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It often is understood to require that the risks of research be minimized and that the risks be acceptable in light of the potential benefits of research.(1-3) Finally, justice requires that people be treated fairly.
It is often understood to require that benefits and burdens be distributed fairly within society.(1-3)Although the ethical principles are useful guidelines that help to focus discussion, they cannot be mechanically or rigidly applied.
Although many examples are drawn from the United States, these issues are also explored from a global perspective. There are three widely recognized principles in American bioethics that apply to both clinical and research ethics: respect for persons, beneficence, and justice.(1-3) Respect for persons entails respecting the decisions of autonomous persons and protecting persons who lack decisionmaking capacity and therefore are not autonomous.
It also imposes an obligation to treat persons with respect by maintaining confidences and keeping promises.(1-3) Beneficence imposes a positive obligation to act in the best interests of patients or research participants.
Although reporting of HIV infections initially was not done by name, there has been a recent and controversial movement in the U. toward name-based reporting of HIV infection.(10) The debate over name-based reporting has focused on the need for more accurate epidemiological information regarding the spread of the epidemic-especially as antiretroviral therapies have proven successful in delaying progression to AIDS-versus concerns about deterring testing and the risk of discrimination. government policy has recommended that HIV-infected health care workers who perform exposure-prone invasive procedures have their cases reviewed by an expert panel, which will decide whether they may continue to perform such procedures and whether they must inform patients of their infection.
To date, the cost of antiretroviral prophylaxis has been prohibitive and therefore, for the most part, pregnant women do not receive it.(33,34) Although knowing their HIV status may be helpful in guiding decisions concerning breastfeeding, in many circumstances, bottle-feeding is not a feasible option because of cost and lack of access to clean water(35).
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Fourth, by foregoing opportunities for education and counseling, routine testing may undermine prevention efforts.
Finally, routine HIV testing in the prenatal context may affect adherence to the norms of pretest counseling and informed consent for HIV testing in other contexts.