HIV and Insurance Testing - by Joshua Frear

William Gifford argues against HIV tests for health insurance applications. His argument, in part, hinges on a view of health insurance that I believe is incorrect. For Gifford, health insurance is a right of everyone. Health insurance is actually a cost-benefit analysis by a private, for-profit firm. This works for societal benefit, because (reminiscent of Adam Smith), the benefit of the company lines up with the good of the members of society. The insurance company wants its insurees to stay healthy, and if they do get sick, to recover to health quickly. That is also what insurees want. But what about those who are already sick and now wish to get health insurance? The company, if it takes on sick individuals, is guaranteed to lose money in the deal. There seems to be some aspect of fair play that is being violated here, when sick individuals get health insurance. They weren’t willing to pay the monthly premiums before, but now, they want the benefits. Clearly, if health insurers had to take on sick individuals, they would be out of business within the year. People would wait until they got sick to get health insurance, and there would be no way the company could even pay its employees.

I don’t think that Gifford wants to allow all sick people to be insurable; he just wants those who have HIV but not AIDS to get insurance policies. HIV can remain latent and asymptomatic for over a decade. The policy would not be covering AIDS care as much as it would be covering other health care. The primary problem with this view is that HIV is not unique in its ability to remain latent for long periods of time. If HIV carriers can be insured, then latent TB carriers and latent syphilis carriers, for examples, have to be able to be insured, too. The link between HIV and AIDS is clear and unmistakable. If it were not, then insurance companies would be willing to take a risk on HIV carriers. The uninsurability of HIV carriers has nothing to do with racism, despite Gifford’s allegations. It has to do entirely with money and risk. That is the necessary basis of all types of insurance.

Pregnancy and Prenatal Harm - by Callie Pagano

I agreed with the arguments presented in the article, "Pregnancy and Prenatal Harm to Offspring" by Robertson and Schulman. When a woman finds out she is pregnant, she has two choices. Either she can choose to abort the baby or she can choose to carry the baby to term. If the woman carries the baby to term, I think that she is obligated to take the best possible care of the fetus that she can. This includes prenatal care, following medical advice and abstaining from behaviors that will cause harm to the fetus, such as alcohol and drug use. If a pregnant woman is fully informed about the proper care her unborn child should receive to be born normally and chooses to ignore that advice, she should be able to be prosecuted for that offense. After all, she had every option of aborting the fetus when she found out she was pregnant. If the woman does not want to take the appropriate steps to care for her unborn child, she should abort it instead of causing harm to her fetus. In addition, if a woman is not capable of taking care of the fetus while she is pregnant, how is that woman supposed to take care of the child once it is born? In my opinion, if a woman is not able to provide proper care for her fetus, she would likewise be an unfit or neglectful mother as well. Perhaps if counseling, monitoring and compliance were forced for mothers that do not comply voluntarily, the new mother would learn the importance of being responsible and caring for her child and as a result, would be better equipped to properly care for her child.

The Dax Case - by Vishal Thaker

Dax Cowart does make several strong points which seem sufficient enough to support his opinion that patients should have their constitutional rights and freedoms even in a hospital setting. I agree with Cowart's belief that freedom means that people have the ability to make the right choices or the wrong choices. However, Cowart's argument, though containing validity, can be found inadequate.


A medical student right before getting the letters "M.D." or "D.O." after his/her name must take the Hippocratic Oath, which abides the doctors to basically do whatever is necessary to better the health of a patient and not to do any harm. Therefore, a medical doctor's obligations to the profession and society seem to contradict the possible personal freedoms in a hospital setting. Thus, an intense problem would arise if the courts did ever rule in favor of patients being able to be completely autonomous in a hospital. Would a doctor be breaching the Hippocratic Oath if a "Dax Cowart" refused medical care and his condition worsened? If the doctor treated a "Dax Cowart" anyway, did the physician breach the patient's constitutional rights?


Therefore, Cowart's argument can be found inadequate because he does not take into account a physician's oaths and accompanying responsibilities. If no state paternalism in medical care existed, complete autonomous patients would sometimes do harm to themselves -- going against doctor's oaths. In closing, Cowart could choose to strengthen his arguments by recognizing that changes to state paternalism would also have to include changes to the Hippocratic Oath.

Lying v. Evasion - by David Thomas

I disagree with the author's assertion that there is no distinction between a physician lying to a patient and being evasive with a patient, especially when considering placebos. Lying to a patient in general is an outright deception of the patient since the patient has placed trust and given the physician paternalistic power. A physician being evasive obviously does not want to outright make the patient believe a falsehood, but at the same time may deem it necessary to leave facts out so the patient is not unnecessarily turned off from a treatment. The decision to be evasive or lie is an issue of paternalism, but its motives are driven by the morals of the physician. The physician is acting on his oath to do all he can for the benefit of the patient. Lying to the patient is equivalent to believing that the patient will be led to believe a different level of well-being than reality. An evasive physician wants to prevent giving a patient false hopes. For example, a physician may not give all the possible solutions to a problem because some of those possibilities would not work due to a patient's very complex situation. Here, the physician is only showing the patient the various effective methods and not including the possibly less effective alternatives.


This is still morally different than lying. A physician who lies about alternative possibilities for treatment does not allow the patient the possibility of knowing that alternatives are out there. Also, the physician assumes that the patient is completely unable to make an informed decision about the best course of action. It is well understood that two physicians may not look at the same problem and come to the same conclusion for a treatment. For this reason, "second opinions" are a way for a patient to determine if the course of action one physician decides as best can be considered as viable by other physicians in the same field.

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