Confidentiality Case 1
In the patient confidentiality case of Carlos, a 21 year old Hispanic male is being discharged from his hospital stay for a gunshot wound. Carlos is intended to receive nursing care at home from his sister, Consuela. Carlos is secretly a homosexual and is concerned that his secret will be revealed and be disgraced by his family. Carlos pleaded with his physician not to inform his sister that he is HIV-positive. Not informing Consuela would seem to increase her risk of contracting HIV while attending to Carlos’ wounds. The ethical issue is whether Carlos’ physician is justified in breaching confidentiality on the grounds that he has the “duty to warn” Consuela of the risks at hand.
Leonard Fleck gives his commentary on the issue stating that the physician breaching confidentiality is only justified when there is an imminent threat of serious irreversible harm; there is no alternative to avert that threat; and the harm that would thereby be averted is proportionate to the harm associated with breaching confidentiality. Fleck argues that breaching confidentiality would be unjustified. Fleck further argues that if Carlos were receiving home health care there would be no reason to breach confidentiality because the nurse would be expected to follow universal precautions when caring for Carlos. The same universal precautions would be explained and demonstrated for Consuela. This would be a satisfactory response that protects both Carlos’ rights and the general welfare of Consuela.
Fleck believes that a frank and serious discussion with Consuela about the need for universal precautions, plus monitored through training in correct wound care fulfills a reasonable duty to warn regarding Carlos’ circumstances. Proper equipment like gloves and other necessary equipment are provided to observe universal precautions. Fleck further concludes that if Consuela is