This case relates to a HIV positive man, who does not want to inform the wife that he is infected. The man only recently discovered his status after having sex with a woman in a foreign country. In his words, he suspected that he had “picked up something”. The man does not want the issue to come up with his wife because he feels that their marriage has enough problems as it is.
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He has threatened to sue for breach of confidentiality if his wife learns about his HIV status from the hospital. The complication with this situation arises from the fact that the wife is a patient in the same hospital; hence, there is likelihood that she will come for treatment in the same hospital.
The ethical dilemma arising from this case is that by applying the Australian Physiotherapists Association (APA) ethical principles, one party benefits, while the other party suffer. According to the APA (1), the four ethical principles require a practitioner to respect the autonomy of the individual, cause no harm, advance common good, and to act fairly.
The ethical principle requiring the respect of the autonomy of the individual can mean that the autonomy of the husband is distinct from that of the wife from. However, there is no easy way to respect the autonomy of each one of them without breach of confidence. Telling the wife of the husband’s status interferes with the husband’s right to confidential treatment. However, keeping quiet with information is likely to cause harm to the wife.
In this situation, the common good to strive for is to control the spread of the HIV infection by giving the wife an opportunity to plan for her protection. This assumes that she needs to know the situation hence someone must tell her first if common good will prevail. However, this means that there will be breach of the husband’s confidence. In addition, the requirement to act fairly also makes it impossible to keep quite with the information, yet talking about it also requires overlooking the desire of the husband.
The reason why there is an ethical dilemma in this case is the consequences arising from either taking action or failing to take action (2). In one case, talking about the situation may potentially break a marriage, which in itself is a very serious consequence. On the other hand, not talking about it puts an innocent person at risk of infection by HIV, which is also a very serious situation. This is the basic reason why there is an ethical dilemma. There is no clear way out, but a risk in both options.
There is a serious legal risk coming from talking to the wife about the husband’s condition. The husband has the option of suing for breach of confidentiality because he is an individual, hence discussing his medical condition with another person makes it breach of confidence (3). However, the wife can also sue for malpractice because it will be negligence not to tell her that she is under considerable risk of HIV infection. So means that whatever action taken under the current condition will have potential legal implications.
Under the APA code, there relevant ethical principles that should aid in getting a solution to this case include the following: patient autonomy, confidentiality, provision of information, best interests, avoid/limit harms, competence, and duties to the patient, to colleagues, to oneself, to others (1). Some of them are at variance because upholding them for the husband interferes with the benefits the wife should derive from them, and vice versa. It makes the case very difficult to deal with.
In order to find a solution, there are two potential approaches. The first approach arises from the possibility that the husband remains adamant and refuses to change his mind about the situation. It will require a difficult ethical evaluation to determine the best cause of action. The second situation would be to pursue the possibility that the husband may change his mind and let the wife know about his HIV status.
In the first case, the principles at variance are the need to maintain the husband’s confidence versus the need to do no harm (1). Keeping the husband’s confidence puts the wife in harm’s way. The greater good in this situation is to let the wife know because she is at a disadvantage in this situation.
The legal issues aside, there is a greater need for the wife to know what is going on than there is to keep the confidence of the husband. HIV is life changing, and has wide-ranging consequences, including life expectancy. Since there is likely to be a legal challenge in either case, it is then not a strong reason to keep the situation quite.
However, it is better to involve the husband in the process. As he pointed out, the marriage has enough problems as it is. However, his response at the time may have been because of learning about his HIV status. It is possible that he was shocked by the news, hence the reaction. Talking to him later, within reasonable time, may yield a more favorable response because he will have a better frame of mind to look at the benefits of letting his wife know.
Australian Physiotherapy Association. The Australian Physiotherapy Association code of conduct. [place unknown: publisher unknown]; 2017 [cited 2020 Feb 7].
Newton L. Ethical decision making: introduction to cases and concepts in ethics. Cham, Switzerland: Springer; 2013. 63 p.