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Can Communities Protect Autonomy? Ethical Dilemmas in HIV Preventative Drug Trials

Published online by Cambridge University Press:  29 July 2009

Deborah Zion
Deborah Zion
Affiliation:
Student at the Centre for Human Bioethics at Monash University, Victoria, Australia.
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Extract

Before sailing past the sirens' “flowery meadow,” Ulysses instructed his sailors to lash him to the mast so that he would not succumb to the siren's singing. His advance directive demonstrated that he valued his dispositional or long-term autonomy over his unquestioned right to make decisions. He also indicated to his oarsmen that he understood the nature of temptation and his inability to resist it. Ideas of autonomy and sexual choice are central to this discussion of new AIDS treatments, especially the trials of preventative vaccines. Questions arise over the rights of individuals and the extent that these should be limited by concerns of the gay community. Should the gay community intervene in the risky decisions of individuals if no explicit advance directive exists? If so, how do they justify their paternalism? Could their aims not be better served through strengthening the individual dispositional autonomy of trial participants rather than making specific claims about the common good?

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 4 , Issue 4 , Fall 1995 , pp. 516 - 523
Copyright
Copyright © Cambridge University Press 1995

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References

Notes

1. [Editorial] The Lancet 1994;343:494.CrossRefGoogle Scholar

2. Flood, A, van Kooten-Prasad, M. Preventative vaccine trials in the United States. National Aids Bulletin 1993;7:11–3, at p. 11.Google Scholar

3. Buchanan, D. Vaccine positive. National AIDS Bulletin 1993;7:13–6.Google Scholar

4. Petersen, K. Education issues – strategies for maintaining safe sexual behaviour throughout vaccine trials, In: McIndoe, N, Ed. HIV/AIDS Vaccine Public Meeting Report 1993;8:3.Google Scholar

5. Kelaher, M, Ross, M, Rohrsheim, R, et al. Dominant situational determinants of sexual risk behaviour in gay men, AIDS, 1994;8:101–5.CrossRefGoogle ScholarPubMed

6. de Wit, JBF, Van Grensven, GJP, Kok, G et al. , Why do homosexual men relapse into unsafe sex? Predictors of resumption of unprotected anogenital intercourse with casual partners. AIDS 1993;7:1113–8.CrossRefGoogle ScholarPubMed

7. See note 3. Buchanan, . 1993;7:13–6.Google Scholar

8. Dworkin, R. Integrity. In: Fisk, M, Ed. Justice. Atlantic Highlands, New Jersey: Humanities Press, 1993:137–66.Google ScholarPubMed

9. See note 8. Dworkin, . 1993:153–4.Google Scholar

10. See note 8. Dworkin, . 1993:155.Google Scholar

11. Schuklenk, U. Against manipulative campaigns by “community based” AIDS organisations. Health Care Analysis 1994.Google Scholar

12. Viney, L, Crooks, L. The psychological meaning. In: Timewell, E, Minichiello, V, Plummer, D et al. , Eds. AIDS in Australia. Sydney: Prentice Hall, 1992:108–41, at p. 118.Google Scholar

13. Altman, D. The most political of diseases. In: Timewell, E, Minichiello, V, Plummer, D et al. , Eds. AIDS in Australia. Sydney: Prentice Hall, 1992:55–72, at p. 68.Google Scholar

14. Information about participating in a trial of an HIV prevaccine, Attached to the Informed Consent Form, St. Vincent's Hospital, University of N.S.W. Project Title: A double blind, placebo-controlled trial to evaluate the safety and immunogenicity of United Biomedical, Inc. (UBI) HIV-1 MN octameric V3 peptide vaccine in HIV 1 negative human subjects. 1993.

15. The ELISA Test is the initial test for HIV in Australia. The Western Blot is the follow-up test considered definitive. However, in other countries the result of the ELISA test is the determinant for visas, and in Australia it is also used by some insurance companies.

16. Brock, D. The ideal of shared decision making between physicians and patients. Kennedy Institute of Ethics Journal 1991;1:28–47, at pp. 32–4.CrossRefGoogle Scholar

17. Mill, JS. On liberty. In: Warnock, M, Ed. Utilitarianism. London and Glasgow: Collins/Fontana, 1983:126–250, at p. 135.Google Scholar

18. Young, R. Personal Autonomy. London: Croom Helm, 1986:73.Google Scholar

19. Radden, J. Planning for mental disorder. Social Theory and Practice 1992;18:165–86, at p. 175.CrossRefGoogle Scholar

20. Fox, EL. Paternalism and friendship. Canadian Journal of Philosophy 1993;23:575–95, at p. 577.CrossRefGoogle Scholar

21. Feinberg, J. Legal paternalism. Canadian Journal of Philosophy 1971;1:105–24.CrossRefGoogle Scholar