Question

FINAL MEDICAL ETHICS CASE STUDY

A twenty-year-old Latinx is brought to a hospital emergency room, having suffered abdominal injuries due to gunshot wounds received in gang violence. He has no medical insurance, and his stay in the hospital is somewhat shorter than expected due to his good recovery. The attending physician feels that he can complete his recovery at home just as easily as in the hospital, so he is to be released after only a few days in the hospital. During his stay in the hospital, the patient admitted to his primary physician that he is HIV positive which was then confirmed by a blood test administered while he was hospitalized. When he was discharged from the hospital, the physician recommended that a professional nurse visit him regularly at home in order to change the bandages on his still substantial wounds and to ensure that complications do not develop. Since the patient has no health insurance, he is dependent on Medicaid, a government program that pays for necessary medical care for those who cannot afford it. Medicaid refused to pay for home nursing care since someone is already in the home who is capable of providing the necessary care. That person is the patient's twenty-two-year-old sister, who is willing to take care of her brother until he is fully recovered. Their mother died years ago and the sister is accustomed to providing care for her younger siblings.

The patient has no objection to his sister providing this care, but he insists that no one disclose to her that he is HIV positive. Although he has always had a good relationship with his sister, she is not aware of his sexual orientation. Even greater is his fear that his father, who has extreme religious and cultural convictions, would learn that he is homosexual. Since healthcare providers are bound by a code of ethics that place a high priority on keeping confidentiality, the young Latinx's physician cannot divulge information about his medical condition.

Some would argue that the responsibility of confidentiality is even greater with HIV due to the often unwarranted stigma to homosexuality. This can be devastating for the individual who may not be ready to share their sexual orientation with others. On the other hand, the patient's sister will be putting herself at risk by providing care for him. You have been tasked with researching and providing a report on possible steps to the hospital ethics board.

Answer 1

HIV infection : Human Immunodeficiency Virus infection.

Homosexuality: sexual activity with a person of the same sex.

Possible steps for given Ethical scenario:

The report on possible steps for given Ethical scenario pertaining to Mr. Latinix's Diagnosis of HIV infection should include the following options.  

According to Medical ethics, a physician should keep the confidentiality of Medical information regarding the client. But same time the principle of Nonmaleficence , that is ' to do no harm' force the physician to reveal the patient's HIV status to his sister to protect her. In this situation physician can do any following option:

* Physician or a qualified medical counsellor should do a counselling for the patient about the disclosure of the HIV status to the sister. As she is a major person and if she can protect this information from the other family members, then there is no harm in informing her. Counsellor can try to convince the patient about the risk that his sister has to take in caring for him, that he is putting her in risk of accidental infection.

If the Patient is agreeing for disclosing the information to his sister, then the physician can disclose the disease status to his sister. There will not be any ethical problem.

* Even after counselling , if Mr. Latinix is not agreeing for disclosing the information to his sister, then to protect his sister (the healthy family member) , a physician can reveal the HIV status to his sister, after informing him about the disclosure of information. ( still the debates are going among physicians regarding such type of issues )

But the physician no need to tell the cause or reveal the sexual orientation ( homosexuality) to the sister. It may create a stigma for the person in his family. Physician can educate his sister not to reveal the matter to other family members.

* If two Options are not acceptable by the patient/ physician, then the physician can present to his sister regarding the spread of infectious diseases ( that client may develop due to his open wound or he is t risk for infections ) that may spread through improper dressing of wound, lack of aseptic techniques, mishandling of dressing instruments and direct contact with the patient's blood or body fluids. So special care has to be taken while giving care to the client. Not to esxpose to his wound directly, do not touch the blood or body fluids of patient etc.  

Instruct the patient to be careful and he can also discuss with his sister, about his condition or about taking precautions while giving care to him. So that he will not put her also in unnecessary risk.