zations saw in the test a terrible threat, the protection of the research enterprise from subversion by those who failed to comply with protocols, or the recommendation for universal directly observed therapy for tuberculosis-that the gap between the ideological perspective of bioethicists drawn to the issue of AIDS and the most articulate proponents of the rights of those groups most at risk was manifest.

Nevertheless, the lessons of the past decade have made clear that to the extent that bioethics seeks to enter the policy arena there are considerable advantages to open collaborative relationships with activists. In some instances it is only through such collaboration that bioethicists can learn about the complexity of the issues to which they will bring their analytical tools, and can fully appreciate the contextual forces that shape the lives of the individuals who will be affected by particular policy choices. Most important, such collaboration will be enhanced if those selected for various working parties are committed to the possibility and value of compromise. But on some matters it may not be possible to identify such individuals. There are occasions when compromise will be viewed as an unacceptable capitulation to expedience rather than as a virtue. (Needless to say, the unyielding adherence to principle or position may characterize ethicists or activists.) Under such circumstances fruitful collaboration may not be possible. At best it may be possible only to agree to disagree.

Fortunately, that was not, for the most part, the case during the first decade of the AIDS epidemic. At a time when national administrations were indifferent, even hostile, to the concerns of those with HIV it was vital for ethicists and activists to find common ground in shaping perspectives that were both humane and effective. That they did so was a singular achievement.

NOTES

1.  

Zuger, A., and S.H. Miles. 1987. Physicians, AIDS and occupational risk: Historic traditions and ethical obligations. JAMA 258:1924-1928.

2.  

Dickens, B. 1989. Confidentiality and the duty to warn. In L. Gostin, ed., AIDS and the Health Care System. New Haven: Yale University Press.

3.  

Bayer, R., C. Levine, and S. Wolf. 1986. HIV antibody screening: An ethical framework for evaluating proposed programs. JAMA 256:1768-1774.

4.  

Shoeman, F. 1991. AIDS and privacy. In F. Reamer, ed., AIDS and Ethics. New York: Columbia University Press.

5.  

Bayer, R. 1991. AIDS and the future of reproductive freedom. In D. Wilkin, D. Nelkin, and S. Paris, eds., A Disease of Society: Cultural and Institutional Responses to AIDS. New York: Cambridge University Press.

6.  

Levine, C., N.N. Dubler, and RJ. Levine. 1991. Building a new consensus: Ethical principles and policies for clinical research on HIV/AIDS. IRB: 4 Review of Human Subjects Research 13:1-17.

7.  

Oppenheimer, G.M., and R.A. Padgug. 1991. AIDS and the crisis of health insurance. In F. Reamer, ed., AIDS and Ethics. New York: Columbia University Press.



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