Ethical scenario

Issue:

Your patient is known to have a sexually transmitted disease that can be life threatening and he has not wanted this disclosed to anyone. One day his new partner shows up to visit, and it becomes known to you that he does not know of his partner's HIV status.

What should I do?This scenario represents conflicting moral duties- our duty to protect the privacy of our patients and the equally compelling duty to warn others of risk. Confidentiality is protected by law and we as health care provides also know it forms the basis of trust, which is central to a therapeutic relationship.

Our concerns are often centered around: Is the new partner HIV positive? He should know- in order to seek treatment now if he needs it, or in the future to avoid risks. What also feeds into our moral indignation is the fact that we uphold the importance of truth in relationships- and we can be made to feel complicit with his act if we remain silent.

What did we do?When an ethics referral was made for this case and it was determined that this patient had a history with our hospital. The Nurse and Social Worker who were previously involved spoke with the patient and they subsequently informed the Department of Public Health.

The new partner is not our patient – and the duty to inform is properly designated to Public Health under law. They will inform him that he may have been exposed to HIV and recommend testing. Public Health, however, will not inform him of the source of potential exposure – (he may figure it out himself) – but at least some measure was taken to protect the patient's confidentiality.

If you have a question about this case, or have another scenario that you'd like discussed you can email your questions to blair.henry@sunnybrook.ca