Health Communication Final Paper
A Student-Authored Sample
Below is a sample final paper, consistent with the Option 1 format.
Author: Katie Kiefel, Loyola U. Chicago Grad
Acquired Immune Deficiency Syndrome (AIDS) is a deadly disease that affects the victim as well as the victim's family, friends, and caregivers. The AIDS epidemic has been in the United States since 1981. By the end of 1993, over 339,000 AIDS cases were diagnosed nationwide, and over 204,000 people had died (Marieb, 1995, p. 739). Because AIDS victims deteriorate physically and emotionally, family and friends must be prepared to deal with the loss of a loved one. According to Dworkin and Pincu, "information changes almost daily in terms of the conceptualization of the illness, the medications and treatments recommended, and the social and political climate surrounding AIDS" (1993, p.275). Due to such changes, patients, families, and caregivers often face excessive and prolonged stress. Thus, therapeutic interaction between those associated within the context of AIDS is needed to alleviate the burden of this disease.
Barnlund reports that therapeutic communication is not limited to trained health practitioners or health care practice (cited in Kreps & Thornton, 1992, p. 47). Barnlund's approach "implies that any individual has the potential for communicating therapeutically by helping another person to understand himself or herself more fully, thereby aiding that individual in deciding how to direct behaviors to best achieve needs and goals" (Kreps & Thornton, 1992, p. 47). Therefore, therapeutic interaction can be positive since it may help individuals obtain goals and other needs.
Therapeutic interaction was shown between family, friends, and a man diagnosed with AIDS in the movie, "Philadelphia." However, much therapeutic interaction was not shown between this PWA (person with AIDS) and the majority of his co-workers. In the movie, "Philadelphia," Andy Beckett (Tom Hanks) is a highly successful, corporate attorney in Philadelphia who has acquired the AIDS virus. This attorney is also homosexual. Later, Andy, is fired from his law firm. His employers contend that Andy was fired because of sexual-orientation discrimination. Trying to prove his side, Andy hires a civil-suit lawyer to represent him. It turns out that the lawyer, Joe Miller (Denzel Washington), homophobic. Joe, however, agrees to represent Andy, and ultimately he presents an excellent case. Joe also helps to win the case, vindicating Andy. Of course, if Joe would have had a better understanding of AIDS, he may have initially accepted the case with more enthusiasm and an open mind. Moreover, he would have better appreciated Andy's plight.
SECTION ONE
Many people assume that health care providers know how to communicate in a competent manner. However, some health care providers have difficulty communicating in a competent manner. Kreps and Thornton believe that health care providers need to have a more disciplined awareness of human interaction (1992, p.3). There are several instances in the movie "Philadelphia" where human interaction needs to be disciplined. However,in this movie, the improvement with human interaction needs to be in the workplace. The majority of health care providers in the movie display a disciplined awareness of human interaction. In the beginning of the movie, the audience sees Andy, who is HIV positive, sitting in a hospital waiting for the results of his blood tests. Andy looks around at all of the ill people. The audience can discern by the look on his face that he is worried he will soon become weak, and need the assistance of nurses like the patients next to him. It is Dr. Gilman, not a nurse nor assistant, who provides Andy with a complete report of his tests. Dr. Gilman assures Andy that his T-cells are steady, doing as well as could be expected. When dealing with any serious illness, it is usually better for the doctor, who is more knowledgeable of diseases, to explain to the patient the results of tests. Verbal, as well as non-verbal skills, were well-disciplined in the hospital setting of "Philadelphia." Dr. Gilman acts very caring and gentle; she usually has a smile on her face to reinforce her positive attitude. Her caring attitude is shown again at the end of the movie. She stands next to Andy's bed and tells him that he was a great fighter. Dr. Gilman knows that Andy can die at any moment, but she smiles and winks at Andy to give him the reassurance that she is there for him. The last time the audience sees Andy, he appears content. Perhaps it is because he realizes that his family supports him and the hospital is giving him the best care. Shaw and Paleo (1986) report that women care providers may experience a more nurturing role that this epidemic necessitates (p. 154). In "Philadelphia," most of the health care providers communicated in a friendly, unbiased, and personal manner to Andy.
Although the health care providers in "Philadelphia" appear to be somewhat "disciplined in human interaction," the majority of Andy's bosses and co-workers are not. At the beginning of the film, Andy is promoted to senior partner at the law firm. A few days later, co-workers notice red and purple-tinged lesions on Andy's face. Some of the co-workers realize that these are lesions, known as Kaposis sarcoma, are a sign of AIDS. Soon after, Andy is blamed for misplacing some computer files that contain important information on a particular case. Jamie, a co-worker, informs the law firm that she cannot find this complaint file. She says she needs Andy's help to recovering the file. The next day the workers have a meeting and decide Andy is at fault for losing the file. They also tell him he has an attitude problem. As a result, he is fired. However, Andy knows that the true reason he is fired is because his co-workers found out he has AIDS. Andy did not misplace the computer file. Rather, anotherco-worker who knew Andy had AIDS, his the document to make it look like Andy made a huge error.
Stodgill states that "the fear and mythology surrounding the disease can quickly overwhelm even a company's best intentions" (1993, p.53). Many people at the law firm are afraid of Andy's disease, and some are even more frightened by the way he acquired it. According to Herek (1990), "The stigma associated with the HIM illness continuum derives primarily from the fact that people infected with HIV are assumed to be at fault through their own behaovior" (cited in Dworkin & Pincu, 1993, p. 275). Andy's attorney, Joe, tells the court, "This case is about the fear of homosexuals." The majority of Andy's co-workers are heterosexual, and are ignorant to homosexual lifestyles. Thus, many have closed-minds about homosexuality and make jokes about it. Instead of accepting Andy, his co-workers ostracize him so they do not have to deal with his lifestyle and his disease.
