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Adrian attends his GP’s surgery. He and his partner Claire have recently undergone HIV and sexual screening. He has been found to be negative for everything but his partner has been found to be HIV positive. His GP has already seen Claire and told her that she is HIV positive and referred her to a clinic for further counselling and probable treatment. During the consultation with Adrian it becomes clear that Claire has lied to Adrian and said that she tested negative for everything! Adrian thinks that he can stop using condoms as a result of the negative tests. 

What issues does this raise. What should the GP do?

 Claire’s point of view

Claire may expect her confidentiality to be maintained. She is an autonomous adult and should have the right to tell or not tell who she wants about illness. She probably fears that telling Adrian will jeopardise her relationship with him. She has only recently received her diagnosis; she may be in ‘shock’ and may need time to consider her situation.

 Adrian’s point of view    

He could be at risk of contracting a serious possibly fatal illness if he is not told. He would want to be told.

The doctor ‘s point of view

Confidentiality is an important principle. Patient need to trust their doctor otherwise they may not tell them everything. However confidentiality can be broken if there is a risk of serious harm to others. Non –Maleficence, avoiding harm is an important principle in medicine. A doctor has to act in the best interest of his patient [beneficence].In this case he has two patients. It is in the eventual best interest of both his patients that the situation is honestly explained.  The doctor has to comply with the law – see below.

Society’s point of view

It is also important for Public Health to ensure that infectious diseases are not spread. Many infectious disease such as whooping cough, salmonella, gonorrhoea and TB are NOTIFIABLE  diseases. The doctor is obliged to break confidentiality and notify public health authorities of patients with them so they can ensure that the infection is not spread. It has been said that the fight against infectious disease is like ‘a war’ and normal rules about autonomy do not apply because of the wider risk to the public.  HIV is surprisingly not a notifiable disease. However people have been prosecuted for manslaughter for knowingly passing HIV on. If the doctor does not do anything he would be colluding with a crime.

It would therefore be against the law [pillar of Justice] for the doctor not to make sure Adrian is told.

What the doctor should do 

The doctor should therefore ask to see Claire immediately. He should handle the situation sensitively and be aware that Claire is likely to be deeply upset and scared at her diagnosis. He should tell her that he has seen Adrian and Claire has to ensure that Adrian is not put at risk; otherwise he will have to break confidentiality and tell Adrian himself.

[In this scenario you have a conflict between a patient’s confidentiality – Autonomy and all the other ethical pillars]

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