Case and Commentary
Jan 2005
A. Informing the appropriate authorities of Mr. Jonsen's STDs and of the possibility that he may put others at risk is acceptable; state law requires the former. Regarding the latter, endangerment to third parties, reporting Mr. Jonsen may be supported by the Code if Dr. Macklin is convinced that Mr. Jonsen plans to continue endangering others. According to Opinion 2.23, "HIV Testing," if the physician is unable to persuade the patient to discontinue putting others at risk, the physician should notify authorities of the endangerment. If Dr. Macklin does not know for certain that Mr. Jonsen is endangering others, or if he is successful in persuading his patient not to continue to do so, Dr. Macklin need not notify the authorities that Mr. Jonsen is a danger to others.
B. Asking Mr. Jonsen to stay so they can plan therapy, counseling, and referral for follow-up care is the preferred action. Requesting that Mr. Jonsen stay will provide some time for him to reflect on his medical condition and will give Dr. Macklin an opportunity to talk about necessary treatment and counseling services. It will also give Dr. Macklin more time to persuade Mr. Jonsen against endangering others by his conduct.
C. Making a note in Mr. Jonsen's chart and doing nothing else should be avoided because it violates the Code in Opinion 2.23, "HIV Testing": "the physician should, within the constraints of the law: (1) attempt to persuade the infected patient to cease endangering the third party; and (2) if persuasion fails, notify authorities..." Moreover, in the state where Dr. Macklin is practicing, state law requires a report on all sexual transmitted diseases.
