Morality of Treating HIV/AIDS in Drug Abusers

[Nathan F]

So, I was reading the article on the outbreak of HIV in Indiana caused by a large number of people sharing needles for drug abuse, and it raised a question in my mind: should individuals who have contracted communicable and potentially fatal diseases through sharing needles for recreational drug use be given a lower preference for treatment, considering the finite nature of the resources used to treat the disease?

Mind you, this is an exercise in philosophy, so assume for a moment that there will be severe extraneous costs to treating individuals who have contracted the disease through drug abuse and needle sharing that will negatively impact the treatment of those who have not.

I, personally, am rather torn on this. There are many people out there who have contracted the disease through sexual contact, even when proper precautions have been made (that is, the use of prophylactics designed to protect against STDs, or a partner who is either unaware of their status or who has lied about it), through rape (as in the case of so many instances of the disease in sub-Saharan Africa), or through other body fluid transfers not related to sexual activity or drug abuse (such as the police officer I know who contracted it by pulling a man from a burning car in which he sustained lacerations that acted as a disease vector).

I can see a case being made either way. On one hand, having a board of arbiters of an individual's fate based on the vector of a disease, which can often be cloudy at best seems scary. On the other hand, it seems wrong to potentially limit treatment to an individual who has contracted a disease through a fluke, or as a by-product of an activity that isn't destructive to self and society (as drug abuse can be), because treatment is being given to someone who has contracted a disease through objectively reckless and destructive behavior.

[Borgholio]

Mind you, this is an exercise in philosophy, so assume for a moment that there will be severe extraneous costs to treating individuals who have contracted the disease through drug abuse and needle sharing that will negatively impact the treatment of those who have not.

I should probably mention that it's no longer an exercise in philosophy if you have added an artificial financial barrier. Ideally, the cost for treating a drug user and typical person will be the same. If resources are limited, then it could actually make sense to first treat those who are most likely to spread the disease (the drug users). But if the cost of treating them is so high than you can treat 5 or 10 normal people for the cost of one addict, then that means it makes more sense to treat the normals instead since you'll end up saving way more lives that way.

[Patroklos]

Recidivism, or reinfection in this case, is also a factor in triage decisions like this.

[Broomstick]

Or you can make it easier for people to get new, clean needles, which can also halt transmission.

Back when I worked in drug treatment there was one category of drug injectors who didn't get HIV/AIDS. That was the diabetics. Why? Because diabetics can get new needles easily. In fact, their drug-abusing friends and relatives were less likely to get AIDS, too, because it wasn't uncommon for a diabetic to hand them a couple needles.

Needle-swap programs also reduce disease transmission.

Institute that, and you'll have less dilemma because there will be less disease transmission in the first place.

[salm]

To be consistent you´d have to do the same for other "fun" related health problems and injuries. Where do you draw the line? Is skiing dangerous enough to give a person who breaks his leg worse treatment than a person who breaks his legs while driving to work? After all, nobody forced the person to go skiing and take the risk.
Or is skiing not destructive enough? What about football?
How do you determin which activity is bad enough or unreasonable enough or unnecessary enough to implement a health care penalty?

[Nathan F]

Mind you, this is an exercise in philosophy, so assume for a moment that there will be severe extraneous costs to treating individuals who have contracted the disease through drug abuse and needle sharing that will negatively impact the treatment of those who have not.

I should probably mention that it's no longer an exercise in philosophy if you have added an artificial financial barrier. Ideally, the cost for treating a drug user and typical person will be the same. If resources are limited, then it could actually make sense to first treat those who are most likely to spread the disease (the drug users). But if the cost of treating them is so high than you can treat 5 or 10 normal people for the cost of one addict, then that means it makes more sense to treat the normals instead since you'll end up saving way more lives that way.

How is it no longer a philosophical exercise to establish the circumstances surrounding it?

