Interactive Case
for January-February, 2000 (closed to comments)
You learn that one of your patients, a 35 year old man, is positive
for the HIV virus. He has not yet developed AIDS. He asks you
not to tell his wife because he is afraid that it would break
up his marriage. The man's wife is your patient too. What should
you do?
Dear Students,
Thank you for your responses to the ethics discussion case
for January/February 2000. We received answers from 57 students
representing 3 schools. Here is the breakdown of your opinions:
8 students: Do not tell the wife.
16 students: Do not tell the wife but try to convince the husband
to do so.
15 students: Tell the wife.
9 students: Tell the wife if you cannot convince the husband to
do so.
9 students: Try to convince the husband to tell his wife or get
them both together to discuss the situation.
Keep reading and you will find faculty comments regarding this
case. We hope you find them interesting.
The next interactive ethics problem will be posted in October,
2000. Hope to hear from you again.
|
Schools |
# of Responses |
|
Sam Houston High School |
20 |
|
Lamar High School |
6 |
|
Garland High School |
1 |
Faculty Comments
First Opinion:
This is a very tough case in my view. It involves, as the students'
responses note, pitting the physician's duty to confidentiality
towards one patient against his duty to "do no harm"
towards another. Texas law permits a physician to disclose the
HIV test results to the spouse without the patient's permission,
but the word "permit" suggests that the doctor should
use his/her judgment in disclosing the results - it doesn't say
"must" disclose the results. I would handle the case
this way.
First, I would give the man a short period of time to think
through this issue - he has an emotional shock to contend with,
both his own HIV status and the possibility that he already has
infected his wife. His refusal may be a "denial" mechanism
to cope with this emotional shock, and a response that will not
necessarily persist long.
Second, I would inform the man of my conflicting duties to
protect the confidentiality of his test result AND to inform his
wife. This would be a way to have a dialogue with the man about
the issues, and to find out his reasons for not wanting to tell
his wife.
Third, the only way I can truly respect both physician duties
is by persuading the man to tell the wife himself. While "persuasion"
is not something I like to do with patients, I find it a much
lesser wrong than the other two choices. I would address his fears
about telling her, but point out that she will very likely find
out herself, perhaps in response to catastrophic circumstances.
If the above measures fail and the man still wants to keep
his HIV status a secret from his wife, then what? Here are the
choices.
(1) Maintain the confidence and permit the woman the chance
of
infection but encourage the husband to practice safe sex with
his wife. [It think this is a bad option because the wife is still
at risk, and my confidence in her safety would be low.]
(2) Ask the wife to consent to an HIV test because "I
have reason to believe" you might be infected, and hope she
agrees.
[This is perhaps a little better, but my informing her about her
risk without discussing the reasons for it, and what she could
do to protect herself, seems cruel at best and harmful at worst.]
(3) Advise the man that following Texas law, I was going to
disclose the HIV status to his wife since my duty to them was
equal, but the risk to her (potentially lethal infection) was
greater than the risk to him (exposure to marital problems).
[This would be my choice.]
Second Opinion:
In the case presented, the question centers on the balance
between a physician's duty to protect patient privacy and the
duty to warn others that might be harmed. In this situation, most
physicians would stress to the husband that it is extremely important
for him to notify his wife of his HIV status.
By the very nature of the intimate relationship that is marriage,
the wife deserves to be protected. First, she deserves to be aware
of anything that might threaten her own health. Second, a relationship
of trust and intimacy should be based on a free and open exchange
between those involved. The initial thrust of the doctor's ongoing
discussions with the husband should be on giving him the opportunity
to tell his wife on his own terms. As a patient, his privacy should
be respected, but he needs to be aware of the gravity of the situation.
Often, physicians will negotiate a timetable and offer to be involved
in any way that would help the husband notify his wife. At the
outset the patient should be told that if he doesn't tell his
wife, you may feel compelled to do so. This may seem heavy-handed,
but the husband needs to know of the physician's duty to warn.
In Texas, the Department of Health operates a Partner Notification
Program. Physicians can activate this program when patients are
unable to tell their partners and a health risk exists. If such
a process did not exist, then the physician should make a good
faith effort to contact the partner.
Certainly this is a very difficult issue, but most patients will
understand if you respect their situation and work with them to
determine a timetable.
Student Comments:
02/18/00
No, the doctor should not tell the wife. A doctor should only
keep a business relationship with his
patients. By him telling the man's wife, he not only destroys
a marriage but gets himself involved in an
altercation. A doctor who is truly a professional should care
about his patients but not get involved in
any other aspect of their lives besides medical.
Jamechia, 11th Grade
Sam Houston High School
Anatomy & Physiology
02/18/00
I would first try to get the patient to tell his wife, and then
if he didn't I would tell his wife. This is only out of protection
for his wife, and so that it won't be such a shock to her if anything
should happen to him. It might even help him to talk to her about
anything he may be feeling.