Not only are many of Andy's co-workers homophobic, but his lawyer, Joe Miller (Denzel Washington) is also. As soon as Joe learns that Andy has AIDS, he quickly withdraws himself from their handshake. Many people have misconceptions on how AIDS can be transmitted. Stodgill states, "because it is both deadly and transmittable (though not through casual contact), fear about 1 catching HIV can run rampant" (1993, p. 53). Joe walks to the opposite side of his office and tells Andy that he cannot represent him for personal reasons. "This disease forces us to confront our beliefs and attitudes about specific stigmatized populations, sexuality, sexual orientation, health, sickness, quality of life, and death and dying" (Dworkin & Pincu, 1993, p. 276). Joe is not afraid to admit that he is biased. He tells his wife, "I'm prejudiced. I don't like homosexuals." Realizing that his job is more important than his personal beliefs (and after a visit to his doctor for information on ways to transmit AIDS), Joe finally agrees to represent Andy. Joe remarks, "These people (homosexuals) make me sick, but the law has been broken." Joe, unlike the majority of Andy's co-workers, confronts his true beliefs on homosexuality. Knowing he is homophobic, Joe realizes that he is judgmental. After confronting his biases, Joe develops a more disciplined awareness of human interaction (Kreps & Thornton, 1992, p.3). Joe ignores his homophobia to follow his chosen career and help a fellow counselor.
SECTION TWO
In "Philadelphia," there are numerous examples of tensions dealing with ethical and economic standards. Andy is not the only PWA in his law firm. A woman named, Melissa, also has AIDS. However, Melissa acquired AIDS through a blood transfusion. One worker at the law firm testified in court: "I feel the deepest
sympathy for Melissa who contracted the disease through no fault her own." Ironically, Andy is fired and Melissa is not. Some people may fear AIDS and blame homosexuals for bringing on the disease themselves because of their unusual sexual orientation. Andy's boss remarks, "Andy brought AIDS to our office.. to our men's room " The workers feel that Melissa acquired this disease accidentally, and therefore, she cannot be blamed. In contrast, the workers believe that Andy made a poor choice by living an alternative lifestyle. Thus, they feel he is to blame. Stodgill reports, "the virus' association with Q homosexuals and drug users can inspire scorn and prejudice other diseases don't" (1993, p. 53). Health care providers may have these same biased attitudes when working with AIDS patients. However in "Philadelphia," Andy's regular doctor does not seem prejudiced toward gays.
Andy fears being blamed, mocked, ridiculed, and not accepted by his co-workers. As soon as workers suspect Andy has AIDS, his fears come true. When someone shows signs of AIDS, mongering among co-workers fan irrational responses leading to bitterness and frustration (Stodgill, 1993, p. 54). Perhaps Andy is also afraid to admit he has AIDS because then he may also have to tell his co-workers he is homosexual. According to Barret (1989), "Gay men also must explore feelings of guilt and shame over their earlier life-style and the irrational belief that they are responsible for this disease" (p. 573). Although Andy fears feeling isolated at work, his family provides him with their utmost support. Winiarski (1991),states that the family can be a wonderful resource which can become a source of love and acceptance and during impending crises can become a source for emotional healing (cited in Dworkin & Pincu, 1993, p. 278).
Andy's doctors and family seem supportive and unbiased toward his lifestyle and disease. In the workplace though, many discriminate against him. Their choice to fire him was based on unethical grounds. Andy cites the 1973 ADA law (Americans with Disabilities Act) that prohibits discrimination against the handicap in the workplace. In recent years,an additional supplement was attached to that law to prevent discrimination ag nst PWAs in the workplace. His bosses may contend that they do not discriminate, but they may have fired him for financial reasons. "A person with AIDS may affect health-coverage costs, depending on the company. Some states allow companies to "punish" policy-holders by dropping them when AIDS claims are made" (Slatin, 1994, p. 26). Mark Prendergast, founder of an AIDS advocacy group says, "only 20 percent of businesses nationwide have any kind of policy on HIV and AIDS" (cited in Slatin, 1994, p. 26).
In addition to economics, other ethical issues can be examined in the movie "Philadelphia." For instance, Joe is approached by a law student in a drug store. The student praises Joe's decision to take Andy's case. He also assumes that Joe is gay because he is working with Andy. Thus, he makes a pass at Joe. Joe becomes horrified and embarrassed; he screams at the student: "I should kick your faggoty little ass." Joe's attitude is not appropriate especially since he is representing Andy, and he is in a public place. Like Joe, many health care professionals may face these same types of situations. Health care providers may be homophobic, but they still work with patients because it is their job. It is an ethical problem that they need to confront.
SECTION THREE
According to Ratzan (1994), a New Health Order should be adopted by developing synergistic relationships between individuals and organizations to promote the vital life of the individual (p. 204). Ratzan states, "Our goal must be to prepare health communicators to use ethical, persuasive means to craft and deliver campaigns that promote good health and disease prevention; to plan, to influence, to evaluate health care policy; and to employ heath care decision king that will enhance the quality of life for individuals and communities throughout the globe" (1994, p. 204). The above goals can be obtained by educating people in an ethical and unbiased manner.
In the movie "Philadelphia," a New Health Order is necessary. The majority of the people in this movie, with the exception of Andy's doctors and family, are very ignorant of the AIDS disease.
