Ethics

1 Confidentiality with HIV/AIDS Duty of Confidentiality with HIV/AIDS Ethical Decision Making October 31, 2010 2 Duty of Confidentiality with HIV/AIDS As a healthcare professional there is a duty to maintain patient confidentiality. This is not only an ethical duty but also a legal priority. When a legal priority is broken than the issue can go to court where there is common law and statutory duties that are imposed by different privacy statues. Common law decisions are based upon earlier court rulings in similar cases (Burkhardt &Nathaniel 2008). Statutory law is formal laws that are written and enacted by the federal, state or local legislatures (Burkhardt & Nathaniel 2008). When a patient is diagnosed with HIV/AIDS this can because an ethical dilemma because the healthcare professional is aware that a third party is at risk for contracting the serious infection. Under the NSW Public Health Act 1991, HIV and AIDS are included in a list of schedules medical conditions that must be reported by medical practitioners and laboratories in accordance with legislation (Mair, 2008). The Act must take proper steps to keep patient confidentially and that he or she who suffers from a sexually transmissible condition to inform sexual partners before intercourse takes place. This Act does not say that a healthcare professional is to inform others who will be at risk, such as other healthcare workers who will come in contact with this patient. The NSW Health Records and Information Privacy Act 2002 prohibits the use of personal information for a purpose other than the purpose for which it was collected except if there is a serious and immediate threat to the life, health or safety of the individual or another person or threat to the public health or safety (Mair,2008). This act causes the dilemma of whether or not a healthcare worker is to advise sexual partners of a patient who has HIV/AIDS. 3 In New South Wales Supreme Court in 1999 there was a case that had to deal with a patient who had AIDS and his partner contracting the illness. The issue of a doctors duty to third parties of which could be infected by HIV/AIDS was being discussed. The claim was that the defendant who was the doctor, Dr. Oei, was negligent in failing to give AT an HIV antibody test and failure to recognize his HIV symptoms of his illness. In New South Wales, the Department of Health published a policy directive “HIV Confidentiality: A guide to legal Requirements.” This policy allows the Department to specify who information can be given to regarding a patients HIV status (Mair,2008). Basically disclosure is limited to healthcare professionals that are involved in the patient care. AT proved to be HIV positive and BT who was married to him after they had already lived together and been sexually involved also had contracted HIV. AT went to the doctor on November 26, 1991 with complaints of a sore throat, fever and a cough. A general history found lymphadenopathy, and viral laryngotrachitis and pharyngitis. On January 28,, 1992 AT proceeded to the Dr. Oei’s office. He had a fever, urinary symptoms, bilateral pain and fatigue. Before examination he had a coated tongue, lypmhadenopathy, abdominal tenderness and hepatomegaly. A probable diagnosis of appendicitis and hepatitis were made and tests were ordered. The next day AT returned still not feeling well and had a fever. One of the tests led to a probable diagnosis of a urinary tract infection. They had a consultation on February 1, 1992 Dr. Oei told AT that he could have gotten hepatitis from unprotected sex. AT was handed two pamphlets about hepatitis D and a third one on safe practices which he was also counseled on. AT came back on February 10, 1992, feeling a little better on this day. One March 4, 1992 AT came back once again and reported he felt feverish, had chills, aches and pains. On March 19, 1992 he returned and stated he felt better. The defendant ordered a full blood count and liver 4 function test. December 1, 1992 was AT’s complained of being irritable, a headache, fever, aches and pains. He was diagnosed with a viral illness and ordered further tests. January 15, AT had bilateral ringing of the ears, abdominal pain and constipation. Ear wax was noted in both ears and an abdominal tenderness. January 22, 1993, he was feeling better and the barium enema results were in he had splenomegaly. A CAT scan showed hepatosplenomegaly and possible cirrhosis of the liver. ATs last visit to the defendant was on January 30, 1993. BT met AT around March of 1992 while AT was under the care of the defendant. AT told BT he had contracted hepatitis B, he also shared that after his separation he had visited a brothel and had sexual contact with an illegal immigrant. These two began to build a relationship, they started out using condoms and then they stopped using condoms. In June of 1992 BT consulted her doctor and told him her partner had hepatitis B. In June and July BT’s doctor ordered her to have a series of vaccinations against hepatitis and advised her to use condoms. They continued to have unprotected sexual intercourse. February 1993, BT became ill with a headache, and couldn’t move her jaw, a high temperature, watery eyes, sore throat, anorexia, weak extremities. She saw her doctor and he suspected tonsillitis and gave her antibiotics. In January 1994 BT’s doctor ordered blood tests and an HIV antibody test. About March 8, 1994, BT was told her test was positive for HIV; she did not inform AT on her results as she was concerned he might not marry her if he knew. October 1994, AT was diagnosed with HIV and he suggested his wife BT to be tested. AT died on February 26, not from HIV or AIDS. 5 The ethical dilemma that arises is the duty to avoid harm which is the principle nonmaleficence, also the problem of benefitting the patients comes into play which is beneficence. The defendant owed AT a duty of care as his patient however he owed BT as his patient’s sexual partner a duty of care. It was argued that he did owe her the duty of care by diagnosing AT’s infection and giving the proper counseling to him and to advise him to take an HIV test. BT is within the group of people who are at risk for injury from this illness. The author of this paper thinks that the defendant owed AT the duty of care but not BT. He should of given AT the proper tests and diagnosed him than given him the proper information needed and told him to tell his wife and for her to get tested. There is no reason it went on for as long as it went on for. The author’s principles are based on beneficence and nonmaleficence. The patient is to have no harm and to be benefitted. AT was not given ether of those. To solve the problem AT should have been given a HIV antibody test when symptoms of HIV were showing such as splenomegaly, the tongue coating, fatigue, lymphadenopathy and hepatomegaly. This would have caught the illness earlier and possibly helped it from spreading to his wife. This would be the right thing to do, because than it would be caught early enough to have it controlled and not spread as much as it may be if isn’t caught. In conclusion AT was not treated with proper care. He was caused more harm than he should of gone through and BT caught HIV when possibly that could have been prevented. AT died before his case was over. The judge disclosed that the defendant owed BT a duty of care because there was no conflict between the duty owed by the defendant to AT and BT, she was a sexual partner of AT. It is obvious that is AT was HIV positive it would be passed to his sexual 6 partner. AT was unaware of his HIV status until it was too late. The defendant’s knowledge and training equipped him to identify the risk that AT had contracted HIV. 7 Burkhardt, M. & Nathaniel, A. (2008). Ethics & Issues In Contemporary Nursing, 3rd Edition. Delmar Cengage Learning. Clifton Park, NY. Mair, J. (2008). Duty of confidentiality and hiv/aids. Health information management journal, 37(3),