Chelsea McKoy Biomedical Ethics First Paper 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. Position 1 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 he 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 informed and confidentiality is breached this will result in consequences for Carlos that will leave him with no one to care him (Degrazia, Mappes, and Brand-Ballard p. 117, 118). Position 2
The second position Marcia Angell gives her commentary that it is wrong to ask Consuela nurse her HIV infected brother without the proper knowledge that he is HIV positive. Angell argues that Consuela should be neither deceived nor exploited by a health care system that is encouraging her to provide a service it would otherwise be responsible for. Angell further argues that the doctor should give Carlos the choice of telling his sister that he is HIV positive or forfeiting her nursing care. Angell believes that the confidentiality should be honored when the secret is entirely personal and has no substantial impact on anyone else.
The claim of confidentiality must be overridden when it poses a major threat to others in Carlos’ case Consuela is at risk nursing for her brother unaware that he is HIV positive. Angell debates that Consuela has the right to have information she might consider relevant to her decision to act as her brother’s nurse, and from the health care system’s obligation to warn of a possible risk to her health. Angell focuses on Consuela’s right to information whether there is risk involved for three reasons first; there is an element of deception in not informing Consuela that Carlos is HIV infected.
Most people in her situation would want to know if their “patient” were HIV infected and would presume that they would be told if that were the case. Second, Consuela has been impressed to provide nursing care for Carlos that the health care system is responsible and third Angell believes Consuela has already been exploited by her family and the health care system to act as “mother” to her younger brother and should not part take in it again (Degrazia, Mappes, and Brand-Ballard p. 118, 119). Case 2
Tatiana Tarasoff was murdered by Prosenjit Poddar a patient of psychotherapist employed by the University of California Hospital. Tarasoff parents brought an action against the university regents, doctors and campus police. The Tarasoffs complained that the doctors and police failed to warn them that their daughter was in danger from Poddar. Justice Tobriner argues that a doctor or psychotherapist treating a mentally ill patient has a duty to warn third parties of threatened dangers arising out of the patient’s violent intentions.
Tobriner argues that the public interest in safety from violent assault must be weighed against the patient’s right to privacy. Justice Clark dissenting from Justice Tobriner’s majority opinion argues that confidentiality in the psychiatrist patient relationship must be assured for three reasons. First without the promise of confidentiality people needing treatment will not seek it. Second, Effective therapy requires the patients full disclosure of his or her innermost thoughts.
Without assurance that the thoughts disclosed will not be revealed by the therapist, the patients could not overcome psychological barriers standing in the way of such revelations. Third, successful treatment itself requires a relationship of trust between psychiatrist and patient. Clark further argues that if the duty to warn is imposed on psychiatrists, the result will be an increase in violent acts by persons who either do not seek help or whose therapy is unsuccessful.
Clarks believes imposing such a duty will result in an increase in the involuntary civil commitment of patients (Degrazia, Mappes, and Brand-Ballard p. 109, 113, 114). Position 1 The Plaintiff first cause of action “Failure to Detain a Dangerous Patient” alleges that Poddar was a voluntary outpatient receiving therapy at Cowell Memorial Hospital informed his therapist that would kill an unnamed girl identified as Tarasoff when she returned from summer vacation in Brazil. A decision was made to commit Poddar into a mental hospital. Campus police were orally notified to take Poddar into custody.
Officer satisfied with Poddar being rational and release Poddar on a promise to stay away from Tarasoff. The police were then asked to destroy all copies of the letter and notes taken during the session and ordered no action to place Poddar in a 72 hour treatment and evaluation facility. The second call of action “Failure to Warn on a Dangerous Patient” alleges that the defendants negligently permitted Poddar to be released from police custody without notifying the parents of Tarasoff that their daughter was in danger from Poddar.