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Learning Objectives:-
- Concepts of best interets, autonomy and rights
- When is it legally, professionally and ethically justifiable or mandatory to breach confidentiality (balance of public interests)
Legal Aspects of the case
Public Health (Infectious Diseases) Regulations 1988 & Public Health (Control of Diseases) Act 1984 :-
- Certain infectious diseases must be notified to the local authorities (i.e. TB). HIV and AIDS does not fall into this category.
NHS (Venereal disease) Regulations 1974 :--
States that GUM clinics can only release confidential information to the patient's GP only with explicit consent from the patient (it cannot be implied)
- If a patient refuses to give consent about their test results from various investigations, or treatments that they are receiving, then the specialist should not disclose this information.
Good Medical Practice paragraphs 50 to 53
Ethical Issues Raised
- Should the GUM doctor break the patient's confidentiality and tell other medical professionals including the patients GP.
- On the one hand doing so would mean the GP would be better able to deal with any medical complications of HIV and would be able to inform other medical professionals to take rigorous safety precautions to prevent viral spread.
- On the other hand in not telling the GP the patient isn't putting the GP at risk of serious harm if standard procedures are followed, so there isn't a clause to break confidentiality.
In Clinical Practice
- In order to practice safe and effective care for their patients, doctors should share medical information with other healthcare professionals if it is warranted.
- It is important for John's GP to have enough background knowledge because he will need care and antiretroviral medication for the rest of his life. They may have a lot of interactions with other drugs and there are always side effects- so by knowing about any therapies, they will be able to provide safe and effective care for John.
- However in this case since the patient does not wish his GP to know his HIV status, and normally there is little risk that the GP would be infected by the patient, then the wishes should be respected. Indeed, in a survey carried out around 30% of HIV positive patients decided not to let their clinician notify their GP about their HIV status, with discrimination and confidentiality of clinical information being their biggest reasons for not disclosing the diagnosis.
References
- Survey of HIV patients' views on confidentiality and non-discrimination policies in general practice BMJ 1996; 312 : 1463
- NHS (Venereal disease) Regulations 1974
- Public Health (Infectious Diseases) Regulations 1988
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Author: David Ledingham
Editors: Philip Xiu, Jacky Wong
Voice Actors: Salaj Masand, Zoe-Monnier-Hovell
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