A Code of Ethics for Health Care Ethics Consultants: Journey to the Present and Implications for the Field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here.     

ON THE ANALYST'S IDENTIFICATION WITH THE PATIENT: THE CASE OF J.‐B. PONTALIS AND G. PEREC

The writer Georges Perec was in psychoanalysis with Jean‐Bertrand Pontalis for four years in the early 1970s. In this essay, the author presents the exceptional interest this analyst took in this patient and the ways in which that interest manifested itself in his work, psychoanalytic and otherwise. Many correlative factors suggest that identificatory processes persisted beyond the treatment and were maintained into Pontalis's later life. While this paper is primarily intended to provide evidence to support this view of a specific case, the author closes by reflecting that this may be a more general phenomenon and the reasons for this.     

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice

Abstract

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in “clusters” of others with genetically similar strains. This is called “molecular HIV surveillance” (MHS). In 2019, “cluster detection and response” (CDR) programs that re-use MHS data became the “fourth pillar” of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for “HIV data justice.” The essay contributes to a “bioethics of the oppressed.”