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Case
Jim is a 34-year-old man who is well-known to the community health centre that he and his family have attended for several years. He is married and has two young children. His wife is eight months pregnant. He is a computer salesman and spends much time away from home travelling to clients across the country.
A few weeks ago, Jim presented to the clinic complaining of generalized fatigue and lethargy. He had recently lost five kilograms and had noticed some unusual lesions on his inner thighs. As part of the blood screening done at that time, an HIV test was undertaken. This turned out to be positive. Given his clinical picture, it was likely that he had already developed AIDS.
Jim’s primary care nurse is present when his physician relays the bad news to Jim. Clearly distraught, Jim admits that he has had sexual intercourse with a number of women during his business trips, and on several occasions did not bother to use a condom. Fearful of the effects that this revelation would have on both his family and his business contacts, Jim pleads with his caregivers to keep this information, and his diagnosis, confidential. Given his wife’s pregnancy, he feels this knowledge might cause her undue harm. He assures them that he and his wife have not had intercourse since her pregnancy. He refuses any treatment for his AIDS-related symptoms, since this would make the diagnosis obvious to everyone. Instead, he asks that his family, including his wife, be told that he has terminal and incurable cancer. Jim’s physician (who is also his friend) says that he will respect Jim’s wishes for now.
Discussion
Many hospitals in Canada refuse written consent as in the U.S. for medical services. It is believed that general verbal consent will suffice, and HIV testing is already included. In 2001, the legislature did not pass the forced HIV testing amendment, so testing was illegal in Jim’s case (Keatings & Smith, 2010). It is also supported by the fact that the history did not include issues authorizing involuntary testing. In this case, testing done without Jim’s knowledge violates ethical standards of medical care and universal human rights.
Disclosure of patient information falls under confidentiality laws. It means that any information about a patient to which consent is available can only be used for therapeutic purposes (treatment). According to Canada’s Department of Justice Report, disclosing HIV status in all cases is illegal (Keatings & Smith, 2010). However, HIV-positive people have been obliged (since 2012) to disclose their status to their sexual partners to prevent the spread of the disease. Consequently, health care providers may assume that Jim’s pregnant wife may also have an HIV viral load. On the part of health care providers, disclosure of status is not allowed, but withholding the accurate diagnosis could adversely affect Jim’s wife’s pregnancy.
Consistent with the above, the nurse may recommend that Jim be cautious in his contacts. If not treated, the viral load in the mL of bodily fluid will increase, and the symptoms will become more severe. Consequently, the nurse may suggest getting a unique set of tools that come in contact with the skin and blood (scissors, forceps, razors). An additional AIDS test due to a combination of symptoms will also be recommended. In addition, the nurse may offer to monitor the wife’s condition.
Reference
Keatings, M. & Smith, O. (2010). Ethical & legal issues in Canadian nursing (3rd ed.) Elsevier.
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