Doctors, nurses, and other health professionals may harbor the same fears, ignorance, and aversions as other members of the population with regard to HIV. In the health care setting, these attitudes can lead to discrimination that prevents PLHIV from accessing health care.

Discrimination can manifest in outright refusals to admit or treat patients who are infected with HIV or perceived as infected, delays and withholding of care or treatment to these patients, and premature discharge of patients. These actions may have consequences beyond preventing access to treatment for HIV or AIDS; access to all health care services may be undermined. By refusing to treat patients, the risk of serious health consequences increases for both the individual and the general population. Lack of resources in the health care system also may provoke discrimination against PLHIV, when scarce resources are intentionally reserved for other patients.

Legal and Policy Considerations

Direct denials of care on the basis of HIV status are often prohibited under general antidiscrimination legislation or through disability or HIV-specific laws. Some countries have chosen to enact specific protections against discrimination based on HIV status in the health sector within national legislation or policy. Legal frameworks that address the workplace and occupational health and safety issues also may contribute to antidiscrimination protections.

While antidiscrimination laws and policies provide a clear message that it is inappropriate to refuse to treat HIV-positive persons due to their HIV status, the nature of many health care systems allows discrimination to continue under the guise of resource allocation decisions. Under the law in many countries, private hospitals and other health institutions are not required to accept all patients and may not be covered by antidiscrimination provisions (which may only apply to government or public sector health care institutions). Private health care institutions may refuse to provide nonemergency care to a patient who cannot pay. In this case, the courts may need to determine whether...

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