Rebecca, 12th grade
Sam Houston High School
Anatomy & Physiology
02/18/00
I would not tell the patients wife, I would try to get him to
tell her first. If that doesn't work I would
probably get them to together to discuss the matter at hand.
Jesse, 12th grade
Sam Houston High School
Anatomy & Physiology
02/18/00
I think that the doctor should try to persuade the man to tell
his wife the truth before harming her if she hasn't already contracted
the virus. If the man refuses then the doctor should try to set
up a counseling session for the couple to discuss what is going
on. If the doctor really feels that he
should tell the wife because it could risk her health and her
life for that matter, then he should tell her the truth. I don't
think that keeping it a secret is really going to solve anything.
Sarah, 9th grade
Sam Houston High School
Honors Biology
02/16/00
I am writing in response to the ethics question about the HIV
patient and wether or not to tell his wife. I believe that it
should be the husband's responsibility to tell his wife about
his illness. However, if he is firm in his belief that she will
leave him and does not tell her, I would feel that as her doctor
it would be my responsibility to tell her for her own saftey.
If she is not informed, then it is almost certain that she will
unknowingly contract this illness which would eventually lead
to her death. That would be unfair to her, in that she could have
avoided death if she had only been informed.
Danelle, 10th grade
Sam Houston High School
Honors Biology
02/16/00
We would not tell the wife that he was HIV positive. We feel that
it is his place to tell her and that we should not be the ones
to do that. We would strongly try to convince him to tell her.
We would tell him that it is a bad decision not to tell her.
Ashley, Samina, Tai, and Fred, 9th & 10 grade
Sam Houston High School
Honors Biology
02/16/00
If I was a doctor in this situation, I would tell his wife because
both of them are my patients and I would be concerned with her
safety as well as his.
J.J., 9th grade
Sam Houston High School
Honors Biology I
02/16/00
In response to your question, we would have a talk to both of
the patients, and let them know that a relationship should not
be based on your health, but rather on your love for each other.
Wyatt, Q.N., and Anthony, 9th grade
Sam Houston High School
Honors Biology I
02/16/00
We would tell his wife. We would tell her because there may be
a possible chance that she may be infected with the HIV virus.
We would tell her for her own safety so she could go get tested.
The earlier it is detected, the more effective the treatments
may be.
A.C., E.E., and S.R., 9th, 10th, & 11th
Sam Houston High School
Honors Biology
02/16/00
S.M. said "The doctor should consult both patients and try
to convince him, the man with HIV, to talk to his wife."
Dannica Smith said " The doctor should speak to both patients,
and tell the man's wife because her life could be in danger. This
could effect their sexual life, and there's a possibility that
she might have contracted HIV." V.M. said "The doctor
should talk to his patient, the man with HIV, and have him talk
to his wife and break the news to her. If he refuses, the doctor
should then proceed to test his wife for the virus." Q.P.
said "I think that the doctor should respect his patient's
wishes and keep the news to himself. This doesn't mean he shouldn't
do anything, he could suggest having the wife tested, or marriage
counseling. With this he could help the man to come up with the
courage and tell his wife."
9th & 10th grade
Sam Houston High School
02/15/00
In response to the question aboout the patient with HIV my opininion
stands that it is a doctors responsibility to keep a patients
information completely confidential. If he, himself did not eventually
tell his wife, I would be forced to tell her by my conscious,
not as a doctor, but as a friend.
Chelsea, 9th grade
Sam Houston High School
02/15/00
The doctor should let the woman know that her life is in danger.
Even though the husband asked the doctor not to, it is to the
wife's benefit that she is told. If she is not told soon, she
might still be sleeping with her husband and she could get HIV
too. If she was to get HIV then she would wonder how she got it
then she would find out that her husband has HIV. By finding out
this way, it could cause her emotional stess and eventually lead
to depression, or their marriage would be destroyed. So it is
best that she is told so her life would be in less danger, and
she would know ahead of
time to help prevent this situation.
Keila, Krystal, Rayla, Nick, and Arain, 9th & 10th grade
Sam Houston High School
Honors Biology
02/15/00
We would tell him that he needs to tell his wife because she has
a right to know. We would not tell her ourselves due to a law
prohibiting and keeping all medical information confidential unless
otherwise directed. Also, we are not to get emotionally involved
with patients. We would tell the man that if he doesn't tell his
wife that he is already putting his marriage in jeopardy because
she would be upset that he didn't tell her himself. However, if
he does not tell his wife, we would call her in for an appointment
and tell her that we think it may be a good idea if she were tested.
Ashley, Jeremy, Armond, Johnny, and Bao, 9th & 10th grade
Sam Houston High School
Honors Biology
02/15/00
We believe that in this type of situation, since the husband has
HIV, we should test the wife (spouse) to see if she has the virus.
We would only do this after we had obtained the husband's consent.
If he does give us his consent, then we as doctors, would arrange
to counsel the couple together. In the session we would explain
to them the situation and what we would do, like taking blood
tests, to act on this in the best interests of the couple.
