Case Scenario: DISCLOSURE OF PHYSICIAN'S HIV STATUS

The physician, Doe, was a resident in obstetrics and gynecology at a medical center. In 1991, he cut his hand with a scalpel while he was assisting another physician. Because of the uncertainty that blood had been transferred from Doe's hand wound to the patient through an open surgical incision, he agreed to have a blood test for HIV. His blood tested positive for HIV, and he withdrew himself from participation in further surgical procedures. The medical center and Harrisburg Hospital, where Doe also participated in surgery, identified those patients who could be at risk. The medical center identified 279 patients, and Harrisburg identified 168 patients, who fell into this category. Because hospital records did not identify those surgeries in which physicians may have accidentally cut themselves, the hospitals filed petitions in the Court of Common Pleas, alleging that there was, under the Confidentiality of HIV-Related Information Act [35 P.S. § 7608(a)(2)], a "compelling need" to disclose information regarding Doe's condition to those patients who conceivably could have been exposed to HIV.

Doe argued that there was no compelling need to disclose the information and that he was entitled to confidentiality under the act. The Pennsylvania Supreme Court held that a compelling need existed for at least a partial disclosure of the physician's HIV status. The medical experts who testified agreed that there was some risk of exposure and that some form of notice should be given to the patients at risk. Even the expert witness presented by Doe agreed that there was at least some conceivable risk of exposure and that giving a very limited form of notice would not be unreasonable. Failure to notify the patients at risk could result in the spread of the disease to other noninfected individuals through sexual contact and through exposure to other body fluids. Doe's name was not revealed to the patients, only the fact that a resident physician who had participated in their care had tested HIV positive. "No principle is more deeply embedded in the law than that expressed in the maxim Salus populi suprema lex. (The welfare of the people is the supreme law), and a more compelling and consistent application of that principle than the one presented would be quite difficult to conceive.

Ethical and Legal Issues

1. Do you agree that there was a need for a partial disclosure of the physician's HIV status?

2. If "the welfare of the people is the supreme law," did the court fall short of its responsibility by not allowing disclosure of the physician's name? Discuss your answer.