AIDS and Confidentiality

Does an AIDS patient have rights to FULL confidentiality? Meaning being does an AIDS patient have the right to deny this information to their spouse and/or sexual partner? Even greater, does a physician have an obligation to inform the partner? A lot of controversy is currently occurring due to this topic.

In a recent case, Mr. B., a twenty-eight year old prominent member of the city council was recently tested positive for HIV antibodies (the virus that causes AIDS). He currently has no symptoms, so it is not yet obvious to anyone but him and his doctor that he is infected. He was informed that he had between a five and thirty-five percent chance of developing AIDS in the next five years. Mr. B. was told that it was very possible to spread this disease through sexual contact, needles, or donating blood - among various other methods. He was counseled to take preventative measures from spreading the virus.

Later, Mr. B. revealed that he was bisexual and that he probably contacted the virus through a homosexual encounter. He is also engaged (to a woman). He then refused to tell his fianc e because it could ruin his marriage plans.

Our ethical dilemma is this: Should the doctor inform the fianc e? Should he protect the doctor/patient confidentiality? What if Mr. B. had an affair with the physician s daughter. Should he break the privilege then? What about the other sexual partners Mr. B. has had sex with? Ho far should confidentiality be taken in this case? IF confidentiality is a prima facie duty, what would constitute the overriding of confidentiality?

First off, the most important question is whether or not this is a prima facie situation. My answer is yes. There are certain cases (which are the majority) where the patient should be granted full confidentiality. Patients could lose jobs, face public outcast, and become the subject of strong prejudice if certain people knew about their situation. Obviously, it isn t the business of the person down the street if they have no contact with one another.

This happens to be one of those cases where the overriding of confidentiality should be undertaken. As a doctor, the physician has an obligation to protect the health of the people if possible. He knows Mr. B. has no intention of telling his fianc e of his situation, putting her at great risk especially if they decide to have a family (in which even more people, being the children, would be subjected to this disease). This type of disregard for doctor/patient confidentiality has been legally upheld in California. Currently, they have in place the Confidentiality of Medical Information Act that makes exceptions to breaking this agreement in cases where the health or safety of an individual are at risk namely partner notification programs. This type of exception has been made in other types of situations too. This type of information has legally been allowed to be released for mental patients showing hostile behavior toward a specific person (AIDS Law Manual, 1999).

Today, in some cases, reporting of infectious diseases in certain situations is required of physicians by law. The United States Supreme Court even stated that patients do NOT have a right to informational privacy with regard to treatment records (Winslade, 1995). Indeed, patient confidentiality rights are diminishing in order to protect others at risk.

As far as the doctor s daughter is concerned, I believe that she falls under the same category as the fianc e, as would anyone Mr. B. has intimate contact with all for the same reasons. These people have a right to know in order to be tested for the HIV virus. It isn t fair to keep them in the dark about their situation and let them run the risk of finding out way too late.

In another light, if the physician chooses to not tell anyone, that is also his legal right. In a recent court ruling in San Antonio, a clinic was cleared of all responsibility when sued by Ms. Linda Garcia for not informing her that her husband was infected before she married him. Unfortunately for her, Texas law does not include fianc es or other sexual partners in their partner notification program. Fortunately for her, he test came up negative (Elizondo Jr, 1990).

All in all, a patient s confidentiality is protected thoroughly. In very few cases is it compromised. Unfortunately, the most controversy arises out of the smallest number of cases. Should the doctor notify any of the parties talked about previously? Legally and ethically, it s his call. Luckily for them, physicians have the law on their side no matter what in most cases here.

Works Cited:

Elizondo Jr., Juan. Clinic had no duty in AIDS confidentiality case, court rules. Associated Press. http://www.reprternews.com/texas/aids0314.html.

AIDS Law Manual. General Medical Records Confidentiality Statutes. http://www.alrp.org/LM11genmed.html.

Weslade, William J. Encyclopedia of Bioehtics. Simon and Schuster Macmillan. New York. 1995. P. 456.