Tia, Amber, Urecha, 9th &10th grade
Sam Houston High School
Biology 1 Honors, 4th Period
02/14/00
No, he should not tell her because a doctor is suppose to keep
confidentiality of his/her patients. If the man loves his wife,
he would not do such a thing to infect his wife with the HIV.
He is a man on the verge of death, so he should be left in happiness.
This is a personal business, so if he wants to, he should tell
his wife himself.
Tam and group, 9th grade
Sam Houston High School
Honors Biology-1st period
02/14/00
We think the guy with HIV should tell his wife about it since
he's putting her health in danger also. The doctor should try
to convince him to tell his wife himself but if he does not agree
to do so, the doctor should tell her without the patient's consent
because his concern is for the woman's health. If their marriage
is strong to begin with, the husband will be concerned with his
wife's health and if the wife loves her husband unconditionally,
than she'll stand by him no matter what.
Michelle and group, 11th grade
Sam Houston High School
Honors Biology
02/14/00
If I were in the position given, I would most likely encourage
the patient to inform his wife. I wouldn't tell his wife without
his consent, but I would expect him to make the right decision.
S.M., S.C., V.H., A.F., and A.B., 9th & 10th grade
Sam Houston High School
Honors Biology I
02/14/00
Yes, you should tell her, because she needs to be treated immediately.
She could already have contracted a deadly and potent disease.
Since she is your patient, it is in her best interest to be told
as soon as possible.
Mimi, Glory, and Rebecca
Sam Houston High School
Honors Biology
02/14/00
With the confidentiality information law you can't tell his wife
his personal information, but I would urge him to tell her and
I would also try to encourage her to take the HIV/AIDS test.
K.G., 10th grade
Sam Houston High School
Honors Biology
02/14/00
As a doctor I would tell his wife because she could be in danger
of being HIV positive also.
D.P., 9th grade
Sam Houston High School
Honors Biology
02/03/00
The doctor in this situation has a moral obligation to inform
this man's wife or to persuade the man to inform his wife. Although
the doctor in most cases has a professional responsibility to
keep his patients records confidential, in this case the doctor
patient confidentiality doesn't apply because the man's wife would
be in danger of contracting a disease that can be prevented if
she knew of her husband's condition.
B.S., 12th grade
Lamar High School
Health Science
02/03/00
I think a doctor is obligated to tell a patient's spouse that
they have HIV. On the other hand, the patient should be able to
tell their spouse that they have HIV. Furthermore, if you know
you have HIV and give it to someone else then you can be charged
with attempted murder, therefore making you an accomplice if you
don't tell the patient's spouse. As a doctor, I think you are
ethically responsible for your patients, including the spouse.
C.Y., 12th grade
Lamar High School
Health Science
02/03/00
In response to your ethics discussion I don't think that I
would tell his wife. I believe that it is his personal business
to tell his wife. A marriage is built on trust and if he can't
tell his wife himself then that's their problem, not the doctor's.
A doctor works under confidentiality, and even though they are
married, they are still individuals who want their privacy.
J.R., 12th grade
Lamar High School
Health Science
02/03/00
Based on the dilemma of the HIV patient and his wife, I, as
a physician, would persuade the patient to tell his wife; however,
I would not inform the wife myself even if she is a patient of
mine as well. My decision is based on patient confidentiality.
If he did not want his wife to be aware of his condition, that
is his decision, and I should not be the person to tell her. The
patient should be able to trust his physician to keep his condition
and information private.
Ruchi, 11th grade
Lamar High School
Health Science
02/03/00
If I were the doctor in the given situation, I would not inform
the wife of her husband's illness. As a doctor it would be my
responsibility to respect the privacy and wishes of my patient
(the man); however, it would also be my responsibility to try
to protect the health of my patient (the woman). So, I would definitely
encourage the man to inform his wife of his illness for her sake,
as well as his. If he refused, I would encourage him to abstain
from or use extra protection during intimate relations with his
wife.
C. D.
Health Science
Lamar High School
02/03/00
In the first place, I think that if the husband truly loves
his wife and cares for her, he should tell her. But if I were
the doctor, I would definitely encourage the husband to inform
his wife. Although the doctor is supposed to keep confidentiality,
if he doesn't let the wife know, he and the husband could later
be charged with attempted murder. This is a very serious issue,
and since lives are at stake, the woman has the right to know.
So, if the husband decided not to tell her, I would.
K.M.
Health Science
Lamar High School
01/10/00
I think that Dr. to Pt. confidentiality is very important and
is a factor in this particular case. He cannot tell the wife even
though she is his Pt. also. Yes, he must protect the wife, but
he is suppose to keep Pt.'s problems confidential. I really think
the doctor should be confident that the husband will make the
right decision, because it seems like he loves his wife. The Dr.
does not have the right to potentially break up the sanctity of
marriage.
Martin, 11th grade
Garland High School
Clinical Rotation I
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