2 November, 1998
To
The
Editor,
The
Lancet,
42
Bedford Square,
London
WC1B 3SL
Dear Sir,
In the Viewpoint article on
ethics of Hepatitis B Virus (HBV) transmission between health care worker (HCW)
and patients1, Ristinen and Mamtani, completely miss the 1st
event- the transmission of HBV infection from a patient to the HCW. Thinking in
utilitarian terms only, health of HCW would be considered more important for
the general health of community, and thus should be at least as closely
safeguarded as that of the patient.
There are therefore two
important additions to the table – to complete the mirror image. Please note
the addition of ‘and their patients’
after HCW
Strategy
|
Is the risk to HCW and their patients avoided? |
Justifiable and acceptable
risk for HCW and their patients? |
Justifiable and acceptable
risk for patients? |
|
4. Patients’
rights are respected and HCW are protected: HBV infected patients are identified and counselled
to refrain from exposing any HCW to their body fluids. Confidentiality
maintained about their infectivity status. |
Yes to some
extent. Most HCW and
their patients protected from transmission. |
No
All HBV infected patients cannot be trusted to tell
their caregiver to take extra precautions thus exposing the HCWs and
their subsequent patients to infection. |
Yes
Patients need not fear for rejection of treatment.
|
|
5.
Protection of HCW is paramount. All patients are tested; those tested positive are
prohibited from taking exposure-prone treatment unless the caring HCW is
fully informed of the risks or is already infected. |
Yes, as completely as possible. Nearly 100% HCW and their patients are
protected from transmission. |
Yes
Risk to HCW and their patients is as close to zero as can be
achieved. |
No
Extreme measure unfairly restricts the
availability of skilled HCW for a particular patient. |
Of course the last suggestion
is as extreme as the first (from the original paper) but at least it will
protect both the HCW and their patients. None of these suggestions may prove
practicable. and the only solution
might be to include the risk of infection in the standard consent form.
Hopefully, if all vaccination programmes succeed, surgeons of the next
generation will hopefully not have to bother discussing these issues at least
for HBV infections. Discussion on very similar lines, albeit even more
delicately tuned, could address the issue of HIV and other blood-borne
diseases.
Yours sincerely,
Jayant S Vaidya MS FRCS Sucheta J Vaidya MD DCH
Reference
1.
Ristinen
E, Mamtani R. Ethics of transmission of hepatitis B virus by health-care
workers.