PARADOXICALLY, THE TRULY humanitarian position in the face of an AIDS plague is that we not identify with the victims and instead cast our lot with what in earlier times was dubbed the "common good."
More than 1 million Americans may have been infected with the AIDS virus. And the 13,000 Americans with confirmed cases of the disease, whose number is doubling every year, should be treated with the care and compassion due to anyone who is ill with a so-far incurable and invariably fatal disease. This shouldn't be confused, however, with a refusal to make painful, sometimes anguishing but nonetheless necessary distinctions in the interest of diminishing the likelihood that this awful disease will spread further.
Plagues are not new. They have been encountered in every age and among everynationality: syphilis among the Spanish, bubonic plague among the French, tuberculosis among the Eskimos, polio in America.
What is new are efforts by medically unsophisticated politicians and attorneys to dictate policy in regard to an illness that has the potential for wreaking a devastation such as has not been encountered on this planet in hundreds of years.
Also different is the response that, in some quarters, is being suggested: Accept the AIDS victim into our schools, place little or no restrictions on employment or housing. The AIDS victims' "rights" in these areas, we are told, should take precedence over the so-far incompletely determined potential for these victims to spread this dread illness.
But what some are describing as "discrimination" and "segregation" has a long and not inglorious history in medicine. Quarantines have been very effective in beating outbreaks of scarlet fever, smallpox and typhoid in this century. Indeed, by protecting the well from the ill we follow a long-established sensible and ultimately compassionate course. Throughout history true humanitarianism has traditionally involved the compassionate but firm segregation of those afflicted with communicable diseases from the well. By carrying out such a policy, diseases have been contained.
Only sentimentalists refuse to make any distinction between the victims of a scourge and those not presently afflicted. Scientists still are unsure why the AIDS virus targets the white blood cells that are the one indispensible element of the body's immune system. But the threat of AIDS demands from us all a discrimination based on our instinct for survival against a peril that, if not somehow controlled, can destroy this society. This is a discrimination that recognizes that caution is in order when knowledge is incomplete so that the public interest can be protected. This argument is not a counsel against good medical care or proper concern for AIDS victims.
Nor is it a suggestion that we curtail any "civil right" which doesn't potentially imperil the lives of others.
It is a suggestion that the humanitarian response to AIDS is exactly the opposite of a humanitarian response to sexism or racism: In the presence of considerable ignorance about the causes and effects of the syndrome, the benefit of the doubt should not be given to the victim of AIDS. This is not a civil rights issue, this is a medical issue. To take a position that the AIDS virus must be eradicated is not to make judgments on morals or lifestyles. It is to say that the AIDS virus has no "civil rights."
At the moment, social and legal solutions to the AIDS problem are proceeding at a pace disproportionate to the knowledge that experts presently possess concerning the illness.
For instance, on Aug. 14 the Los Angeles City Council unanimously approved an ordinance making it illegal to discriminate against AIDS patients in regard to jobs, housing and health care.
"We have an opportunity to set an example for the whole nation, to protect those people who suffer from AIDS against insidious discrimination," said the councilman who introduced the measure.
Councilman Ernani Bernardi said the ordinance was meant to educate the public to "prevent hysteria."
Preventing hysteria is good, but this ordinance was passed despite doctors' not having yet made up their minds on the degree of contact required for the disease to be spread from one person to another.
Consider, for example, the varied and patently contradictory measures put into effect across the country in response to the recent discovery that the AIDS virus can be isolated from a victim's tears.
At Boston University, when an AIDS patient is examined, "We are not using the applanation tonometer (a device that tests for glaucoma) because we don't feel we can adequately sterilize it" said the chairman of the department of ophthalmology.
The Massachusetts Eye and Ear Infirmary specialists plan to "review our technique." Translation: we're not sure yet what we're going to do.
In San Francisco, the chief of the eye service routinely sterilizes his optic instruments with merthiolate which "as far as I know" kills the AIDS virus.
At this point live AIDS virus has been isolated from blood, semen, serum, saliva, urine and now tears. If the virus exists in these fluids, the better part of wisdom dictates that we assume the possibility that it can also be transmitted by these routes.
It seems reasonable, therefore, that AIDS victims should not donate blood or blood products, should not contribute to semen banks, should not donate tissues or organs to organ banks, should not work as dental or medical technicians, and should probably not be employed as food handlers.
