Ethical Dilemma opinion Help!

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Hello Everyone,

If you were to have two patients who see you at the clinic.

Pt 1 came in tested positive for preggo test and wants you to keep the news secret from her family. She refused to have HIV testing because she stated that her husband and her were tested couple years ago already and it was negative.

Pt 2 came in about weeks later for abdominal pain. He told the primary care provider that he diagnosed HIV years ago and his spouse knows about it, and they are having protected sex.

The NP later found out that both patients are married. What would you do in this case? I know that I would break the pt's confidential law if I tell Pt 1 that "Your husband Pt. 2 has HIV, and you should go tested." I want to hear from your opinions.

Thanks!

MM

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what are the laws in your state re HIV reporting?

What ideas do you have?

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I would follow state law where you are practicing. There are specific rules on HIV testing and disclosure for each of the 50 states. Many have similar laws. In my state, sexual partner and/or needle-sharing partner notification are required once a patient tested positive for HIV. So in this scenario, the wife (Patient 1) must know that her husband (Patient 2) tested positive for HIV.

Link: http://www.hivlawandpolicy.org/

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Great article
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Thank you for your reply. After reading from the website that you provided, I am still confused if the pt refused to sign the inform consent to notify the partner regarding the HIV status, then will the NP be allowed to report to the partner LEGALLY?

Please reply if anyone knows the answer to this. Thanks in advance!

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Specializes in Hospice.

I don't have the answer, but all I can think about right now is the baby. Maybe Mom is in denial, maybe she doesn't want anybody to know about the baby because she hasn't decided to keep the baby, maybe the baby isn't the husband's. Lots of things to consider before spilling the beans.

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We're trying to help YOU find the answer, because we don't do your homework for you

what other resources can you find. What are your thoughts. Sometimes there are no clear ethical answers, which is why there are ethics review boards

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Specializes in Hospice.
We're trying to help YOU find the answer, because we don't do your homework for you

what other resources can you find. What are your thoughts. Sometimes there are no clear ethical answers, which is why there are ethics review boards

I definitely read this post wrong, I thought it was real, not a homework question. :roflmao:

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Thank you for your reply. After reading from the website that you provided, I am still confused if the pt refused to sign the inform consent to notify the partner regarding the HIV status, then will the NP be allowed to report to the partner LEGALLY?

Please reply if anyone knows the answer to this. Thanks in advance!

You'll have to look at your state law. Yes, in some states providers can inform the sexual partner. If you're unsure, call the state Department of Health. In all states, the law states that a person newly diagnosed with HIV must inform all sexual partners of his/her status. There are states where a person can be charged for a crime for not disclosing their status to sexual partners (or needle-sharing partners) and putting them at risk.

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Specializes in Pedi.
I don't have the answer, but all I can think about right now is the baby. Maybe Mom is in denial, maybe she doesn't want anybody to know about the baby because she hasn't decided to keep the baby, maybe the baby isn't the husband's. Lots of things to consider before spilling the beans.

I had the same thought- these hypothetical patients sounds like the parents I deal with regularly. Maybe the husband is telling the truth and he and his wife are having protected sex... and maybe the baby isn't his and that's why she doesn't want to disclose her pregnancy to anyone. Maybe she's going to terminate the pregnancy.

OP, check your state's laws on partner notification. And, as Juan states, the infected partner can be charged with a crime if he knowingly keeps this information from his partner:

HIV Criminal Philippe Padieu Busted by Women He Lied To - ABC News

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