Question

I need a huge favor relating bioethics. Can you please look at these cases and analyze them as best as you can, in relation to privacy and confidentiality. Anything can help me, your opinion, your own ideas. Pleasee I would be eternally grateful..!!! Thank you!

Case 1: Informing the wife?----Mr. S is married and the father of two school children. He is treated in your clinic for a rare form of pneumonia that is often associated with AIDS. His blood test results show that he is indeed HIV-positive. Mr. S says that he wants to decide himself if and when he will tell his wife about the infection. You indicate that it could be life-saving for his wife to protect herself from infection. Besides, it would be important for her to have an HIV test herself. In case of a positive test result she would then have the opportunity to take drugs to slow down the outbreak of the disease and thereby prolong her life. Six weeks later, Mr. S comes into your clinic for a control investigation. Answering your question he says that he hasn’t informed his wife yet. He doesn’t want her to know about his homosexual contacts because he fears that she would end their relationship and the family would shatter. But to protect her he has had only “safer sex” with her. As the treating physician, you wonder whether you should inform Mrs. S of the HIV status of her husband against his will so that she would have the opportunity to start treatment if needed.

Case 2: Prison events --- As part of your medical duties you spend one day every two weeks seeing inmates in a nearby prison. Yesterday you treated a prisoner with multiple abrasions on his face and trunk. When you asked what caused the injuries, the patient replied that he had been attacked by prison staff during interrogation when he refused to answer their questions. Although this is the first such case you have experienced, you have heard of similar cases from your colleagues. You are convinced that you should do something about the problem but the patient refuses to authorize you to disclose information about himself for fear of retaliation from the prison authorities. Furthermore, you are not certain that the prisoner has told you the truth; the guard who brought him to you said that he had been in a fight with another prisoner. You have a good relationship with the prison staff and do not want to harm it by making unsubstantiated accusations of mistreatment of prisoners. What should you do?

Case 3: Warning the friend?------A 45 year old rich, handsome, sociable and elegant man, a member of the jetset society, had an amorous relationship with an equally elegant and beautiful 35 year old woman. Due to some bouts of jealousy on the part of the man (possibly of morbid dimensions), the young woman decided to put an end to the relationship. Following this, the man visited a psychiatrist, whom he had been seeing for some time, informed him that he was carrying a gun and that his next visit would be to his ex-girlfriend because he intended to kill her. He added that this information was confidential from patient to doctor and that any breach in confidentiality would not remain unnoticed. The psychiatrist decided that a breach of confidentiality was necessary in this case and informed the lady and the police. When asked by the police, the man denied that he had bad intentions. A heated discussion among professionals followed, which was re-fuelled by the fact that this man eventually managed to kill his ex-friend with the very gun he carried when he visited the psychiatrist’s office.

Answer 1

in relation to privacy and confidentiality. the first case is to be handled in the perspective of bioethics .....one of the basic tenets of bioethics is confidentiality. You can not breach that confidentialty whatever issues may arise.You must not break your patient.s confidential information even to his wife. Never.

The second case of prison  is exercising your moral value or your conscience. You are not dealing with the ethical problem of patient's care provider and patients . here the problem lies with the prison personnel. or the prisons administration.This event can be handled or investigated by Police or concerned authority. The same event you can face in a battered child syndromme where a third party involvement is there.

The last one in my opinion is a social problem and. you should caution the girlfriend as this is disclosing the evil intention of your patient not the confidential health event. You should not tell her the person is suffering from depression or anxiety i.e health event. Here no breach of confidential information of health event occur, Only evil intention is exposed,