For instance, at the beginning of the film, Andy's attorney, Joe, feels uncomfortable talking to Andy: a gay man with AIDS. He is quite unsympathetic to Andy's condition. Joe coldly says: "I'm sorry about what happened to you. It's a bitch." Worried about having been in contact with an AIDS patient, Joe goes to his doctor to ask some questions about the disease. Joe receives reassurance that AIDS can only be caught though the exchange of bodily fluids. Joe stays in the doctor's office for about five minutes. They communicate about the disease in a very poor manner. Joe does not ask many questions, and the doctor does not offer any expansion on the questions asked. Ratzan (1994) reports, "The educational perspective must be based in communication, with the distinct ability to discriminate among values, to craft effective messages to different audiences, and to negotiate with the best interests of the public health and specific patients in mind" (p. 207).
Andy too could have benefited from a New Health Order. He is not aware of the legal rights that PWAs have. Thus, he has to go to the library and research for himself. Fortunately, he finds a law that prohibits AIDS discrimination in the workplace. If Andy's co-workers were more educated, perhaps they could have been aware of such laws. Rosse (1988) believes that those who work with HIV/AIDS clients need to become more knowledgeable about the disease and to understand the minimal occupational risk of HIV exposure (p. 278). Education would help reduce fears. In "Philadelphia," the librarian realizes that Andy has AIDS and says: "Won't you be more comfortable in a private research room?" What the librarian probably means is that he would feel more comfortable if Andy isolated himself.
After people accept PWAs, their fears may be reduced. Joe accepted Andy after he got to know him on a more personal level. At the beginning of the film, Joe is seen as a homophobic. He tells his baby girl to stay away from her Aunt Theresa who is a lesbian. He calls a gay law student a "faggot." Nevertheless, after working with Andy, Joe realizes that he is a person with feelings and not just another gay "AIDS victim." Toward the end of the movie, Joe attends Andy and Miguel's costume party. He becomes more accepting of alternative lifestyles and the AIDS disease. In one of the final scenes, Joe tells Andy that he is courageous. Joe proceeds to touch
Andy's face and help him replace his oxygen mask. His acceptance of Andy is further illustrated when he attends a family gathering after Andy's death. Exposure, in addition to education, may provide more positive and accepting attitudes toward AIDS and alternative lifestyles.
In a study conducted by Riley and Greene, participants were surveyed to see if education would reduce fears when working with HIV/AIDS patients. The education consisted of lectures and
workshops by knowledgeable professionals from the University of Maryland, Baltimore County, currently working with HIV/AIDS victims. The caregivers that were educated came from Smith
College/Catholic University, Maryland Women's Health Coalition, and Nursing Updates. Riley and Green found that the UMBC courses had a more positive and significant increase on the Smith College/Catholic University participants who took the course for over a three-week period. In contrast, the other two groups had less of a positive attitude toward AIDS victims because they only took the course for three nights. Thus, Riley and Greene's study showed that the more educated heath care providers are about the AIDS disease, the more likely they have a positive attitude about providing treatment (1993, p. 400). If people in general were to enroll in courses like the above, perhaps anxieties and negative beliefs about AIDS would be reduced.
In "Philadelphia," the law firm employees would have benefited from the above types of courses. In addition, companies should provide mandatory training and AIDS awareness for managers, supervisors, employees etc. Stodgill (1994) reports AIDS training and education should: present facts on HIV transmission and prevention; address personal concerns about AIDS in the workplace; encourage empathy for AIDS victims; and provide workshops or forums for open discussion (p. 53).
SECTION FOUR
Caregivers are needed to assist victims of AIDS and the victim's families. As Dworkin and Pincu (1993) report, "When working with an HIV-affected population, there are themes that the counselor must be ready to address within herself or himself and with clients"(p.275). The caregiver must deal with different types of AIDS victims. For instance, some victims acquired the disease through sexual relations or drug use. Therefore, the caregiver needs to be sure not to be judgmental toward one group or another. Obviously if a caregiver is homophobic, he/she would have a difficult time supporting a gay man with AIDS. Moreover, a caregiver must deal with loved ones. Family and friends are often confused about the nature of the infection, transmission, and testing; thus, the caregiver must deal with information in a rational and concrete way, while simultaneously helping the client deal with his/her feelings (Dworkin & Pincu, 1993, p.276). There is no right or wrong advice that a caregiver can give to the family of the patient. However, it is very important for the caregiver to express support for the patient and the family. Dworkin and Pincu (1993) note, "It is important for counselors to be aware that even though support groups can be helpful, they can also be frightening, because groups force the client to face the illness" (p. 277). Structured support groups also help prepare the victim's family to cope with the inevitable death of their loved one.
There are different types of support groups for AIDS victims and their families. According to a study by Frey, Query, Flint, and Adleman (in-press), "formal social support is offered via weekly support groups, a buddy system, in-house educational seminars, social events sponsored by the house, religious/spiritual assistance, and collective bereavement rituals" (p. 7). In contrast, informal social support groups depend on the extent to which patients form close relationships with other patients with whom they can talk to and share feelings (Frey, Query, Flint, and Adleman, in-press, p. 7).
