Scenario: Limits on Medical Confidentiality: To Tell or Not!
You are Jane Palmer, a MCpl Medic assigned to the Medical Wing in support to the Combat Training Centre, Gagetown. There is a unit deployment in full swing and in the process of a medical screening you come to realize that one of the high profile "cute guys," that has been working his way through the female quarters, and is presently dating your best friend, has tested HIV-positive. The convention of Doctor/patient confidentiality is in effect, and the patient is aware of his condition, but there is no telling if "Romeo" actually intends to change his lifestyle. Any irresponsibility on his part may now prove fatal to others. On the other hand, medical confidentiality no longer applies if a patient is going to knowingly cause harm to either himself or others. The problem is, we don’t know what “Romeo” will do in the immediate future as MCpl Palmer was likely not in the room my the MO disclosed this to “Romeo”.
MCpl Palmer has an intense moral issue of which she is in the position to act as a moral agent determining whether or not to break medical confidentiality. The Jones model can greatly assist in this matter weighing the magnitude of consequences against the probability of effects, temporal immediacy, proximity, consequences, and concentration of effects to determine the most appropriate choice for MCpl Palmer. However, with the close proximity of her best friend’s involvement with “Romeo” bias is likely to enter into the weighing of all factors. We don’t know for sure how “Romeo” contracted HIV. As “Romeo” is known to the female quarters, MCpl Palmer will naturally make the assumption that he has multiple partners and with a positive HIV test, she may likely assume that this means that he has unprotected sex. The possibility of contracting HIV through the sharing of needles, or through a tainted blood transfusion will likely have not been considered. “Romeo” could have a drug issue i.e. Heroin, can be out of the system in 3-4 days.
Magnitude of consequences: this is the sum of all harm. In this aspect should she not break confidentiality, the risk is that her friend and possibly other females within whom “Romeo” comes into contact with could become infected with the HIV virus leading to eventual death.
Breaking confidentiality could result in MCpl Palmer facing several carges harged with a breach of security, being transferred from her occupation. Now that “Romeo” knows, he has a legal responsibility to disclose this to all past and present sexual partners. Not doing so can result in “Romeo” facing his own future charges for willfully infecting others. The quarters could be anywhere from 100-200 personnel. Of these personnel it is unknown how may he may have already infected. Unknown is if they too have passed it on.
Social Consensus: breaking confidentiality will could lead to “Romeo” losing trust in the medical system and being fully open and honest in the future with any of his health care providers. Futhermore, this could lead to “Romeo” to deal with the stigma of people knowing his illness and possibly ostrasize him for it. Breaking confidence, can also lead to those who have