In a first-person special to the Los Angeles Times (latimes.com, 5/12), Marc Siegel, MD, examines the ethical debate faced by many doctors who learn that an HIV-positive patient may be concealing his status while having unprotected sex with a negative partner.
Dr. Siegel recounts the story of a patient, “Carlos,” who contracted HIV from another one of Siegel’s patients, “Miguel.” Siegel knew that Miguel was HIV positive, but Carlos didn’t. After finding out that he himself was HIV positive, Carlos asked Siegel if he’d known that his partner had HIV.
“You have to ask him,” Siegel replied. “I can’t say.”
According to the article, the encounter, for Siegel, raised questions about the tension between a doctor’s obligation to confidentiality and his moral obligation to help prevent others from becoming infected with the virus.
“If I had known in advance [that the two patients had a sexual relationship], would I have found the legal and ethical basis to warn Carlos?” Siegel asks. “Or would I have had to let it happen?”
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DISCLOSE!!!!!, , 2008-06-06 18:31:11
i feel like this, if im in a monogamus relation with you and you know you have aids and just lie down with me and i ask and you lie YOU PUT ME AT RISK,CUZ IF YOU WOULD HAVE TOLD ME I WOULDNT HAVE EVER GAVE YOU THE TIME OF DAY....I DONT FAULT THE DOC I BLAME MIGUEL.....
FW, Toledo, 2008-06-03 17:07:27
...You did the right thing Doc. There ARE laws in place to protect you and the patient. Giving in to your conscience would have involved human reasoning and the laws are in place to take that away in this society, so as, you do not have to get involved in their relationship. Takes the stresses factor out of your career. HIPAA and peoples Civil Rights.
Ben Simmons, Oakland,CA, 2008-06-02 10:47:00
As an HIV+ man since 1989 and having lost my partner to A.I.D.S. in 1992, I believe that everyone must assume that EVERYONE IS POSITIVE until proven otherwise.
CONDOMS, CONDOMS, CONDOMS is the rule of the day.
Ben Simmons (retired, R.N.)
Pat, Austin, Texas, 2008-06-01 12:40:06
I have yet to hear from another guy on the otherside of a gloryhole what his status is. Personally, I prefer not to have oral sex when the other is wearing a condom. It defeats the purpose of oral sex.
poz, , 2008-05-23 21:26:06
hi this is to mike in st.lou do you honestly believe what you posted there are a lot of innoscent pe ople mainly women infected by someone who swore to the end they were neg and these are good descent women WHO DID PRACTICE SAFE SEX I THINK IF YOU ARE POZ AND YOU KNOW GET OUT OF DENIAL YOU ARE TAKING INNOSCENT LIVES, ITS NO EXSCUSE TO INFECT ANOTHER PERSON WITH FREE TESTING AVAILABLE........ITS JUST NO EXSCUSE P.S. IM POZ TOO BUT I REFUSE TO IMPOSE ON INNOSCENT PEOPLE...
Mike, St.Louis, MO, 2008-05-20 13:04:09
I believe STRONGLY that every HIV negative person has an obligation to assume that everyone they sleep with is HIV positive until told or proven otherwise. The burden can't just be placed on HIV+ people to do all the work. Having a disease like this is psychologically debilitating enough. Anybody having sex should know that the possibility is out there. Maybe they haven't even tested positive yet. The solution is to pretend everyone is HIV+. Stop waiting for everyone else to protect you.
shane, Auckland, 2008-05-18 06:28:43
Ignorance is to blame. Obviously they dont know each other too well. He can only blame himself not others I pitied the person I contracted it from, and he in the end who really wants to contract it? Look listen learn there must be some kind of clue a potential partner is lieing about his status. Get checked out together Yay!
poz, , 2008-05-17 02:59:24
i dont agree with the ones who try to blame neg people how can you if a person know they are poz why not tell the person why ruin another life cuz yours is ruin i think its selfish and low down i cant believe people are blaming people who were once neg cuz of thier risky life style and then they are wolves in sheep clothing get real if you have hiv and know it i thinks its only humane you let the other person know!!!!!
DW, Kansas City, MO, 2008-05-16 09:56:27
The issue here is the need for a reduction in risk behavior. Non-disclosure never transmits HIV. This is a POLITICAL red herring designed to placate people who are BEHAVING in a risky manner. Non-disclosure and the surrounding debate is a way of saying, "HIV is not my problem; it is the problem of those with HIV." I argue "not so." Not a single case is transmitted through non-disclosure. It is transmitted through unsafe behavior.
AD, Oregon, 2008-05-16 05:50:07
The rules for the medical provider are clear-confidentiality is paramount. When discrimination against HIV+ individuals ends, the perfect(stigma-free) environment for full disclosure will arise normally. Until that happens, I would support a law criminalizing the act of "non-disclosure" IF a law existed to equally penalize the (second)party if it then disclosed info to a third party.This way the HIV+ individual has the rightful control of dissemination of info that could lead to discrimination.
Dawn, Ventura County,CA, 2008-05-15 20:34:09
Everyone is responsible for your own safety, regardless if someone is HIV positive or not. Accept responsibility for our own sexual lifes & assume everyone has something!! practice safe sex-Until we know for sure all is ok via medical test together. Be responsible, protect, educate yourselfs & others!! Its no one elses duty to protect you..its up to you!!!! The HIV+ person should always disclose & always wear protection. I am positive and for me not using a condom is not even an option ever!!!!
JMC, , 2008-05-15 15:54:08
I work in healthcare and it still saddens me that individuals don't ask and not protect themselves anyway. I feel that it is our responsibility to protect the rights of patients. I was in a situation that a friend was seeing a person that I had cared for and I had no legal or moral right to disclose information. We are still friends however, his partner felt it best to change facilities. I am glad to share that they are still together.
DM, North Carolina, 2008-05-15 14:20:24
I don't know what the law is in California, but in North Carolina, Miguel would have been legally obligated to disclose his status to Carlos before engaging in intercourse. I agree that being safe is everyone's responsibility. I disclose, because a few minutes of pleasure is not worth my going to prison. Furthermore, I feel morally obligated to disclose. I don't want anyone to go through the hell that I've been through dealing with HIV.
Brandon, Philadelphia, 2008-05-15 11:29:28
I'm a physician in PA. This situation seems rather simple to me. It's solely a matter of personal responsibility, meaning the two having sex. The physician has absolutely no role in this, except to protect his patients' privacy and to provide proper healthcare. In the long-term the consequences of breaching confidentiality are much worse than any other social implication in this story.
Brett, Conway Arkansas, 2008-05-14 17:56:55
I have been poz for 20 years. I've struggled with full disclosure to sex partners for most of that 20 years. After discussing this with several poz and negative gay men, I've come to the conclusion that each person is resposible for having safer sex at the level they are comfortable with. If I am sexually active, then I am responsible to take care of myself. I assume that all sex partners are poz. It is not the doctors responsibility to disclose any information to patients sex partners.
Queenie
