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AIDS is an acronym for Acquired Immunodeficiency Syndrome. AIDS is generally, although not universally, thought to be associated with the presence of HIV, the Human Immunodeficiency Virus. Evidence suggests that HIV is spread through transmission of bodily fluids typically associated with intimate sexual contact and/or intravenous drug use. HIV is fragile once outside the body, and is therefore not transmittable through casual contact. The United States Centers for Disease Control (CDC) currently estimates over 40 million persons worldwide are infected with HIV; in the United States alone estimates place the infection rate at one in every two hundred and fifty persons, or approximately one million individuals. All these persons cannot appropriately be said to have AIDS; however, the CDC's technical descriptor of AIDS has to do with either the presence of an opportunistic infection associated with the HIV, and/or a diminution of the body's CD4 (T-lymphocyte or T-cell) count to below 200 per cubic millimeter of blood. Within the United States the twenty-five to forty-four age group has the largest number of reported AIDS cases; however, the fastest growing category for infection with HIV consists of women in their teens. The current wisdom is that AIDS is treatable but not curable. With proper treatment, it is not unusual for individuals to live ten years or longer from time of initial diagnosis with HIV to eventual death, with the average longevity following onset of AIDS symptoms being twenty-four months.
Dunn, C.P.
AIDS. In: Freeman, R.E. & Werhane, P.H. (ed.),Dictionary of Business Ethics. Oxford: Basil Blackwell Ltd.[forthcoming]
Such is the current state of our knowledge of AIDS. Nearly two-thirds of large businesses (more than 2500 employees) and one in ten small businesses (fewer than 500 employees) report having had an employee with either HIV or AIDS in their employ, making this a workplace issue. Links between HIV infection and such social 'baggage' as homosexuality and drug abuse make this a volatile issue for those formulating corporate policy. From the view of KANTIAN ETHICS, or deontology, there is a potential clash of rights (see RIGHTS, CONCEPT OF) between the HIV+ worker and the HIV- co-workers. The concern on the part of some individuals is that the ease of transmitability of HIV has been grossly understated. One study of corporate and public service employees found that "thirty percent of the respondents expressed skepticism about the accuracy of public information" related to AIDS, with nearly one in four stating they would be "afraid of getting AIDS from working near PWAs [Persons with AIDS]" (Barr et al, 1992: 226). Such individuals typically advocate for disclosure of co-workers' HIV status. Conversely, those infected with HIV are concerned with the variety of discriminatory practices, including erosion of the right to PRIVACY, revocation of health benefits or escalation of the cost of such benefits (see HEALTH CARE ETHICS/BUSINESS ETHICS), shunning by co-workers, and even termination of employment, which often accompany making a positive diagnosis with HIV a matter of public record. Additionally, the right of the AIDS sufferer to his or her WORK must be considered against the backdrop of the right of the employer to exercise the doctrine of EMPLOYMENT AT WILL. This particular conflict is compounded by the American with Disabilities Act (ADA), which most commentators believe is in part intended to treat workers with AIDS as a disabled class subject to the protections contained in this legislation.
The issue of resolving rights conflicts with respect to persons with AIDS in the workplace is necessarily complicated by consideration of RISK tolerance. Few, if any, rights are absolute; therefore, the challenge for the deontologist is to decide which among a competing set of rights is most foundational. This determination is in some sense dependent upon the probability, or risk, of alternative realizable policies. Neither the view that the rights of the AIDS sufferer must be protected at all cost, nor the view that the rights of co-workers are inviolate, seems correct. However, the suggestion that determination of a 'rights hierarchy'--and thereby of one policy versus anotherÐis dependent upon risk assessment necessarily moves the argument toward consideration of the utilitarian consequences of alternative policies.
