(3) Example 2. Also, consider the case of an airline pilot who informs his
physician that his 50-year-old mother has Huntington's chorea. This means that the
pilot has a 50 percent chance of becoming afflicted with this disease. If the pilot were
to develop Huntington's chorea, his ability to fly safely would be seriously affected, with
potentially catastrophic results for large numbers of people. The pilot, however, refuses
to take the test for the genetic marker for Huntington's chorea (a test that is 95 percent
accurate) and refuses to inform the airline of the possible risk. Since there is a real
possibility of serious harm on a large scale, this might be a situation in which the
physician would have to consider breaking the confidence to prevent serious harm of a
IS A BREACH OF CONFIDENTIALITY JUSTIFIED TO PROTECT SEXUAL AND
NEEDLE-SHARING PARTNERS OF HIV-POSITIVE PATIENTS?
Should the physician or other health care professional violate the confidence of a
patient who has tested HIV-positive in order to warn a spouse and lover of the risk?
This breach of confidence would be limited to the amount and kind of information
necessary to protect sexual and needle-sharing partners from exposure. (This
assumes that attempts to persuade the patient to disclose the information or grant
permission for the disclosure have been unsuccessful.)
Limiting the breach of confidence to only those who need to know is crucial because
of widespread discrimination against those with the HIV infection. Ethically, there is
a strong argument for informing spouses, sexual and needle-sharing partners, based
on beneficence. A basic question is which strategy would save the most lives:
notifying spouses or lovers or guaranteeing strict confidentiality? Would those
exposed to the AIDS virus but not yet exhibiting the symptoms be less likely to seek
testing if confidentiality were not protected? Or would carefully limited breaches of
confidentiality to sexual or needle-sharing partners not discourage people from
seeking testing and medical attention?4
For example, a married bisexual male with night sweats and a persistent cough tests
HIV-positive, but refuses to tell his wife about his condition. He insists on strict
confidentiality even though his wife is at risk for exposure and the children could end
up losing both parents. The physician reluctantly agrees. The patient finally
discloses the true nature of his illness in the last weeks of his life, his wife tests
positive. One year later, she begins to show symptoms and blames the physician for
failing to fulfill his moral responsibility to her and the children.
Based on situations like the one above and others, ethicists Tom Beauchamp and
James Childress argue that "...the rules of medical confidentiality are not, at present,
well delineated and would profit from a thorough restructuring.
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