Besides formal and informal comfort groups, caregivers may suggest some additional support guidelines. Richman (1989) reports that there are six kinds of support that caregivers can provide to families and PWAs: listening without giving advice; technical appreciation when good work has been accomplished; technical challenge by encouragement; emotional support during difficult times; emotional challenge to overcome obstacles and fulfill goals; and sharing social reality by verifying perceptions of the social
context (cited in Kreps & Thornton, 1992, p. 86). Caregivers can lessen communication barriers by providing the above kind of support. They must also realize that after a PWA dies, the family can experience grieving at any unexpected time. Once again, there is usually no advice that a caregiver can provide to families after someone dies of AIDS. Giving advice will not prevent people from grieving. Rather, caregivers can only support families through verbal or non-verbal communication. Support is distinct from "advice" because support often occurs by sharing similar experiences. By sharing experiences, people can relate to each other, and this process may help them realize that they are not the only ones dealing with the loss of a loved one.
SECTION FIVE
As the AIDS virus progresses, victims need escalating levels of care. If one of my loved ones had AIDS, I would want to get him/her as much treatment as possible, even if it meant constant hospitalization. However, there are many dilemmas involved when deciding to place a loved one in a new context. Caregiving cost is a
factor. As more care is needed, there are more caregiving costs. In "Philadelphia," Andy's physical condition continually deteriorates.
At the beginning he looks healthy. Then, he develops lesions on his face and body. He has constant flu-like symptoms, He loses his balance often, and he eventually goes blind in his right eye. Andy is shown in the hospital increasingly. The cost for his treatment is probably outrageous. Hellinger suggests, "Estimates of the lifetime cost of treating PWAs have climbed steadily over the past several years and now exceed $100,000" (1993, p. 474).
Hellinger conducted a study to estimate the cost of treating a HIV infected person until death. He used data from the AIDS Cost and Service Utilization Survey. This study took place in the Spring and summer of 1992. There were 1,164 HIV victims taken to 26 medical sites in 10 cities. This study examined monthly cost in each stage and the lifetime medical expenses of an AIDS patient. The showed that the average cost from infection until death was 119,000. The cost from HIV infection until full blown AIDS is
$50,000. The cost from AIDS until death is $69,000. Hellinger concluded his study by reporting that the cost of treating a person
with AIDS had fallen as a result of a reduction in the use of inpatient hospital service (1993, p. 474). Although the medical costs have slightly decreased, the average family most likely cannot afford these medical bills.
Not only is economics a key factor when deciding to place a PWA in a new context, the quality of care is just as important. I would not want to have my loved one in the hands of biased health care providers. According to Dworkin and Pincu, there are many themes that caregivers must be ready to address within herself or himself and with clients (1993, p. 275). Health care providers must deal with different types of AIDS victims. For example, some victims acquire AIDS through sexual relations or drug use. Therefore, the caregiver needs to be sure not to be judgmental toward one group or another. In addition, the health care provider must express enough communication competence to deal with family and friends of PWAs. Since loved ones are often confused about the nature of the infection, transmission, and testing, the caregiver must deal with this information in a rational and concrete way, while simultaneously helping the client deal with his/her feelings (Dworkin & Pincu, 1993, p. 276).
The only way to be certain that there is excellent quality of care is by ensuring the heath care providers are well-educated. Riley and Greene state, "Knowledge about factors such as prevention, clinical presentation, transmission, and client lifestyle related to HIV also is important" (1993, p. 396). Although more facts about HIV syndr6me are needed, studies by Merdinger, Wren, and Parry reveal that it is imperative that education addresses negative beliefs as well as feelings about working with PWAs (cited in Riley and Greene, 1993, p. 397). Thus, quality heath care providers are those that are well-educated and have positive attitudes about providing treatment.
Health care providers may have great attitudes about caring for AIDS patients; however, loved ones may face psychological burdens when dealing with PWAs. Although the thought of losing a loved one may bring people closer together, watching a PWA deteriorate physically and emotionally is frightening. It is especially threatening when loved ones have to place a PWA in a new context because they can no longer have the medical qualifications to assist with his/her heath. Adelman and Frey (1994) report, "AIDS is an illness so imbued with fear that even loving family members are afraid to visit dying sons and daughters" (cited in Frey, Query, Flint, and Adleman, in-press, p. 3). People may not accept the fact that a loved one is dying right before their eyes. If loved ones do not comfort a PWA, the patient may feel shunned and isolated. Thus, there are psychological burdens that face almost everyone associated in the context of AIDS. Family, friends, and PWAs need to support each other to alleviate pain.
AIDS is a frightening disease that produces inevitable deaths. The movie, "Philadelphia," is a prime example of how an AIDS victim is affected emotionally and physically. Andy's family helps provide support to him by showing acceptance to his disease and his alternative lifestyle In contrast, many of his co-workers display ignorance and fear toward him. The only ways to reduce these fears of AIDS is to be well-educated and supportive. People can begin to learn about AIDS by consulting their health care providers. Thus, it is imperative that health care providers also be well-educated and unbiased toward anyone with AIDS or other deadly diseases.
Bibliography
Barret, R. L. (1989). Counseling gay men with AIDS: human dimensions. Journal of Counseling and Development. 67, 573-575.
Dworkin, S., & Pincu, L., (1993). Counseling in the era of AIDS. Journal of Counseling and Development. 21 275-281.
Frey, L.R., Query, J.L., Flint, L.J., Adelman, M.B., (in-press). Living together with AIDS: social support processes in a residential facility. HIV infection and social interactions. Thousand Oaks, CA:Sage.
Hellinger, F. J., (1993). The lifetime cost of treating a person with HIV. Journal of the American Medical Association, 270, 474-478.
Kreps, G.L., & Thornton, B.C., (1992). Health communication theory and practice. Prospect Heights, IL: Waveland Press.
Marieb, E. (1995). Human anatomy and physiology. Redwoo& City, CA: Benjamin/Cummings Publications.
