What issues would the case raise for the ethics of care theory and deontology? W

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What issues would the case raise for the ethics of care theory and deontology? What advantages and disadvantages does each view have? How would the each theory support certain policies and actions and address practical issues with implementation?

CLASSIC CASE FILE Carlos R One commentator on this case argues against For many who are HIV positive, their anguish only deepens if others know about their condition. They violating confidentiality. He contends that for a phy- demand medical confidentiality, and physicians are sician to have a duty to warn, there must be () "an obliged to comply-but the "duty to warn" others of imminent threat of serious and irreversible harm," the risk of infection haunts both physicians and pa 2) no other way to avert that threat except by tients. Typically those thought to need warning are breeching confidentiality, and (3) a situation in which sexual partners and spouses, but sometimes caregiv- the harm done by the breech is on a par with the ers-whether professionals or family members-are harm avoided by the breech. In his view, none of the ones of concern. This case is of the latter kind. these conditions are fully met in this case. He does It recounts the events that lead up to the question not believe that the risk of Consuela becoming in- at issue-whether the physician's weightier duty is fected with HIV is very great-and certainly not confidentiality or warning-then provides the op- "imminent." He also thinks that there are alterna- posing views of two commentators. tives to breeching confidentiality-the main one Twenty-one-year-old Carlos R. entered the hos- being instructing Consuela in safe wound care pital for treatment of gunshot wounds received in Moreover, he insists that the risks to Consuela from gang violence. During his stay, he confided to the not telling her about Carlos' HIV status are far ou attending physician that he was HIV positive, and weighed by the awful disruption of family relations testing proved him correct. Eventually he recovered that breeching confidentiality would cause. well enough to leave the hospital to have his wounds cared for at home. The attending physician advised confidentiality to warn Consuela. She maintains that Carlos to have daily visits from a nurse to tend to Consuela has a right to information whether or not his wounds. But Carlos was uninsured, and Medicaid there is an appreciable risk to her. One reason is would not pay for the home nursing visits because that if Consuela is not being told the truth, she is his 22-year-old sister Consuela was willing and able being deceived. Most people in Consuela's situation to care for him. For 10 years since their mother would want to know the facts and would probably died, Consuela had assumed the role of mother for assume that Carlos was not HIV positive because no both Carlos and their younger sister The second commentator argues for violating one said so. Furthermore, in getting Consuela to Carlos was willing to let Consuela be his nurse, provide nursing care, "the health care system is using but he was adamant that she not be told about his her to avoid providing a service it would otherwise HIV status. She was unaware of his homosexual ac be responsible for." If so, then the system has an ob- tivity, and so too was his father. More than anything ligation to give her the information she needs to else he feared that his father would learn the truth. decide whether to accept the responsibility There was also the cultural factor. Among many In the end, the physician should require the pa- Hispanics, homosexuality is a social stigma. tient to choose: "Carlos can decide to accept Con- The choice for Carlos' physician, then, was be suela's generosity-in return for which he must tell tween preserving confidentiality and breeching it to her he is HIV-infected (or ask the doctor to tell warn Consuela of the risks involved in caring for an her)-or he can decide not to tell her and do with HIV-positive patient. out her nursing care."7

Explanation / Answer

HIV/AIDS is a information that requires confidentiality in treatment.however many hospitals and doctors refuse to treat such patients and they are referred to government hospitals who provide care and treatment for such people.In this case that has been referred,the hiv status of the patient must be shared with the nurse or care taker so that precautions are taken .HIV does spread through cuts in the body and any such contact may infect the caregiver in this situation.Breach of trust is important but the caretaker should have the right to information so as to safegaurd her or him.breach of trust for the right cause is essential.Carlos at any point cannot decide whether it should be confidential if it requires involvement of another person in his life or treatment.This si one of the main reasons some hospitals refuse treatment and patients are reffered to hospitals under the government aided hospitals.

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