Confidentiality:
Case 2
A 75-year-old woman shows signs of abuse that appears to be inflicted by her husband. As he is her primary caregiver, she feels dependent on him and pleads with you not to say anything to him about it.
How is this case different from Case 1? How would you handle this situation?
Confidentiality:
Case 1
Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet.
What is your role legally? What would you say to your patient?
NOTE: The UW Dept. of Bioethics & Humanities is in the process of updating all Ethics in Medicine articles for attentiveness to the issues of equity, diversity, and inclusion. Please check back soon for updates!
Confidentiality:
Case 1
Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet.
What is your role legally? What would you say to your patient?
Confidentiality:
Case 1 Discussion
Because the patient's wife is at serious risk for being infected with HIV, you have a duty to ensure thatshe knows of the risk. While public health law requires reporting both your patient and any known sexual partners to local health officers, it is generally advisable to encourage the patient to share this information with his wife on his own, giving him a bit more time if necessary.
Confidentiality:
Case 2
A 75-year-old woman shows signs of abuse that appears to be inflicted by her husband. As he is her primary caregiver, she feels dependent on him and pleads with you not to say anything to him about it.
How is this case different from Case 1? How would you handle this situation?
Confidentiality:
Case 2 Discussion
In this case, the doctor may feel conflicted. A vulnerable elderly woman needs protection and may be fearful of her abusive husband. Reporting to Adult Protective Services, required if the physician suspects elder abuse (http://www.aasa.dshs.wa.gov/aps/), may also make the patient fear that she will be exposed to further abuse by her enraged husband. The therapeutic alliance with the patient provides a unique opportunity to support the patient’s health and safety. The physician should discuss services that might be available to assist her; encourage the woman to seek help; provide medical care and counseling; and explain the physician’s duty to report. It should also be noted that anyone who suspects elder abuse is required to report it - neighbors, social workers, family members, etc. Whenever the safety of an individual is at stake, confidentiality may be breeched and there are usually specific agencies (public health, Child Protective Services, Adult Protective Services) designated for reporting. These agencies then assume responsibility for investigating the reports and taking appropriate steps to ensure the person’s safety.