Ratzan, S. C., (1994). Editor's introduction: communication-the key to a healthier tomorrow. American Behavioral Scientist 38, 202-207.
Riley,L.J., & Greene, R.R., Influence of education on self-perceived attitudes about HIV/AIDS among human services providers. Journal of Social Work, 33, 396-401.
Rosse, R.(1988). Psychosocial impact of the AIDS epidemic on the lives of gay men. Social Work, 33, 277-281.
Saxon, E.(Producer), & Denne, J. (Director). (1993). Philadelphia (Videotape). Tri-Star Pictures.
Shaw, N., & Paleo, L. (1986). What to do about AIDS. Berkeley, CA: University of California Press.
Slatin, P. D., (1994). When AIDS comes to the office. Architectural Record, 182, 26-27.
Stodgill R., (1993). Why AIDS policy must be a special policy. Business Week. 53-54.
Author: Katie Kiefel, Loyola U. Chicago Grad
Acquired Immune Deficiency Syndrome (AIDS) is a deadly disease that affects the victim as well as the victim's family, friends, and caregivers. The AIDS epidemic has been in the United States since 1981. By the end of 1993, over 339,000 AIDS cases were diagnosed nationwide, and over 204,000 people had died (Marieb, 1995, p. 739). Because AIDS victims deteriorate physically and emotionally, family and friends must be prepared to deal with the loss of a loved one. According to Dworkin and Pincu, "information changes almost daily in terms of the conceptualization of the illness, the medications and treatments recommended, and the social and political climate surrounding AIDS" (1993, p.275). Due to such changes, patients, families, and caregivers often face excessive and prolonged stress. Thus, therapeutic interaction between those associated within the context of AIDS is needed to alleviate the burden of this disease.
Barnlund reports that therapeutic communication is not limited to trained health practitioners or health care practice (cited in Kreps & Thornton, 1992, p. 47). Barnlund's approach "implies that any individual has the potential for communicating therapeutically by helping another person to understand himself or herself more fully, thereby aiding that individual in deciding how to direct behaviors to best achieve needs and goals" (Kreps & Thornton, 1992, p. 47). Therefore, therapeutic interaction can be positive since it may help individuals obtain goals and other needs.
Therapeutic interaction was shown between family, friends, and a man diagnosed with AIDS in the movie, "Philadelphia." However, much therapeutic interaction was not shown between this PWA (person with AIDS) and the majority of his co-workers. In the movie, "Philadelphia," Andy Beckett (Tom Hanks) is a highly successful, corporate attorney in Philadelphia who has acquired the AIDS virus. This attorney is also homosexual. Later, Andy, is fired from his law firm. His employers contend that Andy was fired because of sexual-orientation discrimination. Trying to prove his side, Andy hires a civil-suit lawyer to represent him. It turns out that the lawyer, Joe Miller (Denzel Washington), homophobic. Joe, however, agrees to represent Andy, and ultimately he presents an excellent case. Joe also helps to win the case, vindicating Andy. Of course, if Joe would have had a better understanding of AIDS, he may have initially accepted the case with more enthusiasm and an open mind. Moreover, he would have better appreciated Andy's plight.
SECTION ONE
Many people assume that health care providers know how to communicate in a competent manner. However, some health care providers have difficulty communicating in a competent manner. Kreps and Thornton believe that health care providers need to have a more disciplined awareness of human interaction (1992, p.3). There are several instances in the movie "Philadelphia" where human interaction needs to be disciplined. However,in this movie, the improvement with human interaction needs to be in the workplace. The majority of health care providers in the movie display a disciplined awareness of human interaction. In the beginning of the movie, the audience sees Andy, who is HIV positive, sitting in a hospital waiting for the results of his blood tests. Andy looks around at all of the ill people. The audience can discern by the look on his face that he is worried he will soon become weak, and need the assistance of nurses like the patients next to him. It is Dr. Gilman, not a nurse nor assistant, who provides Andy with a complete report of his tests. Dr. Gilman assures Andy that his T-cells are steady, doing as well as could be expected. When dealing with any serious illness, it is usually better for the doctor, who is more knowledgeable of diseases, to explain to the patient the results of tests. Verbal, as well as non-verbal skills, were well-disciplined in the hospital setting of "Philadelphia." Dr. Gilman acts very caring and gentle; she usually has a smile on her face to reinforce her positive attitude. Her caring attitude is shown again at the end of the movie. She stands next to Andy's bed and tells him that he was a great fighter. Dr. Gilman knows that Andy can die at any moment, but she smiles and winks at Andy to give him the reassurance that she is there for him. The last time the audience sees Andy, he appears content. Perhaps it is because he realizes that his family supports him and the hospital is giving him the best care. Shaw and Paleo (1986) report that women care providers may experience a more nurturing role that this epidemic necessitates (p. 154). In "Philadelphia," most of the health care providers communicated in a friendly, unbiased, and personal manner to Andy.
Although the health care providers in "Philadelphia" appear to be somewhat "disciplined in human interaction," the majority of Andy's bosses and co-workers are not. At the beginning of the film, Andy is promoted to senior partner at the law firm. A few days later, co-workers notice red and purple-tinged lesions on Andy's face. Some of the co-workers realize that these are lesions, known as Kaposis sarcoma, are a sign of AIDS. Soon after, Andy is blamed for misplacing some computer files that contain important information on a particular case. Jamie, a co-worker, informs the law firm that she cannot find this complaint file. She says she needs Andy's help to recovering the file. The next day the workers have a meeting and decide Andy is at fault for losing the file. They also tell him he has an attitude problem. As a result, he is fired. However, Andy knows that the true reason he is fired is because his co-workers found out he has AIDS. Andy did not misplace the computer file. Rather, anotherco-worker who knew Andy had AIDS, his the document to make it look like Andy made a huge error.
