Shirley, a nurse practitioner, is at a conference when a physician colleague discusses a difficult case. One of his clients, "Jake", is HIV positive but refuses any treatment. The physician explains that Jake fears that his wife will discover and recognize the names of the medications, because he knows "these drug names are mentioned on television all of the time." Jake has not told, nor does he ever intend to disclose to his wife that he is HIV positive. Jake firmly believes his condition is his private information and, for now, the couple uses condoms for birth control. The physician is concerned that Jake will not tell his wife. The physician is presenting this case to colleagues to highlight the public awareness campaign that, to some extent, have affected client privacy. He argues, "Listen to how they call out your name and the drugs at the pharmacy counter."

Shirley recognizes bits and pieces of information and comes to the painful realization that Jake is really Paul, and Paul is the husband of one of her clients, Lilly. Lilly has begun to discuss with Shirley that she wants to get pregnant soon. The town is too small for Shirley to be mistaken. Or is it?

On the class Discussion Board answer the following questions:

1. Is is ethical for the nurse practitioner to ask the physician if Jake is Paul?

2. Is it ethical for Shirley to tell Lilly she suspects Paul is HIV positive?

3. Should this information change how Shirley counsels Lilly about a pregnancy?

4. What is in Lilly's best interest?