Instruction: Read the situation carefully. Apply the Seven Step Reasoning Model
to determine the best ethical choice to make. Write your answer in the space
provided below.
"Please Don't Tell!"
A twenty-year-old Hispanic male was brought to a hospital emergency
room, having suffered abdominal injuries due to gunshot wounds obtained in
gang violence. He had no medical insurance, and his stay in the hospital was
somewhat shorter than expected due to his good recovery. Physicians
attending to him felt that he could complete his recovery at home just as easily
as in the hospital and he was released after only a few days in the hospital.
During his stay in the hospital, the patient admitted to his primary
physician that he was HIV positive, having contracted the virus that causes
AIDS. This was confirmed by a blood test administered while he was hospitalized.
When he was discharged from the hospital, the physician recommended that
a professional nurse visit him regularly at home in order to change the bandages
on his still substantial wounds and to ensure that an infection did not develop.
Since he had no health insurance, he was dependent on Medicaid, a
government program that pays for necessary medical care for those who
cannot afford it. However, Medicaid refused to pay for home nursing care since
there was someone already in the home who was capable of providing the
necessary care. That person was the patient's twenty-two-year-old sister, who
was willing to take care of her brother until he was fully recovered. Their mother
had died years ago, and the sister was accustomed to providing care for her
younger siblings.
The patient had no objection to his sister providing this care, but he
insisted that she not be told that he had tested HIV positive. Though he had
always had a good relationship with his sister, she did not know that he was an
active homosexual. His even greater fear was that his father would hear of his
homosexual orientation and lifestyle. Homosexuality is generally looked upon
with extreme disfavor among Hispanics.
The patient's physician is bound by his code of ethics that places a very high priority on keeping confidentiality. That is, information about someone's
medical condition that he or she does not want known cannot be divulged by
the physician. Some would argue that the responsibility of confidentiality is even
greater with HIV/AIDS since disclosure of someone's homosexuality normally
carries devastating personal consequences for the individual who is forced "out
of the closet."
On the other hand, the patient's sister is putting herself at risk by providing
nursing care for him. Doesn't she have a right to know the risks to which she is
subjecting herself, especially since she willingly volunteered to take care of her
brother?
If you were the physician, what would you do in this case? Would you
breach the norm of confidentiality to protect the patient's sister, or would you
keep confidentiality in order to protect the patient from harm that would come
to him from his other family members, especially his father?
Perhaps as good a question as "what would you do" in this situation is the
question, "how would you decide what to do" in this situation? The process of
making a moral decision can be as important as the decision itself, and many
ethical decisions that people encounter are so complex that it is easy to exhaust
oneself talking around the problem without actually making any progress
toward resolving it. The response to many moral dilemmas is "where do I start?'
and the person who is faced with these decisions often needs direction that will
enable him or her to move constructively toward resolution and "see the forest
for the trees."
In order to adequately address the ethical dilemmas that people
encounter regularly, the following is a model that can be used to ensure that all
the necessary bases are covered. This is not a formula that will automatically
generate the "right" answer to an ethical problem. Rather it is a guideline that is
designed to make sure that all the right questions are being asked in the process
