thecoolest47 Posted December 18, 2007 Report Share Posted December 18, 2007 Reading the ethical scenarios and responses in threads that we have made in the last few days, I thought it would be neat if we did a bunch of these before interview season started. I guess I'll post one right now, just to get the ball rolling. ==== Mr. Harrison, a 38 year-old homosexual man with erectile dysfunction presented to Dr. Brown for treatment. During the course of his work-up, Mr. Harrison is found to be HIV positive. He has also confided to Dr. Brown that he has multiple sex partners and wants to "do better" <snip> Source: http://www.endo-society.org/ethics/scenarios_2000.cfm What should Dr. Brown do? Link to comment Share on other sites More sharing options...
pedro_md Posted December 20, 2007 Report Share Posted December 20, 2007 Good idea man! This is tough. On one side, you should have some fidelity to the patient and follow his request. You should not descriminate the guy because he is HIV+. But, at the same time, I feel like treating him would be almost the same as putting a loaded-machine gun in his hands, i mean, in his croach... I guess if he were to only have sex with other HIV+ men, then that would be OK. If he were to always wear protection?! Condoms are always ripping and even when you used them properly, they don't provide 100% protection. As a physician, you have an obligation towards your patient, but you also have an obligation towards society. The first thing I would do would be inform the patient of all the risks associated with the treatment and the risks that he would create for his partners and hope he just changes his mind. If he still insisted on the treatment, I personally would deny. You are allowed to deny treatment if you do not agree with the treatment in cause... unless, of course, the patient would be worse off by not being treated, but that CLEARLY isn't the case! DENY! Link to comment Share on other sites More sharing options...
pedro_md Posted December 20, 2007 Report Share Posted December 20, 2007 One more thing: "sexual activity poses a “significant risk of serious bodily harm,” there is a duty on the HIV-positive person to disclose their status." Only if I knew that he followed this principle stated by the Canadian Supreme Court would I treat the patient. But since you will never known, then I would refuse. Do we hand over machine-guns to everyone? How many shootings are there because of improper gun licensing laws, especially in the states?! This is kind of the same.... Link to comment Share on other sites More sharing options...
UserName Posted December 21, 2007 Report Share Posted December 21, 2007 No I think the doctor definitely has to treat the problem regardless of the sexual orientation or what kind of a disease the patient carries. He can perhaps make sure he is fully aware of the dangers and maybe have him sign some legal documents if there were any.. but if treating ED is the doctor's job, then he should do it. it's also the responsibility of the partners of the homosexual man to inquire about his health and HIV status of their partner.. they really owe it to themselves and if i was a doctor i won't refuse treatment for a real and serious problem on the assumption that people out there are going to have sex with this man without protection or knowing exactly what they are getting themselves into.. this is really their own business. i need to inform him of the dangers and legal rules and that's it. Link to comment Share on other sites More sharing options...
UserName Posted December 21, 2007 Report Share Posted December 21, 2007 Keep in mind that not treating him will still not stop him from passing the virus. he can still pass the virus by oral sex for example. and having ED doesn't mean he is completely out.. maybe just not too good.. so really the doctor has not much control over the outcome other than advice (or maybe telling authorities if it seemed the guy wanted to intentionally hurt someone) Link to comment Share on other sites More sharing options...
thecoolest47 Posted December 21, 2007 Author Report Share Posted December 21, 2007 The physician should treat the man for ED... HOWEVER... He should also report the HIV case to proper health care authorities. He should also advise the patient to tell his partners about his condition. If the patient is unwilling to do so, the physician has a DUTY to warn the partners of impending danger. To maintain therapeutic trust, the physician should tell the patient that he has an obligation to do so... Perhaps this will cause the patient to divulge this information to his partners himself. In this situation, societal beneficence is more important than a respect for patient autonomy due to the potential harm that the patient may cause to third parties. The sexual orientation of the patient should not factor into this ethical decision making process. Link to comment Share on other sites More sharing options...
C-Swirsk Posted December 23, 2007 Report Share Posted December 23, 2007 I work in clinical research setting, where we routinely outline the limits of confidentiality to patients before they undergo assessments. Essentially we tell them that information they share with us can be passed within the circle of care and that we have a responsibility to inform the appropriate people/ authorities if a person is a harm to themselves (suicidal) or others, there are signs of child abuse or you they have a communicable disease that could potentially harm others. So in the example you have a duty to ensure that patient’s partners are informed by the patient himself or public health. I agree it would be a good idea to inform the patient of the obligation you have, and when possible outline the limits of confidentiality before assessing the patient. The care of the patient and your obligations as a physician are the same regardless of the patient's sexual orientation. Link to comment Share on other sites More sharing options...
NorthernDude Posted December 26, 2007 Report Share Posted December 26, 2007 It's the responsibility of a dr to treat the medical problems of the patient. In this case, the dr should treat the ED. The fact that the patient is homosexual and has multiple sex partners is not reason for the dr to refuse treatment. Nowhere in the case is it stated that the HIV+ man has unsafe sex. Laws state that legally an HIV+ person must disclose their status to their sexual partners. If this man is doing that, short of attempting to educate the patient on safe sex practices, the dr is stepping over their professional boundaries and making the decision using their own morals as opposed to professional ethics if he refuses to treat the ED. HIV+ patients have a right to live their lives just as the general population does. Obviously this is my personal opinion, however based on research work I've done with HIV+ patients, they already face enough discrimination and are judged, without their doctors playing God. I'm pretty sure that to refuse to treat based on the information in the passage, would be akin to refusing to put a smoker on oxygen as they may then go smoke in someone else's face. Link to comment Share on other sites More sharing options...
NLengr Posted December 31, 2007 Report Share Posted December 31, 2007 From a legal point of view: You are required report new HIV cases to public health. They normally then take over with contact tracing for you. Link to comment Share on other sites More sharing options...
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