Ethics: Patient Confidentiality vs Harm to Others

[2010hope]

I wanted input for how you would proceed with this situation:

 

You have a patient that you've just diagnosed with AIDS. He doesn't want to tell his wife. What do you do if he refuses to inform his wife?

 

 

My questions are:

 

What are the doctor's legal obligations to prevent the spread of disease?

Can you break patient confidentiality in this case?

Are AIDS patients required by law to inform others that they are sexually active with about their status?

 

Thanks!

[astrogirl]

Check this out:

http://www.aidscalgary.org/files/publications/Disclosure.pdf

[future_doc]

Very comprehensive, astrogirl. Thanks for sharing!

[Starling]

I think in general you're supposed to disclose if the patient poses imminent and serious risk to someone, and that would apply in this case. I'd first of all try to get the guy to change his mind and offer ways of making it easier for him (like maybe get them both to come in). But if he still refused I'd tell him I'm required to notify his wife.

[Edge]

Reading about this, there a question that comes to mind, while HIV is reportable, are other infectious diseases reportable under the same standards as HIV/AIDS such as TB or Meningitis, H1N1, and other STDs such as Gonnorea, siphyllis, or herpes?

[nosuperman]

Check this out:

http://www.aidscalgary.org/files/publications/Disclosure.pdf

 

Nice!

 

From the article:

 

"Canadian law recognizes the duty of healthcare professionals to maintain patient confidentiality. In most cases, it is considered professional misconduct for a healthcare professional to disclose patient information without consent.

 

However, legal and professional bodies have recognized that confidentiality must give way in certain circumstances

to protection of the public interest.

 

For example, the Canadian Medical Association advises physicians that disclosure of a patient’s HIV status to a

current sexual partner may not be unethical when specific criteria are met (Elliot, 1999):

 

• The partner is at risk of infection with HIV and has no other reasonable means of knowing;
  
• The patient has refused to inform their sexual partner;
  
• The patient will not allow a physician to inform the sexual partner on the patient’s behalf;
  
• The physician has informed the patient of his or her intent to disclose the HIV status to the sexual partner.
  

 

According to the CMA and the Canadian Association of Social Workers, the healthcare professional should counsel

the patient on possible barriers to risk reduction and should attempt to motivate the patient to disclose their HIV

status or cease unsafe behaviours before reporting the situation to public health authorities (Elliot, 1999)."

[nosuperman]

Reading about this, there a question that comes to mind, while HIV is reportable, are other infectious diseases reportable under the same standards as HIV/AIDS such as TB or Meningitis, H1N1, and other STDs such as Gonnorea, siphyllis, or herpes?

 

Intuitively I'd think not. When a person has HIV/AIDS, they have a legal duty to inform all potential partners. [R. v. Cuerrier ][Carl Leone] This isn't the case with STDs, or other relatively non-lethal bacterial and viral infections. A lot of the time its patient confidentiality that allows patients to even have these issues examined and treated so doing away with it altogether would probably have overall adverse effects. That being said I'm sure there are plenty of questionable conditions that toe the line between the definitions used in the HIV/AIDs legislature... and I'd hate to be the physician wading through that mess.

 

Something like meningitis I think has to be reported (I'm not a med student so can't be sure) to the local health unit but it wouldn't be the sort of ethical issue you'd run into with HIV/AIDS or STDs because the patient is going to be hospitalized until they're non contagious.

[Mark Peter]

If I will be a doctor of such patient and I have to face such scenario then I will definitely tell his wife about his disease and I will also suggest her some precautions.

[switcheroo]

Intuitively I'd think not. When a person has HIV/AIDS, they have a legal duty to inform all potential partners. [R. v. Cuerrier ][Carl Leone] This isn't the case with STDs, or other relatively non-lethal bacterial and viral infections. A lot of the time its patient confidentiality that allows patients to even have these issues examined and treated so doing away with it altogether would probably have overall adverse effects. That being said I'm sure there are plenty of questionable conditions that toe the line between the definitions used in the HIV/AIDs legislature... and I'd hate to be the physician wading through that mess.

 

Something like meningitis I think has to be reported (I'm not a med student so can't be sure) to the local health unit but it wouldn't be the sort of ethical issue you'd run into with HIV/AIDS or STDs because the patient is going to be hospitalized until they're non contagious.

 

Around my parts, many STDs are reportable. All past at-risk sexual partners will be informed by the public health office if the infected partner refuses to disclose. Really, this takes the ethical dilemma off the physician's shoulders, because we have no say in whether or not the partner is informed.

[bloh]

You must report HIV. In fact, if the patient doesn't say so to his/her sexual partners he will be charged criminally. This has prompted some people to forgo HIV testing because if one doesn't know they are positive and they spread it, they cannot be charged. Thus some have argued for abolishing the criminal aspect of HIV spread in hope that it would entice more people to actually undergo testing and get treatment.

 

As for the question regarding gonorrhea...I'm not sure about the legality. But the last time I contracted it, the nurse at the clinic encouraged me to let my recent sexual partners know so they can get tested as well. However, he mentioned no legal ramifications to me if I did not.

[Ollie]

Reading about this, there a question that comes to mind, while HIV is reportable, are other infectious diseases reportable under the same standards as HIV/AIDS such as TB or Meningitis, H1N1, and other STDs such as Gonnorea, siphyllis, or herpes?

Chlamydia, gonorrhea and syphillis are all reportable diseases (herpes is not). A positive test is reported to public health and contact tracing is done (usually partners from the last 3-6 months). The person can either inform the contacts themselves, or public health will call them and tell them that they need to go get tested. TB is also reportable and there are specific protocols for TB treatment and contact tracing. I don't think meningitis is, but it's not that common, so when there is a case they will usually put out an advisory for people who may have been in contact to go get vaccinated. Influenza is not reportable, but public health dose track numbers of cases based on postive swabs.

[nosuperman]

Chlamydia, gonorrhea and syphillis are all reportable diseases (herpes is not). A positive test is reported to public health and contact tracing is done (usually partners from the last 3-6 months). The person can either inform the contacts themselves, or public health will call them and tell them that they need to go get tested. TB is also reportable and there are specific protocols for TB treatment and contact tracing. I don't think meningitis is, but it's not that common, so when there is a case they will usually put out an advisory for people who may have been in contact to go get vaccinated. Influenza is not reportable, but public health dose track numbers of cases based on postive swabs.

 

Thanks for the info! Is failing to report chlamydia, gonorrhea and syphilis considered a crime in the same way that HIV/AIDs is?

[Maxime]

In Quebec, STDs are reportable (MADO), but HIV is not, unless you have received/given blood, organs or tissues. It used to be reportable, but laws changed maybe 5-6 years ago.

[A-Stark]

Here's the list in NS: http://www.gov.ns.ca/hpp/publications/06026_It'stheLawPoster_Dec09_En.pdf