To disclose or not to disclose ... That is my question.

[Devon Rex, ADN, BSN]

I'm currently taking an Ethics class and our discussion question has to do with disclosing private information. Please read below, then my comments as to what I think and what others in our group think. I wanted to know if this were a real life situation, which route would be the correct one (legally and/or ethically).

Read the case and answer the questions:

In the Jeanette April residential treatment center for teenagers with emotional problems, the staff has become aware that Serena Adams, an 18-year-old female who is HIV+, has been sending notes to Donnie, an 18-year-old male resident, suggesting dates for sex. The fact that Serene is HIV+ is known only to the staff members and to Serena. Both state law and the American Disabilities Act forbid exposing the fact that anyone is HIV+. When the treatment team was told about this development, after the discussion, they asked Jackie La Martine, Serena's social worker to speak to her to explore the situation with her and try to avoid any sexual liaison between Serena and Donnie or at the least to make sure they know safe sex methods. When approached, Serena refused to cooperate, arguing that the information must be kept confidential, that she and Donnie love each other, and that how they have sex is their own business. She asked that no one tell Donnie of the facts. The team members are split as to what to do. Some argue that, as long as Serena informs Donnie, they should not interfere. Others argue the team should try to prevent any sexual relationship between them.

1. Should Ms. La Martine and the team leave Serena and Donnie alone to make their decisions despite the risk, or is their a duty to protect Donnie in this case?

I think patients have the right to privacy and confidentiality, except for when they place someone else in danger. Thus, in my view, Donnie should be told about Serena's HIV status.

Other students think it is most important to keep Serena's privacy and confidentiality intact. In other words, if she does not want Donnie to know, we (the healthcare providers) should respect that and not disclose anything to Donnie.

Which route is right? I live in Florida... we have what we call the "Baker Act" in which if someone is suicidal or homicidal, a physician can invoke the law and keep admit the person into the hospital. Also, if the patient makes threats, we are obligated to disclose the target party so they can keep safe. I see the case of HIV+ as a similar case, in which the healthcare provider has the duty to report the target... in the above hypothetical case... Donnie. What do you legal nurses say? Thanks !!

[morte, LPN, LVN]

I think a general "lecture" "meeting" that a person should be considered + unless proven otherwise, and safe sexual practices be in place, maybe the way to go. Otherwise, it would seem that she is threatening his well being, and should be treated as if she is commiting assault and battery, perhaps even attempted murder....

[Devon Rex, ADN, BSN]

I did a little bit of more research and found that in states like California and Florida they have a law that prescribes someone who knows they have an infectious disease (ie. HIV+) to disclose their status with the person prior to engaging in a sexual act. That way he/she can make an informed decision on whether or not to participate in a sexual encounter.

However, the law did not talk about whether a healthcare provider could be held liable if it keeps the information confidential.

[DalekRN]

Not that this is realistic, but its Donnie's responsibility to make sure his sexual partners are disease free and/or he takes measures to protect himself. There must be some accountability on his end too. In the end I agree with it being assault/battery for her to go through with sex without his fully informed consent- the consequences being well known to those who have HIV.

[Anonymous865]

I can't tell you what Florida law says, but here is what Tennessee law says about it:

Section 68-10-101 requires a physician to file the appropriate form with the health department to report a positive HIV test. Tennessee statute also provides: "If any attending physician or other person knows or has reason to suspect that a person having a STD is behaving so as to expose other persons to infection, or is about to behave, the attending physician or other person shall notify the municipal or county health officer of the name and address of the diseased person and the essential facts of the case." Tenn. Code Ann. Section 68-10-102.

The health department would be responsible for taking appropriate measures to prevent the spread of disease.

[Devon Rex, ADN, BSN]

Thanks for your posts everyone !!

[Esme12, ASN, BSN, RN]

IN a residential treatment setting sex between the patients is prohibited.

[nurseprnRN, BSN, RN]

If Donnie is a patient he may not be considered competent to make that decision even if he is 18. Might need to look into his guardianship status, too.

[Devon Rex, ADN, BSN]

Thank you GrnTea... good point to consider in real life cases!

[Lerman2010]

You have no right to tell the other party of her medical status. Period. All you can do is advise her of the risks and what precautions to take. As for the laws - its is about INTENT. If she intends/plans to infect him on purpose and she has told you this, then that changes the situation. She would then be breaking the law. We don't have to like whats going on or about to go on, but as a medical professional, we are obligated by HIPAA laws to protect her medical information.

I assume sexual intercourse between patients at the facility is not okay. Perhaps, you can find a way to separate them on that rule.

[lucki_star7]

I agree with GrnTea. In my opinion it would be violating HIPAA if the healthcare providers told Donnie. However, if Serena had sex with Donnie knowing that she had an infectious disease and did not disclose this information she would be breaking the law, because this could potentially kill him if he ended up becoming HIV+ and developed AIDS. I have heard of people going to prison for having sex with other people and knowing that they were HIV+ and not allowing the other person to make an informed decision!

[Esme12, ASN, BSN, RN]

It depends on the state......there are mandatory reporting and informing of partners on the books.