Stodgill states that "the fear and mythology surrounding the disease can quickly overwhelm even a company's best intentions" (1993, p.53). Many people at the law firm are afraid of Andy's disease, and some are even more frightened by the way he acquired it. According to Herek (1990), "The stigma associated with the HIM illness continuum derives primarily from the fact that people infected with HIV are assumed to be at fault through their own behaovior" (cited in Dworkin & Pincu, 1993, p. 275). Andy's attorney, Joe, tells the court, "This case is about the fear of homosexuals." The majority of Andy's co-workers are heterosexual, and are ignorant to homosexual lifestyles. Thus, many have closed-minds about homosexuality and make jokes about it. Instead of accepting Andy, his co-workers ostracize him so they do not have to deal with his lifestyle and his disease.
Not only are many of Andy's co-workers homophobic, but his lawyer, Joe Miller (Denzel Washington) is also. As soon as Joe learns that Andy has AIDS, he quickly withdraws himself from their handshake. Many people have misconceptions on how AIDS can be transmitted. Stodgill states, "because it is both deadly and transmittable (though not through casual contact), fear about 1 catching HIV can run rampant" (1993, p. 53). Joe walks to the opposite side of his office and tells Andy that he cannot represent him for personal reasons. "This disease forces us to confront our beliefs and attitudes about specific stigmatized populations, sexuality, sexual orientation, health, sickness, quality of life, and death and dying" (Dworkin & Pincu, 1993, p. 276). Joe is not afraid to admit that he is biased. He tells his wife, "I'm prejudiced. I don't like homosexuals." Realizing that his job is more important than his personal beliefs (and after a visit to his doctor for information on ways to transmit AIDS), Joe finally agrees to represent Andy. Joe remarks, "These people (homosexuals) make me sick, but the law has been broken." Joe, unlike the majority of Andy's co-workers, confronts his true beliefs on homosexuality. Knowing he is homophobic, Joe realizes that he is judgmental. After confronting his biases, Joe develops a more disciplined awareness of human interaction (Kreps & Thornton, 1992, p.3). Joe ignores his homophobia to follow his chosen career and help a fellow counselor.
SECTION TWO
In "Philadelphia," there are numerous examples of tensions dealing with ethical and economic standards. Andy is not the only PWA in his law firm. A woman named, Melissa, also has AIDS. However, Melissa acquired AIDS through a blood transfusion. One worker at the law firm testified in court: "I feel the deepest
sympathy for Melissa who contracted the disease through no fault her own." Ironically, Andy is fired and Melissa is not. Some people may fear AIDS and blame homosexuals for bringing on the disease themselves because of their unusual sexual orientation. Andy's boss remarks, "Andy brought AIDS to our office.. to our men's room " The workers feel that Melissa acquired this disease accidentally, and therefore, she cannot be blamed. In contrast, the workers believe that Andy made a poor choice by living an alternative lifestyle. Thus, they feel he is to blame. Stodgill reports, "the virus' association with Q homosexuals and drug users can inspire scorn and prejudice other diseases don't" (1993, p. 53). Health care providers may have these same biased attitudes when working with AIDS patients. However in "Philadelphia," Andy's regular doctor does not seem prejudiced toward gays.
Andy fears being blamed, mocked, ridiculed, and not accepted by his co-workers. As soon as workers suspect Andy has AIDS, his fears come true. When someone shows signs of AIDS, mongering among co-workers fan irrational responses leading to bitterness and frustration (Stodgill, 1993, p. 54). Perhaps Andy is also afraid to admit he has AIDS because then he may also have to tell his co-workers he is homosexual. According to Barret (1989), "Gay men also must explore feelings of guilt and shame over their earlier life-style and the irrational belief that they are responsible for this disease" (p. 573). Although Andy fears feeling isolated at work, his family provides him with their utmost support. Winiarski (1991),states that the family can be a wonderful resource which can become a source of love and acceptance and during impending crises can become a source for emotional healing (cited in Dworkin & Pincu, 1993, p. 278).
Andy's doctors and family seem supportive and unbiased toward his lifestyle and disease. In the workplace though, many discriminate against him. Their choice to fire him was based on unethical grounds. Andy cites the 1973 ADA law (Americans with Disabilities Act) that prohibits discrimination against the handicap in the workplace. In recent years,an additional supplement was attached to that law to prevent discrimination ag nst PWAs in the workplace. His bosses may contend that they do not discriminate, but they may have fired him for financial reasons. "A person with AIDS may affect health-coverage costs, depending on the company. Some states allow companies to "punish" policy-holders by dropping them when AIDS claims are made" (Slatin, 1994, p. 26). Mark Prendergast, founder of an AIDS advocacy group says, "only 20 percent of businesses nationwide have any kind of policy on HIV and AIDS" (cited in Slatin, 1994, p. 26).
In addition to economics, other ethical issues can be examined in the movie "Philadelphia." For instance, Joe is approached by a law student in a drug store. The student praises Joe's decision to take Andy's case. He also assumes that Joe is gay because he is working with Andy. Thus, he makes a pass at Joe. Joe becomes horrified and embarrassed; he screams at the student: "I should kick your faggoty little ass." Joe's attitude is not appropriate especially since he is representing Andy, and he is in a public place. Like Joe, many health care professionals may face these same types of situations. Health care providers may be homophobic, but they still work with patients because it is their job. It is an ethical problem that they need to confront.