UTILITARIANISM requires that we consider the consequences of including or excluding AIDS sufferers from the workplace, with an eye toward bringing about the 'greatest good for the greatest number.' Those familiar with the debate over whether HIV+ medical providers should be compelled to disclose their HIV status to patients have seen this particular issue evolve from one in which rights were of central importance to concern over the impact of mandatory disclosure policies on the health care profession in general and ultimately the welfare of society at large. The presupposition of utilitarian argumentation is that relevant benefits and costs can be both identified and quantified. While utilitarians are well versed in dealing with such complexities, when it comes to workplace AIDS transmitability, the issue is so emotive as to make consensual policy formulation a virtual impossibility. What is known is that the well-being of the AIDS sufferer is to a great extent a function of AIDS policy. Research into the longevity of HIV+ individuals indicates that a supportive community (see COMMUNITARIANISM) leads to life extension. One of the drawbacks of traditional utilitarianism, however, is its compatibility with injustices: in seeking to promote the greatest good for the greatest number, the interests of the non-majority are rather easily overridden. For the HIV+ minority, the consequences of restrictive workplace AIDS policy might well be the foreshortening of their very lives.
At least one writer suggests Kantian and utilitarian ethics can be meaningfully combined. Brady suggests we should make "exceptions to rules when so doing recognizes or promotes the affiliation and connectedness of persons" (1990: 144-45). With this understanding, should HIV+ individuals be offered organizational membership in spite of a general rule affording all employees a safe working environment? Consistent with designation of HIV infection as a disability under the ADA, Brady's principle implies that the objective of affiliation should override more general workplace safeguards. In effect this principle injects classical utilitarianism with JUSTICE considerations. The objective is to have the manager approach the crafting of workplace AIDS policy with specific reference to the idiosyncrasies of each specific work environment.
Consideration of the personal--and relational--implications of AIDS policy formulation and implementation suggests we consider the ETHICS OF CARE. The topic of AIDS in the workplace needs to be a matter of conversations about how we as human beings live, and more particularly how we live in caring relationship with one another. Such caring conversation is hindered by language which creates unnecessaryÐor even inflammatoryÐdistinctions. As Sedgwick has noted, "many of the major nodes of thought and knowledge in twentieth-century western culture as a whole is structuredÐindeed, fracturedÐby a chronic, now endemic crisis of homo-heterosexual definition, indicatively male, dating from the end of the nineteenth century" (1990: 1; see also POSTMODERNISM AND BUSINESS ETHICS). This is nowhere more true than in conversations about the appropriate policy response to persons in the workplace who happen to have been infected by HIV. Jonsen offers perhaps the best closing to this discussion of policy alternatives relating to AIDS in the workplace: "In all epidemics, fear stimulates isolation and responsibility requires inclusionÉ[t]his might even be called the moral law of epidemics" (1991: 660).
REFERENCES
Barr, J. K., Waring, J. M., & Warshaw, L. J. 1992. "Knowledge and attitudes about AIDS among corporate and public service employees." American Journal of Public Health 82(2): 225-228.
Brady, F. N. 1990. Ethical managing: Rules and results. New York, New York: MacMillan Publishing Company.
Cohen, E. D. & Davis, M., ed. 1994. AIDS: Crisis in professional ethics. Philadelphia: Temple University Press.
Deka, D. 1994. "AIDS in the workplace." Graduate thesis: College of Business Administration, San Diego State University.
Feldblum, C. R. 1991. "The Americans with Disabilities Act: Definition of disability." The Labor Lawyer 11: 11-26.
Gilbert, D. R. & Freeman, R. E. 1994. "AIDS in the workplace: A critique from lesbian/gay theory." Presentation within Social Issues in Management Division, Academy of Management Annual Meeting.
Heacock, M. V. & Orvis, G. P. 1990. "AIDS in the workplace: Public and corporate policy." Harvard Journal of Law & Public Policy 13(2): 689-713.
Jonsen, A. R. 1991. "Is individual responsibility a sufficient basis for public confidence?" Arch Intern Med 151: 660-662.
Sedjwick, E. K. 1990. Epistemology of the closet. Berkeley, CA: University of California Press.
Stone, R. A. 1994. "AIDS in the workplace: An executive update." The Academy of Management Executive VIII(3): 52-61.
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