This is a common scenario especially if you practice where there is the HIV pandemic. So, lets discuss the principles that guide a doctor’s decision and conclude with what the right response should be to the HIV+ man.
Respect for patient autonomy – informed consent, confidentiality, truth telling, communication are all important obligations under the umbrella of the principle of respect for autonomy. The doctor must respect the patient’s right to making their own informed decisions and living their lives based on their own beliefs, preferences and values.
Beneficence – this refers to the act of kindness and good deeds aimed at providing the needed treatment/care for the patient.
Non-maleficence– this is based on the Hippocratic principle of ‘primum non nocere’ – first do no harm. Avoid causing harm.
Justice – respect for the law of the land, respect for human rights and distributive justice which is about all citizens getting a fair and equable distribution of available resources.
The doctor is expected to make a decision based on these principles.
There is the famous case of a patient who told his doctor, ‘when I leave this place, am going to kill my wife!’ The doctor did not alert the patient’s wife that harm was coming her way. The man killed his wife and the doctor was found guilty in court.
For the man infected with HIV who does not want the doctor to tell his wife, considering all the principles discussed above:
1. It is the doctor’s duty to tell the patient that he should tell his wife and put a time limit to it. In the past I have encouraged patients to tell their partner in a controlled environment if they fear repercussions like ‘with relatives or friends’ or in the hospital with counsellors around. Some have disclosed in the police station fearing what their partners can do.
2. Tell the patient if he doesn’t tell his wife by the said date, you will have to tell her as the doctor. You have a duty to protect the wife.
3. If he doesnt agree, tell the wife and get her help from social services, police etc if needed