SECTION THREE
According to Ratzan (1994), a New Health Order should be adopted by developing synergistic relationships between individuals and organizations to promote the vital life of the individual (p. 204). Ratzan states, "Our goal must be to prepare health communicators to use ethical, persuasive means to craft and deliver campaigns that promote good health and disease prevention; to plan, to influence, to evaluate health care policy; and to employ heath care decision king that will enhance the quality of life for individuals and communities throughout the globe" (1994, p. 204). The above goals can be obtained by educating people in an ethical and unbiased manner.
In the movie "Philadelphia," a New Health Order is necessary. The majority of the people in this movie, with the exception of Andy's doctors and family, are very ignorant of the AIDS disease.
For instance, at the beginning of the film, Andy's attorney, Joe, feels uncomfortable talking to Andy: a gay man with AIDS. He is quite unsympathetic to Andy's condition. Joe coldly says: "I'm sorry about what happened to you. It's a bitch." Worried about having been in contact with an AIDS patient, Joe goes to his doctor to ask some questions about the disease. Joe receives reassurance that AIDS can only be caught though the exchange of bodily fluids. Joe stays in the doctor's office for about five minutes. They communicate about the disease in a very poor manner. Joe does not ask many questions, and the doctor does not offer any expansion on the questions asked. Ratzan (1994) reports, "The educational perspective must be based in communication, with the distinct ability to discriminate among values, to craft effective messages to different audiences, and to negotiate with the best interests of the public health and specific patients in mind" (p. 207).
Andy too could have benefited from a New Health Order. He is not aware of the legal rights that PWAs have. Thus, he has to go to the library and research for himself. Fortunately, he finds a law that prohibits AIDS discrimination in the workplace. If Andy's co-workers were more educated, perhaps they could have been aware of such laws. Rosse (1988) believes that those who work with HIV/AIDS clients need to become more knowledgeable about the disease and to understand the minimal occupational risk of HIV exposure (p. 278). Education would help reduce fears. In "Philadelphia," the librarian realizes that Andy has AIDS and says: "Won't you be more comfortable in a private research room?" What the librarian probably means is that he would feel more comfortable if Andy isolated himself.
After people accept PWAs, their fears may be reduced. Joe accepted Andy after he got to know him on a more personal level. At the beginning of the film, Joe is seen as a homophobic. He tells his baby girl to stay away from her Aunt Theresa who is a lesbian. He calls a gay law student a "faggot." Nevertheless, after working with Andy, Joe realizes that he is a person with feelings and not just another gay "AIDS victim." Toward the end of the movie, Joe attends Andy and Miguel's costume party. He becomes more accepting of alternative lifestyles and the AIDS disease. In one of the final scenes, Joe tells Andy that he is courageous. Joe proceeds to touch
Andy's face and help him replace his oxygen mask. His acceptance of Andy is further illustrated when he attends a family gathering after Andy's death. Exposure, in addition to education, may provide more positive and accepting attitudes toward AIDS and alternative lifestyles.
In a study conducted by Riley and Greene, participants were surveyed to see if education would reduce fears when working with HIV/AIDS patients. The education consisted of lectures and
workshops by knowledgeable professionals from the University of Maryland, Baltimore County, currently working with HIV/AIDS victims. The caregivers that were educated came from Smith
College/Catholic University, Maryland Women's Health Coalition, and Nursing Updates. Riley and Green found that the UMBC courses had a more positive and significant increase on the Smith College/Catholic University participants who took the course for over a three-week period. In contrast, the other two groups had less of a positive attitude toward AIDS victims because they only took the course for three nights. Thus, Riley and Greene's study showed that the more educated heath care providers are about the AIDS disease, the more likely they have a positive attitude about providing treatment (1993, p. 400). If people in general were to enroll in courses like the above, perhaps anxieties and negative beliefs about AIDS would be reduced.
In "Philadelphia," the law firm employees would have benefited from the above types of courses. In addition, companies should provide mandatory training and AIDS awareness for managers, supervisors, employees etc. Stodgill (1994) reports AIDS training and education should: present facts on HIV transmission and prevention; address personal concerns about AIDS in the workplace; encourage empathy for AIDS victims; and provide workshops or forums for open discussion (p. 53).
SECTION FOUR
Caregivers are needed to assist victims of AIDS and the victim's families. As Dworkin and Pincu (1993) report, "When working with an HIV-affected population, there are themes that the counselor must be ready to address within herself or himself and with clients"(p.275). The caregiver must deal with different types of AIDS victims. For instance, some victims acquired the disease through sexual relations or drug use. Therefore, the caregiver needs to be sure not to be judgmental toward one group or another. Obviously if a caregiver is homophobic, he/she would have a difficult time supporting a gay man with AIDS. Moreover, a caregiver must deal with loved ones. Family and friends are often confused about the nature of the infection, transmission, and testing; thus, the caregiver must deal with information in a rational and concrete way, while simultaneously helping the client deal with his/her feelings (Dworkin & Pincu, 1993, p.276). There is no right or wrong advice that a caregiver can give to the family of the patient. However, it is very important for the caregiver to express support for the patient and the family. Dworkin and Pincu (1993) note, "It is important for counselors to be aware that even though support groups can be helpful, they can also be frightening, because groups force the client to face the illness" (p. 277). Structured support groups also help prepare the victim's family to cope with the inevitable death of their loved one.
