In general terms, law is expected to ensure social justice to protect society while ensuring order, support for fundamental human rights and, at the same time, preserve and protect the public good. Ethics on the other hand is a series of guidelines derived for a specific group to ensure their correct and good behaviour in respect of their professions or workplace. It is related to colleagues and other persons that they come in contact with during the performance of their (professional/ workplace) duties and activities. Since an element of good versus bad is involved, ethics is associated with morality. Thus, an action may be perfectly legal and yet be considered immoral by a certain group of people. Ethics, in very simple terms, is a moral code of contact.

It might seem that overall, 'medical ethics' conveys that it is the power conferred to cure and control. It is desirable to replace the word 'power' with the word 'knowledge'. All medical, paramedical, technical, nursing and other staff providing health care are called health care workers (HCWs). According to Dr. Eustace J.de Souza, Executive Director, F.I.A.M.C.,
Bio-medical Ethics Centre, Bombay, every HCW should follow three primary ethics.
*    The ethics of LOVE
*    The ethics of TRUTH
*    The ethics of DO NO HARM.

To heal the sick, alleviate suffering, promote health and prevent the spread of the disease are components of the first. HCWs should maintain strict confidentiality regarding patients illnesses and informa- tion imparted in confidence during consultancy. At the same time, they should respect patients rights and give the correct information about their health status. The 'do no harm' ethic is obviously important. It should also include taking all sensible safety precautions to prevent the spread of infection.

A basic concept is developed in HIV prevention, that is called 'universal precaution.' It is neither practical nor ethical to test every single patient for HIV. Blood and sexual fluids are the major vehicles carrying the virus. Therefore, the best policy for HCWs is to handle every single blood specimen (sexual fluids if handled) with care and precautions as if it were infectious. This means that a habit needs to be inculcated so as to control the spread of the virus.

Patients rights were mentioned earlier. They also have obliga-tions. A very important ethic for them is 'do no harm'. They should not perform any negligent act that can spread HIV/AIDS to others. In fact, Section 269 of the Indian Penal Code has a provision for negligent act likely to spread infection of disease dangerous to life.

This is punishable with imprison- ment extending to six months, a fine or both. This Section was provided during the British rule to protect against plague, cholera, etc. It is understood that this was also implemented. There is also a Section 270 which mentions 'malignant act likely to spread infection of disease dangerous to life' with imprisonment of two years or a fine or with both. The three basic tenets of ethics should also be applicable to patients spouses, family members, community and society. There is a need for provision for anti-discrimination. No person should be discriminated in education, employment, housing, travel or any community services or benefits on the ground of his or her HIV positive status. Here too, dissemination of information and imparting correct knowledge may be more beneficial than a legislative measure alone which is implemented infrequently.

The one legislative measure urgently needing enforcement concerns mandatory screening of all blood donors of HIV and hepatitis B virus, irrespective of whether they belong to the category of professional/paid or voluntary donors. This intro- duces an ethical issue regarding 'informed consent' of these donors. It should not be difficult to ensure that every donor is made aware that HIV screening will be done routinely before the blood can be accepted for transfusion. The condition for compulsory testing should be incorporated while giving licences to all blood banks including the vast number of small, private ones.

There should be appropriate and, if necessary, separate legislation regard- ing manufacture of blood products including mandatory testing of their paid donors. At the same time, techni- cal recommendations made by the national authority should be scientifi- cally and technically sound and equiva- lent to the international standards. There is also a need to encourage and support manufacture of indigenous products of good standard quality. Many of these are required continuously for the survival of patients suffering from blood disorders, such as haemophilia and thalassaemia.

Dilemmas arise in blood banks and hospital services. In blood banks, the ethics regarding disclosure of HIV status to the respective blood donors is, as a rule, not followed. The reason is that a single ELISA reactive blood unit is descarded without confirmation. In views of this somewhat incomplete testing (with the main objective of safety of recipients in mind) no donor is informed for the fear that the result might be 'false positive' and may create unnecessary panic in a truly uninfected individual. If, however, the person is in fact infected, but is not informed, he/she may continue unsafe sexual practices and may add to the chain of transmission. 'To tell or not to tell' is indeed a dilemma. If a patient refuses to inform his/her spouse of his/her HIV-seropositive status, should the doctor do so, thus breaking 'confidentiality' or, should he remain silent and thus place the other partner at risk?

Yet another dilemma in hospital emergency services confront doctors. After large-scale accidents or due to emergency requirements to treat severe bleeding (during delivery or some surgery), unexpectedly large number of blood units may be required. A situation may arise leaving no time for screening of blood donors. Should a doctor give unscreened blood with a potential danger to the recipent, or should he play safe and refrain from transfusion of unscreened blood? What order of priority should he/she allot between requirements of those who are HIV-infected and those who are not? This and many such dilemmas will increasingly face our doctors who will have to play God.