tim's experiment

A sad and serious matter: a few weeks ago a young doctor who had AIDS was “outed” by the media. He then committed suicide. I am always wary of speculations about suicide. The real motive may not be known even to the suicide himself, and he is not around to correct mistakes. Still for what it is worth the conclusion to which most people jumped was that he realised it would be impossible for him to continue to work as a doctor because of the publicity, and despaired. Well perhaps. We should all feel sorry for the guy. It was the comments which were more interesting.

A spokesman for the doctors said that reluctance to consult a doctor with AIDS was totally unjustified. “Clinical procudures” had been perfected which made it perfectly safe for a doctor with AIDS to continue to practise. The clear implication was that this medic should not only have been allowed to continue to practise, but that he should have been allowed to do so without his patients knowing that he had the disease.  The chairman of the Equal Opportunities Commission took a rather different line, claiming that this case was an example of “stigma”, on whose demerits he expatiated at length.

I think in this context the idea of stigma is not terribly helpful. It is usually best reserved for occasions when someone is a victim of unreasonable prejudice or stereotyping. Refusing to employ former mental patients, or former prisoners, might be a reasonable example. I am less heppy with the idea that it should be applied to a case in which patients may have been reluctant to be treated by a doctor who had AIDS. Let us leave aside the question of how he got it, though — despite all the flapdoodle about conventional intercourse and the general population — this is a difficult disease to get unless you are into rough sex or drugs. The question is whether it is so self-evident that an AIDS sufferer should be allowed to practise medicine as to justify either not telling patients at all, or criticising those who know and avoid the sufferer for unreasonable prejudice. And I think the answer is no.

The problem is that your relationship with your doctor is not just a normal customer-supplier thing. Indeed the medical profession derives much of its prestige and mystique from this important difference. Your doctor is a man (or woman) with your life in his hands. You will tell your doctor things you might not tell your spouse. You will allow him to handle parts of you which are normally private. You need to be able to trust this person.  I would unhesitatingly condemn someone who refused to employ a HIV-positive plumber. But your doctor is not just going to have access to your drains.

Generally speaking the medical profession seems to accept this. We all know that some men prefer to be seen by a male doctor, and some women by a female one. Some of my compatriots expend substantial amounts of time and money to make sure that they see an expat doctor, though personally I believe this is a big waste. There are probably people who prefer their doctors to be young, and people who prefer them to be old. I imagine patients in search of Traditional Chinese Medicine expect the purveyor of this dubious product to be Chinese. If you, as a client, prefer to stipulate that your doctor does not have AIDS this seems to me to be something you have a right to, disappointing though some observers may feel your preference to be. And since you have a right to it, you clearly have the right to the information which you need to make an informed decision.

This may seem to the medical fraternity an unreasonable position. The question has come up before and it did then. But this is not simply a question of whether you can catch a disease from your doctor. I recall many years ago, when AIDS was still invariably fatal, a sufferer was invited by one of my colleagues to talk to our students. I was quite happy with this and indeed we would have invited him back if had survived longer. But your relationship with a doctor is not just a matter for clinical judgments and scientific determinations. It is necessary for you to be comfortable. Patients may be averse to a variety of characteristics in their doctors and that is their privilege.

This may seem a bit rough on doctors who get AIDS, but it is the penalty for working in a prestigious profession. I imagine a barrister who had AIDS might lose a lot of clients too. For doctors there are at least some branches of the profession which do not depend on a supply of live clients. Pathology is an honourable pursuit and the patients never complain…