Commentary: Medical subspecialty enforcement?

From its inception, the American Academy of Psychiatry and the Law (AAPL) has decided not to investigate and adjudicate complaints of unethical conduct of its members or others, but rather refers the complainant to other organizations, such as the "local district branch of the American Psychiatric Association (APA), the state licensing board, and/or the appropriate national psychiatric organization of foreign members" (AAPL Ethics Guidelines). Loss of APA membership, however, terminates one's AAPL membership upon AAPL notification. Further, the AAPL Ethics Committee "may issue opinions on general or hypothetical questions but will not issue opinions on the ethical conduct of specific forensic psychiatrists or about actual cases" (AAPL Ethics Guidelines). This referral policy has been criticized at times with various proposals for change. Candilis and colleagues have thoughtfully considered several alternative courses of action. Extending those considerations, this Commentary considers the practices of other health care professional organizations and some implications of the proposal offered by Candilis et al.

A surgeon with acquired immunodeficiency syndrome: a threat to patient safety? The case of William H. Behringer.

A year ago, the New Jersey case of William H. Behringer, the surgeon with acquired immunodeficiency syndrome (AIDS), caused health experts to focus on health care workers infected with human immunodeficiency virus (HIV) and to call for new policies and guidelines to protect patients against infection. After a year of acrimonious debate over the proper approach to the issues discussed in Behringer, no consensus has emerged. The Centers for Disease Control has quietly abandoned its plan to ease its July 1991 guidelines that call for infected professionals to cease performing invasive procedures or disclose their conditions to their patients. It has now decided to let each state set its own rules and regulations in compliance with its guidelines, or risk financial penalties. The issues discussed in Behringer have remained controversial. This case provides an opportunity to identify reasonable actions that may ensure patient safety without inciting public fears, unduly restricting individual freedom, or violating human rights.