The patient is engaged and trying to get his fiance pregnant. Doctors, when faced with this dilemma have to abide by the laws that govern the patients right to privacy but where does one draw the line? This patient, assuming he has not informed his fiance puts her at risk of contacting this incurable disease and furthermore, also puts the child, when conceived, at risk of also being born with aids. So now we have three potential patients whose lives will be drastically changed because of what the patient may deem as embarrassing by telling the truth.
The patient is also being selfish and ultimately handing a death sentence down to at least two other people. Where is the fairness in this and where are the ethics in this? Why must such a deadly disease be kept quiet when innocent lives are at stake? The laws surrounding this ethical and moral dilemma need to be addressed in a different manner, notwithstanding the patient rights under such conditions. Where it is the duty to keep private the patient records the duty should also be extended to help protect other lives as the Hippocratic Oath states.
Never to do deliberate harm to anyone for anyone elses interest. (Hippocratic Oath #3 of classical version). In withholding this vital information from this patients spouse, not only the patient, but now the doctor has put forth the effort to cause deliberate harm to others solely based upon the interest of one. This is tantamount to conspiracy which is a crime in itself. What of the moral turpitude of doctors with respect to saving the lives of others.
With this law of complete patient confidentiality, doctors are unable to practice complete morality as their oath states they should. Furthermore, the Hippocratic oath states not to let the world know of the patients problem and there is never a case where the world needs to know but there is the times where a doctor should be allowed to disclose relevant information to specific parties. The confidentiality laws that bind seem to be in direct opposition to much of a doctor Hippocratic Oath.
The laws should be changed to reflect partner notification. If partner notification is allowed then that partner has a much better chance at early detection and better alternatives for necessary medical help, versus no notification and up to several years of living, unknown, with a deadly disease. Partner notification can also change the minds of people wanting to have children and thus not interfering in a childs life, in a negative manner. This notification is for the greater good.
In some states, if a person is to spit upon anyone and then it is determined that that person who spat has aids then this can be cause enough to charge this person with a criminal charge of homicide or murder, depending upon the intention of the person. Withholding information of a patients status when aids is involved and when there is a significant other, especially trying to have a child then this would seem just as voluntary as spitting if not more so because the doctor knew.
I believe notification should be allowed in special circumstances and if notification is not adhered to then not only should the patient, but also the doctor be charged with a criminal act. I do believe in the best interest of patient confidentiality that the patient be given a set amount of time such as 30 days, by law to notify specific people such as their partner or their children. I think this notification should include those that are in the constant and immediate proximity of the patients household or intended household.
This would mean the mother or a friend if they lived within the same house. Standards of moral humanity should demand this. While confidentiality means just that, I agree with Kathleen Toomey about index patient counseling to get the patient to self notify or ask for assistance in notifying their partner or other relative people. Many people who do have HIV tend to be more embarrassed in respects of informing a person that they are infected and may have infected someone else. Sometimes the assistance of a doctor can help tremendously.
Now while there is the self notification option which does not violate confidentiality, the law should state the upon the time of notice that a person finds that they are infected that they have to either notify or the doctor will notify for them. This way not only gives the patient a choice with alternatives but continues to go forward in an ethical manner of keeping others safe. If these confidentiality issues cannot be approached and dealt with then where does that leave the Hippocratic Oath?
Would this then mean that the oath is worthless and that the principles really mean nothing? It is understood that the oath is meant to be for doctors and their patients only but at the same time the wording of the oath does not correlate with the current laws so either way, there is a technical breaking of either the oath or of the law or in some cases both. In the same realm, the AMAs code of medical ethics is not legally binding even though the judicial system will violate a doctor based upon the AMAs ethical code.
Further it is said where a patient cannot trust the doctor because of confidential issues being discussed that then this also inhibits the doctors ability to heal as the patient may not divulge the full extent of the issues; with this I say, quit being so selfish, just because a doctor may have divulged an important piece of information, to help save a life, does not mean that this doctor cannot satisfactorily help the patient.
This has nothing to do with the doctor but the patient themselves and their inability to be honest in a moment where the lack of affects other people in an adverse way. Why should confidentiality laws protect that? The duty of confidentiality is not absolute. Doctors may divulge or disclose personal information, against the patients will, under very limited circumstances. (Enotes-Doctor Patient Confidentiality-2008).
Couple this statement with the duty to warn where a doctor may release information to help protect the safety of the public, this should be clear and convincing that doctors should not receive any administrative negative reactions from disclosure over the HIV virus or any other form of communicable disease. If doctors cannot divulge this information without negative repercussions then how does this relate to contacting the Center for Disease Control?
It is assumed, that doctors can contact this center but in doing so, no matter how quiet they may try to be, it is inevitable that the information will become public knowledge about the patient. In a further incident where the doctor could not divulge patient information to a biological family about the admittance of their patient into a psychiatric facility it was later found that the patient in the facility did not need to be there and that his spouse did indeed lie to several doctors to keep him there.
Had the doctor been allowed to divulge this information then the time wasted in the facility would not happen. As it was, the patient was constantly drugged and misdiagnosed as a schizophrenic paranoid when in fact the whole time he was telling the truth. A lawsuit in a federal court is being filed due to the extenuating circumstances. The only reason why the spouse told the doctors what she did was to keep the family separated. (CL Tapken. 2008) So it is plain, that despite the confidentiality laws that they are actually in an archaic form and not always for the good of anyone when information is not divulged.
The recognition of determining what information to divulge, to whom and when, is the challenge that must be faced. There are times when confidentiality is ok as in cases of those who have cancer, in general are sick or where their ailment does not affect the immediate and long term health of another. Communicable diseases, the example of driving from a hospital after being treated and intoxicated by whatever form, the threat to harm ones self or another should all be divulged for the safety of others. The confidentiality issue should, by far, include this preamble of safety for others as well.