Please Don’t Tell: a Case about HIV and Confidentiality

The article main conclusion, is it the physician duty to warn third party which is the patient sister (Consuela) about his patient (Carlos) HIV positive status since she will be taking care of his wounds at home for her own safety. The article stated reasons to support the main idea, Fleck assumes no need to breach confidentiality if there is a home health nurse, but should be aware of universal precaution. The chance of her getting HIV is remote at best. Angell argues Consuela should be informed about Carlos HIV positive, the doctor should breach confidentiality. Since she's being generous to Carlos by providing care, in return Carlos must tell his sister he is HIV positive or ask the doctor to tell her or he can decide not to tell her and do without her nursing care.

Fleck argues that breaching confidentiality would be unjustified. He provided reasons that should be met before a physician breaches confidentiality that can be justified. He stated, when there is an imminent threat of serious, irreversible harm; there is no alternative way to averting threat; and the harm that would thereby be avoided is proportionate to the harm associated with breaching confidentiality. All the reasons Fleck stated above, none of them are imminent threat to Consuela and the risk of transmission during wound care is very low.

Breaching confidentiality is considered against HIPAA, if the patients informs physician not to warn the third party. Carlos had reasons why his physician should not tell his sister about his HIV positive because she may decline or be afraid to provide him care or other family members might know about his sexual orientation and health status. I think that the sister should be informed of the importance of and thoroughly educated in the practice of universal precaution. I also believe Carlos should be educated in universal precautions and should monitor his sister to insure that she follows the precautions for her safety since he chooses not to tell her about his HIV positive status.

I believe Angell argument is the weakest because he states the physician should breach patient’s confidentiality. He believes Carlos should either tell his sister about his condition or forfeit her nursing care. I do not agree with Angell because it is not important for the doctor to breach confidentiality in this situation since the risk of infection is so low, if Consuela follows the universal precautions correctly, compared to the risk of Carlos informing Consuela about his HIV positive status. He may harm himself or commit suicide if he realizes after informing his sister about his sexual orientation and health status. She starts treats him differently as an outcast since it is against their culture. I believe a time will come when Carlos is ready to inform his family. For example: As a nurse aide at times I draw blood from patients who are diagnosis with sexually Transmitted Disease without my knowledge. Some nurses choose to inform me for my safety other do not. But since I use universal precaution I am always safe.

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