Virtual Mentor. January 2005, Volume 7, Number 1.
Case 3.2: Duty to Report—An HIV Diagnosis
The obligation to maintain patient confidentiality dates back to the Hippocratic Oath and remains essential to the practice of medicine. Maintaining confidentiality produces the conditions necessary for optimal medical practice. Specifically, patients who trust their physician to maintain confidentiality will be more likely to share important personal information (eg, whether or not they use drugs) that can help attain a more accurate diagnosis and effective treatment plans.
When patients pose threats of harm to specific third-parties or to the public health, physicians may have a duty to breach confidentiality. These threats can take a variety of forms, including intended violent acts as well as irresponsible or malicious actions arising from the patient's medical condition. Specifically, patients who are HIV positive may put third parties at risk through a variety of behaviors including needle sharing and unprotected sexual intercourse.
A patient's HIV status should remain confidential, except under the clearly defined circumstances where disclosure is necessary for safeguarding public health or identifiable third parties. The reporting requirements differ from state to state, and physicians should be aware (and should make patients aware) of what information will be reported.
Opinion 2.23, "HIV Testing" clearly states that "the limits of a patient's confidentiality should be known before consent [to testing] is given." Dr. Macklin failed to inform Mr. Jonsen of the limits of the obligation of confidentiality in this kind of case. It is not clear whether doing so would have made a difference in Mr. Jonsen's decisions or reaction, but Dr. Macklin slipped up on this obligation just the same.
The physician's duty to report is not limited to communicable diseases (like STDs). When physicians have reason to believe that individuals may be a threat to the welfare of others or have been the victims of violence, they should inform appropriate authorities. Physicians have this duty to report because of their responsibility to the public good. The following Opinions articulate the features of this responsibility.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
© 2005 American Medical Association. All Rights Reserved.