Ethical considerations of a public health intervention aimed at reducing the risk of HIV transmission in HIV-seropositive-populations who are unwilling to take precautions

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. Front-line health care professionals dealing with these cases. Intervention developed by la Direction de la santé publique de l'Agence de la santé et des services sociaux de Montreal. A comité 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. 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. 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.