This is an excerpt of a bioethics student’s paper submitted as a coursework assignment. They were kind enough allow it to be published on this blog. Hopefully it will generate some constructive feedback.
Imagine a situation whereby a law was passed that required all STD’s to be registered and put on an open source noticeboard that was accessible by the public. This includes every STD no matter the severity or duration. Your name will stay on the list until you can show that you are cured from the disease and had this corroborated with a health professional. Health Professionals are only responsible for providing the names and details of disease to a centralised governing body that then controls the publicized list. Of course for diseases that are asymptomatic like HPV and Herpes these individuals stay on the list.
Now imagine you are a student in a university city with a small to moderate population. You have been having sexual intercourse regularly and you find an irregularity on your genitalia. You confide in a friend (who is a nurse) and they inform you that it is probably genital warts (HPV). They also inform you that if you seek treatment your name will be placed on a list that anyone can see on the internet. You have a lot of sexual partners and are very proud of your promiscuity and this could dampen your chances with sexual partners. Also you don’t want your family and friends to think badly of you. What do you do? You cannot go much longer without treatment as the problem is getting worse but you dread the consequences of seeking treatment.
The above situation illustrates how by simply releasing names and putting diseases next to them one has to think twice before seeking medical attention. Medical professionals ought to be held in high regard in society as people seek their help at the worst of times. Once a person’s privacy is violated they lose all trust in the professional body. As afore mentioned if people are hesitant to seek treatment for problems they have, it is counterproductive. Less people will seek treatment, but people continue to have sex regardless.
From the public i.e. those without any STDs’ perspective the registry seems good in theory that is until you have to be placed on it. As mentioned above there are groups in society that are striving to acquire HIV and other STD’s as a badge of recognition to their peers . For this group the registry would be a welcome with open arms. This poses major problems, if one is indifferent toward weather they had a disease or not they are typically not going to be seeking treatment. Thus, those individuals who are posing the greatest danger in society will be the ones going undetected by the public and the individuals who are seeking treatment, and acting responsibly, will be persecuted.
A doctor’s duty to report is also an issue of contention in this situation. Physicians must respect the privacy of the patient at all times. In the face of high risk situations this value may be overlooked in light of more serious concerns. Simply having a disease that others can catch should not land innocent people on a list that could be viewed by people they know. The doctor also has a duty to care for the patient and treat them respectfully. I cannot imagine doctors would gain any pleasure from publically embarrassing their patients even if it is for the safety of the public. A doctor’s first duty should be toward the patient they are treating, the public may have a stake in the situation, but this is a drop in the ocean compared to the effects of disease on the individual, both emotional and physical.
This places doctors in a tricky situation. If a disease is easy enough to treat and they know the patient will comply with treatment what use is public embarrassment? This issue raises the issue of a more selective registry based on scientific evidence of transmission rate, mortality rate and health outcomes as a result of the disease. This would be based in communities so that, for example, there was seen to be a major outbreak of a usually low key disease in a specific community this could be red flagged and this could in turn prompt the public to make personal judgement calls as to whether or not to seek testing or treatment.
An argument for criminalization is that it acts as a deterrent or preventative strategy. This logic in general holds sound but is based heavily on personal morals and will never apply to all people in society. What is deemed wrong or immoral by the law is not always adhered to by the public. The classic example of the being drug laws. Drug laws are put in place to deter offenders from acquiring and using drugs. As is well noted these laws fail in many respects, as with the example of cannabis, people are still able to acquire and use their drug of choice at will. The process is simply driven into an underground market whereby there is no control or regulation (Scheerer, 1981; Baker, 2007). I propose that criminalization of disease will bring about similar public responses. The idea that we could have underground markets for STD medications and treatment could have disastrous effects on the reputation of medical practice and inhibit preventative strategies in public health due to lack of data available.