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A patient comes into the hospital to see his results from an AIDS test: his results are positive. The patient nervously confesses to the doctor that he s been cheating on his wife. His wife and the doctor are friends, they ve been friends throughout school, but later drifted apart. However, they still maintain a good friendship, occasionally get together call each other for advice, or simply to share their problems since they ve been friends for so long. The doctor never actually met her friend s husband in person but after looking at his file she notices his last name and phone number are the same as her dear friend s. The doctor then informs the client of her friendship with his wife.

Should she tell the wife because he could pass this incurable disease to her? Or should she keep this information confidential because of her duty as a doctor?

This situation creates an ethical dilemma because no matter what decision the doctor takes it will oppose a belief. In this scenario the patient is the client seeking the service of a doctor. Therefore, the doctor must take a course of action based on mutual agreement that will not violate their relationship. As a professional, her primary duty is to serve the client, which in this scenario is the patient with AIDS. In order to better serve the client she will persuade and convince him to tell his wife in effort to maintain his autonomy and confidentiality. She will let him know that she must report this to government health authorities, and other health professional working with him. These health professionals need to be forewarned, so that they can take extra precautions. AIDS is now a reportable communicable disease in every state Physicians and hospitals must report every case of AIDS- with the patients name to government public health authorities (Pozar 384).

The doctor is not removing the patient s autonomy, however by giving him advice (persuading him) she is not respecting his autonomy to the fullest extent. In Clinical Ethics it is stated:

Patient preferences are ethically significant because they make explicit value of personal autonomy that is deeply rooted in ethics of our culture. Moral philosophers emphasize the principle of autonomy, the moral right to choose and follow one s own path of life and action. Respect for autonomy is the moral attitude that disposes one to refrain from interference with others autonomous beliefs and actions in the pursuit of their goals. Constraint of a person s free choices and actions seriously infringe on another s rights and welfare. The recognition of patient preferences respects the value of personal autonomy in medical care. In practice, however, many forces obstruct limit the expression and appreciation of patient preferences. These forces such as compromised competence of the patient, disparity between practitioner s knowledge and that of the patient, the psychodynamics of the patient-physician relationship, the stress of illness-often make difficult the realization of respect for the autonomy of the patient (Jonsen, Siegler, Winslade 50).

In other words, based on the value of autonomy the doctor should respect the patient s preferences. If the doctor were to tell her patient s wife she would completely remove the patient s autonomy since the patient would no longer be able to choose or have any influence on the reaction his wife takes. This could lead to consequences such as divorce, which would change his path of life. By influencing the patient to tell his wife the doctor is not removing the patient s autonomy, however she is reducing it by convincing the patient to tell his wife. The patient was planning on not saying anything, so if he tells his wife this action will not be his choice of action but one that the doctor influenced him to do.

According to Jonsen, Siegler and Winslade:

A patient s right to privacy and confidentiality has one of the highest priorities in our legal system. Statutes and court decisions proclaim the duty to provide, maintain, and enforce a patient s right to privacy and confidentiality, and also the perils of failing to do so. The Supreme Court has recognized it as a constitutional right. No longer is privacy and confidentiality merely a moral, ethical, professional obligation; it is a legal duty. The duty of the medical confidentiality is an ancient one. The Hippocratic oath states: what I see or hear in or outside the course of treatment, I will keep to myself, holding such things shameful to speak about (Jonsen, Siegler, and Winslade 166).

In essence, professional ethics require that the doctor maintain patient confidentiality; that is one of the highest values in the heath care profession. In the event that the doctor divulges this information, respective malpractice insurance policies might not cover the institution for a breach of confidentiality if the patient sued. The doctor s livelihood and professional reputation be at stake. She would be viewed as unprofessional for not upholding her duties she would develop a bad reputation that would reflect on the institution as well. After weighing the factors the realizes that if she breaks the confidentiality she could be dismissed from her job immediately and be liable for charges laid, and fines upon conviction.

Disregarding this duty of confidentiality also affects medical care in the long run in a much worse way: this would destroy the doctor to patient relationship. Patients in general need to feel they can trust doctors, that they can confide in them in effort to achieve better health together. The relationship ought to be one in which the patient and doctor work together. For example, the patient helps the doctor by telling the doctor he is ill, the doctor then prescribes medicine to cure the illness. Physicians, then, who bear the responsibility to protect their patient s confidentiality, must be as vigilant as possible and must advocate for better control of information and better policies to safeguard it.

Neglecting this duty will have an adverse effect on society. It is important for patients to view medicine positively, or it will have a negative influence on them and others. Those who have AIDS will hide and not seek medical treatment, and those who suspect they have AIDS will not get tested for fear of being disclosed and will continue to spread the disease. Future patients or clients will be less likely to share such sensitive information with their doctors. The long-term consequences will present an even bigger chaos.

Confidentiality is a stringent, but not an absolute obligation; there are exceptions to the duty. The ethical issue then is determining what principles and circumstances justify the exception to the rule. This is perhaps one of the most difficult problems in medical ethics: the value of confidentiality requires the physician who considers breaching it have the most serious justification. Among these exceptions is to report a communicable disease:

The obligation to safeguard the patient s confidences is subject to certain exceptions, which are ethically and legally justified because of overriding social considerations. Where a patient threatens to employ bodily harm to another person, there is a reasonable probability that the patient may carry out the threat; the physician should take reasonable precautions for protection of the intended victim, including notification of law enforcement authorities. Also, communicable diseases, gunshot and knife wound should be reported as required by applicable statues or ordinances (Hirsh 318).

In this case both communicable disease and bodily harm could be reported.

Confidentiality is prima facie to these exceptions. They are worded as: justify or you may whereas, confidentiality is a doctor s duty. As an example, If the patient refuses to do so, a physician may, without the patient s consent, notify a sexual partner known to be at risk. Therefore, the doctor could tell her because of the exception since he is putting her at risk of bodily harm, which is contaminating her with the communicable disease, AIDS. Another factor is the doctor s friendship, if the doctor does not say anything it will perhaps ruin the relationship she once had with the patient s wife. Informing the wife would not be a sure way to prevent spreading the disease because his wife probably already has the disease. The dominant motivator to tell in this scenario would be the friendship between the doctor and her client s wife. In defense of the patient s rights, the doctor should not mix her personal life with her professional life. Furthermore, due to the setting and nature of the situation the patient to doctor relationship comes first, the patient is the doctor s client so the doctor should seek his benefits before anyone else.

In conclusion, because of the doctor s profession she would not tell the patient s wife, nonetheless, leave this to the patient. In the end result the doctor will feel that she has dealt with the situation to the best of her ability without compromising her patient.

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