The Ethics of Testing for AIDS

May 26, 1991|By ERNEST B. FURGURSON | ERNEST B. FURGURSON,Ernest B. Furgurson is associate editor of The Sun. His column appears on Sunday, Wednesday and Friday.

WASHINGTON — Washington-- At the government's last count, 171,876 Americans had been diagnosed with AIDS. Through last March, 108,731 -- more than 63 percent of those infected -- had died. How many more are carrying the disease without knowing it is impossible to guess.

Around the world, crowds of concerned people took part last weekend in an international day of mourning for victims of this incurable plague. There were candles in the windows of the White House, a vigil at the Lincoln Memorial, a candlelight march in San Francisco, sad demonstrations in cities from London to Singapore.

To calm public fear about the safety of the blood supply in this country, the Red Cross is reforming the testing and management of its donor system. At the same time, new fears were raised by news that three persons had died and more than 50 put at risk by transplanted organs from a shooting victim infected with AIDS. Cases of doctors infecting patients and vice versa have been disclosed.

Where will it all end? How?

Researchers are working furiously to find a cure, following leads in all directions. Some miracle drug may be found tomorrow, perhaps in a rare plant threatened by clear-cutting of the world's rain forests, or some insect endangered by pesticides. But so far, the most that medicine has been able to do is mitigate the disease, letting some of its victims live longer.

In the absence of cure, the best hope is prevention. The ways in which AIDS spreads are well known, and none of them is essential as are breathing and eating. At least in this country, most victims and potential victims know by now what behavior puts them or others at risk.

Not long ago, when this great scourge first began to spread, some righteous citizens were more eager to blame victims than to help them. This was God's punishment for the sins of homosexuality and drug abuse, they said. Since then, that attitude has diminished; a new Gallup Poll shows that 63 percent of Americans disagree with the idea that "it's people's own fault if they get AIDS."

To that extent, the massive public education campaign of recent years has succeeded. Most people have seen that there are "innocent victims" who are not infected through any activity or mistake of their own. Apparently most also believe that whether a person was infected through some socially forbidden habit or by disastrously bad luck, he or she still deserves to be helped.

They are all victims -- and they are all potential menaces to public health. Some carriers are menaces because even after finding out they are infected, they go on with habits that endanger others. But the wider threat is from people who don't know they have been exposed, so may pass the virus on to uncounted others before their own condition is discovered.

The first step to curtail this danger is wholesale testing of citizens -- of doctors, dentists, nurses, hospital patients, immigrants, marriage license applicants, prison inmates and those in the armed services, among others. The Gallup survey finds that Americans overwhelmingly approve the idea.

But there are those, including some civil libertarians and spokesmen for gay organizations, who object that this would intrude on the right of privacy. They also object to laws that now exist in 22 states outlawing various forms of behavior that could spread the virus -- although 79 percent in another national poll favor criminal charges against anyone who knowingly infects another.

Such a law is being debated in California, where some public health officials and AIDS support groups maintain that the legislation would instead work against efforts to stop the spread of the virus. These objectors say the risk of prosecution will discourage possible AIDS carriers from getting tested -- if they avoid testing and do not know they are infected, they can plead ignorance.

There is some logic in this, but not much caring -- for either public health or the individuals they put at risk. Without playing God and dispensing punishment for what has happened in the past, the state has a right and a duty to protect citizens from what may happen to them in the future.

Laws against recklessly endangering the lives of others with automobiles and weapons less deadly than the HIV virus are already on the books, so including AIDS on that list is not unfairly singling out anyone. And any nation in this kind of medical crisis that fails to make testing a routine procedure is still living ethically in the Dark Ages.

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