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The medical duties to an HIV-infected patient are the same as to any other patient infected with a communicable disease. Physicians treating HIV-infected persons also have a duty to the community to cooperate in efforts to prevent the spread of the disease. When a physician enters a physician-patient relationship, he or she accepts the responsibility to care for that patient until the relationship is appropriately terminated. (See Chapter 9.) The physician's wishes or convenience are not a justification for abandoning a patient, and his or her fear of contagion is not an excuse for abandonment. HIV-infected persons are entitled to the same notice and continued care as any other patient.

The more difficult question is whether HIV-infected persons are entitled to special protections not available to other patients. Should it be unethical to refuse to treat a person with AIDS, yet acceptable to refuse to treat patients with other diseases? Should it be considered unethical for a family practitioner to refuse to treat insulin-dependent diabetics because it is too complicated? Physicians are discouraged from requiring patients to be tested for HIV, yet it is just as diagnostically important as a Pap smear or fasting blood sugar. Most incongruous, in our opinion, is that it is considered more ethical to worry about being paid than about being infected with a communicable disease. While access to care for HIV-infected persons is a real problem, it pales when compared to the problem of access to care for the poor. Often it becomes the same problem: the various medical associations that have deemed it unethical to refuse to treat HIV-infected persons limit this prohibition to HIV-infected persons who can pay for their care.

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