Gestion des conflits et incertitudes ethiques des intervenants oeuvrant aupres des personnes vivant avec le VIH et qui ont des contacts sexuels non proteges a Montreal

Objectives: 1) To describe a public health intervention aimed at reducing the risk of HIV transmission by seropositive people who are unwilling or unable to take precautions to counter HIV transmission; 2) To document ethical principles that help front-line health care professionals arrive at justifiable decisions and actions. Participants: Front-line health care professionals dealing with these cases. Location: Intervention developed by la Direction de la sante publique de l'Agence de la sante et des services sociaux de Montreal. Intervention: A comite d'aide aux intervenants (CAI) was struck to advise health care professionals. To document the ethical principles that help front-line health care professionals in these situations, we undertook a multiple case study based on the committee's approach to counselling care providers for each of the 26 cases dealt with by the CAI between November 1996 and January 2003. Results: We identified 7 ethical pitfalls: expecting immediate ideal results; simplification of complex situations; generalizing uncritically from a particular case; uncritical ethical bias against coercive measures; inability or refusal to recognize and accept limits; failure to anticipate unintended consequences of an action; acting on incomplete, unvalidated, or unverifiable information. Conclusion: A process of mutually exercised critical reflection can help health care professionals to identify and avoid ethical pitfalls and arrive at justifiable decisions and actions. Key words: HIV/AIDS; public health; ethics, Quebec Objectifs: 1) Decrire une intervention de sante publique visant la reduction de la transmission du VIH par les personnes qui refusent de prendre les precautions necessaires ou qui sont inaptes a le faire. 2) Determiner des principes ethiques qui balisent les prises de decision face a ces cas. Participants: Les intervenants aux prises avec de tels cas. Lieu: Intervention offerte par la Direction de la sante publique de l'Agence de la sante et des services sociaux de Montreal. Intervention: Un comite d'aide aux intervenants (CAI) a ete mis sur pied pour conseiller ces intervenants. Pour documenter les principes ethiques qui balisent les prises de decision face aux cas traites par le CAI, nous avons procede a une etude de cas multiples se basant sur le traitement des dossiers de chacun des 26 cas soumis au CAI entre novembre 1996 et janvier 2003. Resultats: Nous avons identifie 7 pieges ethiques : s'attendre a des resultats optima