A recent message on one of the e-mail bulletin boards sent by a college student read, “I believe that the AIDS virus was developed in government labs for the purpose of controlling black folks.” In September 1990, Essence, an African American magazine with a circulation of 900,000, had as a lead article “AIDS: Is It Genocide?” In 1991, the New York Times quoted Clarence Page, African American columnist and Pulitzer prize winner: “You could call conspiracy theories about AIDS and drugs (...) fringe ideas, but they seem, to have a large following among the black intelligentsia. … [And] you find it at all levels.” In April 1992, Lorene Gary explained in Newsweek “Why it's not just paranoia.” In that same month, another New York Times article reported: “Bizarre as it may seem to most people, many black Americans believe that AIDS and the health measures used against it are part of a conspiracy to wipe out the black race.”4 In February 1992, Science quoted Peter Breggin, director of the Center for the Study of Psychiatry in Bethesda, Maryland, as saying that research on violence “cloaks the intention to identify problem black children and then … prescribe pacifying drugs.”. (shrink)

To guide treatment decisions for incompetent patients who have no advance directives, health care institutions should look to the preferences of their own communities of patients. That is the best way to ensure that incompetent patients' wishes will be followed.

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for (...) the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals. (shrink)