There are different types of support groups for AIDS victims and their families. According to a study by Frey, Query, Flint, and Adleman (in-press), "formal social support is offered via weekly support groups, a buddy system, in-house educational seminars, social events sponsored by the house, religious/spiritual assistance, and collective bereavement rituals" (p. 7). In contrast, informal social support groups depend on the extent to which patients form close relationships with other patients with whom they can talk to and share feelings (Frey, Query, Flint, and Adleman, in-press, p. 7).
Besides formal and informal comfort groups, caregivers may suggest some additional support guidelines. Richman (1989) reports that there are six kinds of support that caregivers can provide to families and PWAs: listening without giving advice; technical appreciation when good work has been accomplished; technical challenge by encouragement; emotional support during difficult times; emotional challenge to overcome obstacles and fulfill goals; and sharing social reality by verifying perceptions of the social
context (cited in Kreps & Thornton, 1992, p. 86). Caregivers can lessen communication barriers by providing the above kind of support. They must also realize that after a PWA dies, the family can experience grieving at any unexpected time. Once again, there is usually no advice that a caregiver can provide to families after someone dies of AIDS. Giving advice will not prevent people from grieving. Rather, caregivers can only support families through verbal or non-verbal communication. Support is distinct from "advice" because support often occurs by sharing similar experiences. By sharing experiences, people can relate to each other, and this process may help them realize that they are not the only ones dealing with the loss of a loved one.
SECTION FIVE
As the AIDS virus progresses, victims need escalating levels of care. If one of my loved ones had AIDS, I would want to get him/her as much treatment as possible, even if it meant constant hospitalization. However, there are many dilemmas involved when deciding to place a loved one in a new context. Caregiving cost is a
factor. As more care is needed, there are more caregiving costs. In "Philadelphia," Andy's physical condition continually deteriorates.
At the beginning he looks healthy. Then, he develops lesions on his face and body. He has constant flu-like symptoms, He loses his balance often, and he eventually goes blind in his right eye. Andy is shown in the hospital increasingly. The cost for his treatment is probably outrageous. Hellinger suggests, "Estimates of the lifetime cost of treating PWAs have climbed steadily over the past several years and now exceed $100,000" (1993, p. 474).
Hellinger conducted a study to estimate the cost of treating a HIV infected person until death. He used data from the AIDS Cost and Service Utilization Survey. This study took place in the Spring and summer of 1992. There were 1,164 HIV victims taken to 26 medical sites in 10 cities. This study examined monthly cost in each stage and the lifetime medical expenses of an AIDS patient. The showed that the average cost from infection until death was 119,000. The cost from HIV infection until full blown AIDS is
$50,000. The cost from AIDS until death is $69,000. Hellinger concluded his study by reporting that the cost of treating a person
with AIDS had fallen as a result of a reduction in the use of inpatient hospital service (1993, p. 474). Although the medical costs have slightly decreased, the average family most likely cannot afford these medical bills.
Not only is economics a key factor when deciding to place a PWA in a new context, the quality of care is just as important. I would not want to have my loved one in the hands of biased health care providers. According to Dworkin and Pincu, there are many themes that caregivers must be ready to address within herself or himself and with clients (1993, p. 275). Health care providers must deal with different types of AIDS victims. For example, some victims acquire AIDS through sexual relations or drug use. Therefore, the caregiver needs to be sure not to be judgmental toward one group or another. In addition, the health care provider must express enough communication competence to deal with family and friends of PWAs. Since loved ones are often confused about the nature of the infection, transmission, and testing, the caregiver must deal with this information in a rational and concrete way, while simultaneously helping the client deal with his/her feelings (Dworkin & Pincu, 1993, p. 276).
The only way to be certain that there is excellent quality of care is by ensuring the heath care providers are well-educated. Riley and Greene state, "Knowledge about factors such as prevention, clinical presentation, transmission, and client lifestyle related to HIV also is important" (1993, p. 396). Although more facts about HIV syndr6me are needed, studies by Merdinger, Wren, and Parry reveal that it is imperative that education addresses negative beliefs as well as feelings about working with PWAs (cited in Riley and Greene, 1993, p. 397). Thus, quality heath care providers are those that are well-educated and have positive attitudes about providing treatment.
Health care providers may have great attitudes about caring for AIDS patients; however, loved ones may face psychological burdens when dealing with PWAs. Although the thought of losing a loved one may bring people closer together, watching a PWA deteriorate physically and emotionally is frightening. It is especially threatening when loved ones have to place a PWA in a new context because they can no longer have the medical qualifications to assist with his/her heath. Adelman and Frey (1994) report, "AIDS is an illness so imbued with fear that even loving family members are afraid to visit dying sons and daughters" (cited in Frey, Query, Flint, and Adleman, in-press, p. 3). People may not accept the fact that a loved one is dying right before their eyes. If loved ones do not comfort a PWA, the patient may feel shunned and isolated. Thus, there are psychological burdens that face almost everyone associated in the context of AIDS. Family, friends, and PWAs need to support each other to alleviate pain.
AIDS is a frightening disease that produces inevitable deaths. The movie, "Philadelphia," is a prime example of how an AIDS victim is affected emotionally and physically. Andy's family helps provide support to him by showing acceptance to his disease and his alternative lifestyle In contrast, many of his co-workers display ignorance and fear toward him. The only ways to reduce these fears of AIDS is to be well-educated and supportive. People can begin to learn about AIDS by consulting their health care providers. Thus, it is imperative that health care providers also be well-educated and unbiased toward anyone with AIDS or other deadly diseases.
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