example, the spouse of a person who has been tested HIV-positive, and to provide
preventive therapeutic measures to persons other than the patient. Violent threats by a
patient to do bodily harm to others is another situation that may necessitate a
recommendation for involuntary detention or tranquilizing when there is a serious intent
to do harm.
WHICH SITUATION WARRANTS PLACING THE PUBLIC SAFETY ABOVE THE
INDIVIDUAL PATIENT'S RIGHTS?
You are treating a boy for a case of measles. He is not suffering great discomfort or
itching. The child's mother seems intent on sending her son back to his school and
day care center, although the boy is still highly contagious. In this case, you are
obliged to inform the school and day care center that this child is highly contagious,
that others may have already been exposed, and that additional cases my be expected
if the child returns. There is a genuine threat to the child's classmates, so the public
A dialysis technician working in a kidney dialysis unit is hepatitis B-antigen positive.
The technician seeks advice from her personal physician regarding this disease, which
can be transmitted sexually or by exposure to blood. She expresses a reluctance to
inform family and friends or limit professional activities. In this case, there is no
significant threat, as infectivity is low. In addition, kidney dialysis patients are routinely
immunized. Therefore, the technician's interests take precedence over the public
safety. The physician should counsel the patient about using universal precautions
and taking special care to protect patients from exposure to her blood. But, there is no
need to report the technician to her superior (If there were a high risk of infection, there
might be an obligation to report the incident to the health care provider's superior.)
The technician should, however, receive counseling on her personal life and the use of
proper sexual precautions. The decision to abstain, limit herself to mutual monogamy
(one sexual partner), or practice safe sex is her prerogative. The patient's rights
prevail because the disease is not easily contagious.
A school board seeks input on a proposal to routinely test all of its teachers for the HIV-I
antibody test to prevent the spread of AIDS. In this case, health officials should not
support the school board because a blanket infringement on the liberty and privacy of
such a large population would be unwarranted. There is no realistic threat, since AIDS
is not transmitted through casual contact. What's more, such testing would yield false
positives. Additionally, a positive antibody finding does not necessarily mean that full-
blown AIDS will develop. The harm to the teachers' reputations, employability, and
insurability would be substantial and unwarranted, when there is no genuine threat.