End-Of-Life Issues, Ethical Issues, Advance Directives, and Surrogate Decision-Making in The Care of Persons With HIV

Abstract

HIV and AIDS, perhaps more than any other illness during any other time, contributed to the end of a “collusion of silence” and parentalism that characterized medicine prior to the era of civil rights and patient rights. The bioethical aspects of both healthcare delivery and care at the end of life changed dramatically during the beginning of the AIDS epidemic when young persons and their dedicated teams of caregivers were faced with a new infectious illness associated with both sexual transmission and intravenous drug use. This chapter delineates the ethical aspects of HIV and exceptionalism, screening, routine testing, informed consent, advance care planning through advance directives, confidentiality, criminalization, the duty to warn, and pre- and post-exposure prophylaxis (PrEP and PEP).