Health Care Ethics

Analyze the case utilizing Jonsen’s four-topic method – 10 pages minimum
1. Introduction: Identify the major theme(s) of the case: (i.e. confidentiality and truthfulness, death and dying, maternal/fetal conflict or social justice):
2. Medical (or Healthcare) Indications
3. Patient (or Client) Preferences
4. Quality of Life
5. Contextual Features
6. Conclusion/Solution/Decision: Weigh features discussed in 2-5 to support your ethical decision.

Case:
Frank Raines is a 34 year old, married, white male with two children. He has a history of behavior that puts him at high risk for AIDS. He states (brags actually) that he is very sexually active, having had 8-10 partners during the last six months. He seldom uses condoms because he states they diminish his pleasure. Last week, he was informed that a woman with whom he had sexual contact about a year ago has tested positive for HIV, so he came in for a physical exam and an HIV test.
Results from the physical exam were within normal limits. He appears to be in good general health. After appropriate counselling, blood was drawn and sent to the lab. He was given the standard packet of info on HIV, etc.
The lab report is positive for HIV. Mr. Raines is returning for the results this morning.

Doctor’s discussion with patient
Hello, Mr. Raines. We've received the results of your HIV tests, and I'm terribly sorry to tell you that it's not good news. The tests show conclusively that you are infected with the HIV virus. We discussed last week what these results mean and the available treatments.
I know there is a lot for you to think about, and we can go over any questions you might have. I can help you connect to many forms of assistance when you need them Deep down, I guess I expected it, but it's still a shock. I've read all the information you gave me and thought about this a lot since we talked last week. You've just handed me a death sentence, haven't you?

Not necessarily. Right now there is no cure, but proper care does significantly prolong the patient's life after symptoms appear, and we don't know how long it will be before the disease starts to cause you significant problems. Sometimes it takes years. Research suggests that several promising new drugs are being developed, so it is impossible to say exactly what your odds are.
I don't know what to do about treatment yet. I hardly know what to think... I guess we will cross that bridge when we come to it
Of course, but there are some things we need to discuss now. We will need to notify the women you have had sexual contact with, starting with your wife. We certainly don't want this to spread any further! I'll try to give you the names of the women I've been with in the last several months. But you'll have to find an excuse to do the blood test on my wife because I can't let her know I have AIDS. It would destroy my marriage. She doesn't know about the other women. I can't stand the thought of not being able to be with my children. I want you to take care of me, and I don't want you to tell anyone.

Physician’s Conversation with a Consultant (Ethicist)

Doctor :
Justin, I have a really tough one for you this time. (Explains case.) It looks like anything I might do could violate some of my professional and personal ethics
Consultant:
This situation requires that you balance the demands of full respect for your patient's clinical welfare and autonomy with your concern for that of others, that you deal, as you must often, with significant conflicts of interest. Disclosure of his HIV status would compromise confidentiality and could expose him to considerable loss and suffering. Compliance with his request for secrecy could expose his wife and, perhaps, others to infection and death.

The AMA Principles of Medical Ethics mandates "service with compassion and respect for human dignity." The AMA provides some practical guidelines toward this end in what it calls the Fundamental Elements of the Patient-Physician Relationship. It states that the patient has a right to, among other things, "courtesy, respect, dignity...","confidentiality" and "continuity of care".
At the same time, those same principles state that " a physician must recognize responsibility not only to patients, but also to society, to other health professionals and to self." There are, obviously, others who could be put into significant jeopardy if you sit on this information. His wife and other sexual partners could become infected and die as a consequence. This dilemma is well-recognized by authorities in your profession. The AMA, for example, states that the right to confidentiality may be compromised by disclosures "provided for by law or by the need to protect the welfare of the individual or the public interest".

The AMA has proposed more specific ethical guidelines for dealing with HIV and related issues. Of particular interest here are those concerned with danger to third parties. On this point, physicians are instructed to urge patients to inform spouses, among others, of their status and, in the case of non-compliant patients, physicians should see that those in danger of infection are informed. By the way, I ran across some excellent advice on counseling in a piece called "A Clinician's Guide to AIDS and HIV Infections." It should help a lot with the practical application of the AMA's directives.
One final bit of advice that you have heard from me before. You should be very aware of the role of you own attitudes toward HIV infected patients, particularly where the source of the infection is as in this case. While you will not be able to avoid the impact of your views on your decision, you can be aware of them and take their influence into account.
Recognize them, test them against the values of your community and profession, become as informed as you can and intelligently carry out your best intentions. You will make your best decision if you understand the situation, what you want to accomplish and why you want it. You might talk with Margaret Winter about those attitudes and how she would approach dealing with them. Oh, and don't forget, Sandy Connors might help you stay out of trouble on this one.
Which reminds me, how many lawyers does it take to change a light bulb?

Doctor:
I don't know, but the pre-trial hearings on the matter begin next Tuesday
Consultant:
You've heard it, Rats! I'll see you later with some I've heard about you quacks
Doctor:
Thanks for the help, and I look forward to you and your lame attempts at humor

TOPICS TO DISCUSS:
1. Abstract
2. Keywords
3. Table of contents
4. Introduction
5. Medical indications
6. Patient Preference
7. Quality of Life
8. Contextual Features
9. Conclusion
10. References

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This case presents a patient who is male, married and sexually active outside of his marriage unbeknownst to his wife. Over the past six months, Frank Raines, claims to have had between 8-10 partners rarely using condoms as it diminishes his pleasure. A partner from an encounter last week informed him she tested positive over a year ago for HIV. As a result Mr. Raines decides to see his primary care physician to have a physical examination. Doctor indicated he appears to be in good health. After further discussion the physician orders blood to be drawn for analysis to test for HIV among other tests. Results came back positive. ...