This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society.
Organ transplantation began to develop soon after the Second World War. The constant progress made in organ transplantation has resulted in an increase in the number of operations carried out. The laws governing transplantation are often drawn up to deal with the de facto situation in a particular country. The study focuses on Guideline 1 adopted by 44th World Health Assembly (resolution WHA 44-25) concerning consent in cadaver kidney transplantation. The discussion of the question of consent is based on a comparative study of the laws regarding kidney transplantation in the countries of what is known as Greater Europe. The points of discussion presented are not offered with a view to advocating a system where soliciting the consent of the family would be considered as ethically necessary. Given the current legal constraints, the presumed consent procedure, with consultation of the family would appear to be more appropriate.
Since the appearance in May 1999 of the two decrees on the application of the law relative to the reinforcement of sanitation quality control established in July 1998, the disclosure of HIV infection "irregardless of the stage" has become mandatory. This is the first time that it is imposed that one must declare a serologic diagnosis, that is to say an infection in the asymptomatic stage. The sensitive nature of all of the information available on AIDS provides an explanation for the numerous contradictory reactions linked to this decision. We attempt to organise the arguments brought forth according to two approaches: 1) the epidemiological arguments that justify the compilation of the precise data thought to be necessary for the follow-up of the disease and for the implementation of well-targeted prevention actions; and 2) the ethical reservations concerning such an imposed measurement, as well as the questions related to anonymity and confidentiality.
The Convention on Human Rights and Biomedicine, the first legally binding international instrument in the field of bioethics, was adopted in November 1996. In the present paper, following a brief overview of some of the Convention's provisions likely to conflict with national enactments already in effect, we shall attempt, on the basis of the materials available in the International Digest of Health Legislation, to analyse the positions adopted by the different states involved and to identify foreseeable conflicts, focusing on the following four issues: human genome; protection of the embryo; scientific research; and protection of live organ donors.
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