While the Los Angeles ordinance exempts blood banks and sperm banks, it's prepared to exert the full power of the law against nonconformists who exclude AIDS sufferers from employment in restaurants, hotels, barber shops and dental offices.
According to the new law, then, a person afflicted with AIDS may, if he is properly trained, work as a dental hygienist. He may clean your teeth. He may even clean your teeth if he has a paper cut on one of his fingers of which he is barely aware. This despite the fact that the AIDS virus can be transmitted from bloodstream to bloodstream.
The battle lines that are presently forming in regard to the admission of AIDS victims into our nation's schools are similarly disturbing. "This is the test case for the nation," says attorney Charles Vaughn, who represents 13-year-old AIDS victim Ryan White, who has been refused admission to his local school in Kokomo, Ind. "What happens here will set the trends across the country." (In America there are about 180 children, not all of school age, diagnosed as having AIDS.)
To those such as Vaughn who see this issue in civil liberties terms, the plight of Ryan White represents simply another instance of prejudice and discrimination that should be opposed with all of the vigor that has marked the efforts against racism and sexism in the past. In support of their position, they point to the recent directive of the CDC that AIDS cases be evaluated on an individual basis in order to determine whether or not a child should be admitted to school.
Spokesmen from the CDC and other AIDS authorities including Dr. Arye Rubenstein, who treats the largest group of children with AIDS, may be correct in stating that there is "overwhelming evidence that AIDS is not a highly contagious disease." However, in a combined interview, they then gave the following responses to the interviewer's questions. Suppose my child got into a fight with an AIDS victim and both began to bleed? That kind of fight with a possible exchange of body fluids would arouse some concern about transmission of the virus. What if my child is in a classroom with an AIDS victim who threw up or had diarrhea? Such events would be a matter of concern. In its guidelines, the CDC said that AIDS victims who cannot control body secretions should be kept out of ordinary classrooms. Suppose a child with AIDS bit my child? Again, a bite would arouse concern.
Any grade-school teacher can attest that "body-fluid contamination" in the form of scratching, throwing up, diarrhea, biting and spitting are everyday fare within a normal schoolroom. That's why infectious diseases like the flu spread through schools like flash fires.
It is difficult to imagine how the CDC or anyone else is going to make individual determinations under such circumstances.
"I'd rather err on the side of caution," says New York Mayor Edward Koch about admitting AIDS-afflicted children to schools. In this sentiment, he echos the concern of parents everywhere: What if future research shows that AIDS can be caught in other ways? What then? Isn't it more sensible to forego premature steps against "discrimination" and await scientific developments?
AIDS is not about civil rights, political power or "alternative lifestyles." It's a disease, a true plague that already, in the words of infectious disease expert Dr. John Seale, writing in the August issue of Britain's Journal of the Royal Society of Medicine, is capable of producing "a lethal pandemic throughout the crowded cities and villages of the Third World of a magnitude unparalleled in human history." Further, this disease is only partially understood, is presently untreatable, and is invariably fatal. For these reasons alone, caution would seem to be in order when it comes to exposing the public to those suffering from this illness.
But in addition, the incubation period is sufficiently lengthy to cast doubt on any proclamations no matter how seemingly authoritative in regard to the transmissibility of the illness: "The virus may be transmitted from an infected person many years before the onset of clinical manifestations," according to Dr. George D. Lundberg, editor-in- chief of the Journal of the American Medical Association. "Latency of many years may occur between transmission, infection and clinically manifest disease."
Indeed, truly authoritative statements regarding AIDS cannot presently be made. "The eventual mortality following infection with a lentivirus such as the AIDS virus cannot be ascertained by direct observation till those recently infected have been followed well into the 21st century," according to Dr. Seale.
Given these grim realities, lawyers and legislators should ponder long and hard whether or not they wish, by means of legal maneuvering, to inadvertently create situations -- child AIDS victims in the schools, adult AIDS victims working in medical, dental offices and other health care facilities -- in which those afflicted re in a position to pass this virus on to the general public.
Obviously, the most pressing issue at this point is to arrive at an understanding of all of the ways the AIDS virus spreads. But until we do that, political posturing, sloganeering, hollow reassurances and the inappropriate application of legal remedies to a medical problem can only make matters worse and potentially imperil the health of us all.
Richard Restak, a Washington neurologist who has been studying AIDS as a brain related disease, is the author of "The Brain."