There are many complex issues regarding confidentiality and the right to privacy in the modern health care system. It is the duty of physicians, nurses, and others to maintain classified information about their patients’ private health unless they agree to disclosure. Confidentiality is important because it builds trust between patients and physicians; without trust, the practice of medicine would not be possible. A break in confidentiality infringes a person’s right to privacy and can expose patients to discrimination from employers and insurance companies, destroy their personal relationships, and leave them feeling ashamed and embarrassed by society. Given modern technology, databases, the Internet, and growing dependence on modern technology and computers, protecting an individual’s right to privacy and keeping their records confidential has become an extreme challenge. A person should have a right to privacy and has the power to control who may have access and use of their personal information. However, when is it acceptable for a physician to violate a person’s right to confidentiality and privacy?
In this case study, the physician is faced with making an ethical decision between protecting patient confidentiality and the duty to warn. He has to decide on whether to breach confidentiality and warn Consuela about Carlos’ HIV-positive status and her risk of becoming infected or protect patient confidentiality with Carlos. Since Consuela will be in close proximity with Carlos’ wounds and bodily fluids while caring for him, she has a high risk of contracting HIV, therefore she has the right to be informed about the probability of contracting this infectious deadly disease. Since she has not been told otherwise, she will automatically assume that her brother does not have HIV, and therefore she believes she is not at risk while caring for his gunshot wounds. By not telling Consuela, she is being lied to and deceived, which is not ethical by any means. Carlos is being very selfish by not wanting to tell his sister, who is generously willing to take care of him because he is willing to put her in danger just to hide his homosexual lifestyle from her and his father. Furthermore, Consuela is doing the health care system service by taking care of her brother free of charge so they do not have to pay someone else to provide a service that they would have alternatively been held liable. Consequently, the health care system and the physician, in my opinion, are obligated to breach confidentiality and inform her of the risks involved with caring for an HIV-positive patient.
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The Hippocratic Oath has the physician swear that “Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.” Confidentiality and the Hippocratic Oath were put in place to protect the patient from discrimination, shame, and prevent the destruction of personal relationships by keeping their personal health information a secret. However, Confidentiality between physician and patient no longer applies when there is any risk to another person besides the patient. When the patient’s medical or psychological issues or circumstances could involve someone else or could pose a serious threat to someone else; then their issues are no longer their own and should not be kept secret. For example, in instances where they are intended on harming another person; could spread serious communicable diseases, or if the patient is an obvious victim of assault, or has gunshot wounds due to another person. In these cases, they no longer involve one person they involve the people the patient will affect, either by coming in contact with them or others harming the patient. The physician then has a duty to let others know for their protection and to keep them from serious harm under these circumstances.
Consuela definitely has the right to this information whether she is at risk or not. Conclusively, I think the physician should make Carlos choose between: Carlos can agree to allow Consuela to be his nurse, however, he would be required to inform her of his HIV-positive status; or request the doctor to inform her. The other decision would be for Carlos and the physician not to tell her and then do without Consuela’s nursing care. It would not be right to allow Consuela to be deceived and put her health at risk.