The amount of lives saved isn't really the question here...it's the delivery of treatment to people who have given themselves the disease as a byproduct of drug abuse. You certainly could save more lives in the above scenario by reducing the number of individuals who may receive the disease through the same destructive behavior, but is it moral to do that at the potential cost of treating another who came by the disease through other means? That's the original question, not "How do you save the most people?" Unless, of course, your argument is that you should save the most amount of people possible regardless of the origin of the disease. That could be a perfectly valid side to the discussion.

[Nathan F]

To be consistent you´d have to do the same for other "fun" related health problems and injuries. Where do you draw the line? Is skiing dangerous enough to give a person who breaks his leg worse treatment than a person who breaks his legs while driving to work? After all, nobody forced the person to go skiing and take the risk.
Or is skiing not destructive enough? What about football?
How do you determin which activity is bad enough or unreasonable enough or unnecessary enough to implement a health care penalty?

I was just thinking the same thing when I was writing my last post. For instance, I was training in skydiving for a while. An activity that, beyond personal thrill, has no positive societal impact when I am doing it as a recreation and not part of some profession (smoke jumping, paratrooper, researching new lifesaving parachutes, etc.).

I personally would feel absolutely horrid if I discovered that, in the process of receiving treatment for injuries sustained during the skydive, I caused a victim of a car crash to be triaged and have treatment delayed while I was receiving treatment.

[Zaune]

I personally would feel absolutely horrid if I discovered that, in the process of receiving treatment for injuries sustained during the skydive, I caused a victim of a car crash to be triaged and have treatment delayed while I was receiving treatment.

Don't be. If the emergency room only has enough personnel to treat one genuinely life-threatening injury at once then the hospital administration are doing something very badly wrong. At worst, someone with a broken arm might have to spend an extra half-hour in the waiting room before they got a proper plaster cast to replace the temporary splint provided by the EMTs.

[Borgholio]

How is it no longer a philosophical exercise to establish the circumstances surrounding it?

Not within the context of the article you read that doesn't mention the artificial barrier you created. But we can discuss either way.

[salm]

I was just thinking the same thing when I was writing my last post. For instance, I was training in skydiving for a while. An activity that, beyond personal thrill, has no positive societal impact when I am doing it as a recreation and not part of some profession (smoke jumping, paratrooper, researching new lifesaving parachutes, etc.).

I personally would feel absolutely horrid if I discovered that, in the process of receiving treatment for injuries sustained during the skydive, I caused a victim of a car crash to be triaged and have treatment delayed while I was receiving treatment.

I assume only if the car crash victim was on a necessary trip. What if the car crash victim was on a trip to the airstrip with the airplane which would take him skydiving?
The thing is, we do so many recreational things that carry some kind of risk. I have no numbers but I assume you´d be more likely to be injured in a car crash to your recreational activity than in a skydiving accident. Even if not, driving carrys pretty high risk and we drive to recreational activities all the time. And recreational activities are just as necessary for humans as working for an income.
Now, we could decide that we only encourage extremely safe recreational activities like taking a walk in your back yard, but would we want this?
And how would that work on a practical basis? A car crash victim is brought into the ER bleeding like a pig. Do the nurses first have to find out if he was on a trip to work or on a trip to a recreational hiking tour around crater lake before treating him? Perhaps this would be easier with HIV victims but what would prevent the junkies from lying and just saying that they contracted HIV by "acceptable" means such as unprotected sex. Or protected sex with a condom faliure or whatever "acceptable" means.

I think it is better to treat everybody the same because it isn´t really possible to decide who deserves good treatment and who doesn´t. The junkies in question might be a relatively easy target but we shouldn´t single them out.

Now, what is allready done is encouraging certain preventive measures combined with financial incentives. For example German health insurers have to pay only very little for certain dental treatments. If get a half yearly preventive check they have to pay more. And if you can show that you got certain preventive treatments they have to pay even more. You also get certain bonuses for things like preventive cancer checks and stuff like that.
On a less serious note there are examples which are involuntarily hilarious, like, if I can prove that I don´t smoke, have a gym membership and take part in pregnancy classes I get like an alarm clock that makes sounds like a chicken or some shit.