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Doctor's order's

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    #32
    Kirby
    Registered Users Posts: 13,084 ✭✭✭✭Kirby


    Martina1991 wrote: »
    How would a doctor contact a patient's partner or anyone else they've had unprotected sex with?

    Take any infectious disease or STD. The person diagnosed has the responsibility to inform all partners effected, not the doctor.

    There are plenty of infectious diseases where they lock you up in quarintine to protect other people. Your own rights are secondary when you are a public health risk. The responsibility is not on the patient, it's on the doctors who will call in an infectious disease unit to handle it.

    HIV is not airborne like in the above example but still, sleeping with somebody without informing them is not a "breach of trust" as it was so delicately put by somebody else in the thread. It's assault. You are knowingly passing on a potentially fatal and certainly life altering illness.


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    #33
    igCorcaigh
    Moderators, Recreation & Hobbies Moderators Posts: 11,115 Mod ✭✭✭✭igCorcaigh


    Kirby wrote: »
    You are knowingly passing on a potentially fatal and certainly life altering illness.

    The other partner is also knowingly taking a risk by not using protection. It's not an assault.


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    #34
    Rachiee
    Registered Users Posts: 880 ✭✭✭Rachiee


    Assume everyone you sleep with its riddled and you won't have a problem, if you have a partner who you trust dearly and they say they've only had one previous partner and have no stds, you should both go get the all clear together before moving to unprotected sex. you might trust your parter but do you trust your partners ex?

    Incidentally if someone is has an undetectable viral load ( easily achieved with today's medications) they cannot pass on the virus even through unprotected sex


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    #35
    thomasdylan
    Closed Accounts Posts: 514 ✭✭✭thomasdylan


    Martina1991 wrote: »
    How would a doctor contact a patient's partner or anyone else they've had unprotected sex with?

    Take any infectious disease or STD. The person diagnosed has the responsibility to inform all partners effected, not the doctor.


    Person presents with cough, weight loss to ED, CXR suggestive PCP, HIV test positive, CD4 count 20. Person admitted to hospital, person says they have long term partner/spouse but has also had unprotected sex with prostitutes which is where they think they picked it up. Partner is frequently attending patient in hospital, patient says they don't want their partner to know diagnosis and will not tell them even though they have always had unprotected sex. Is there an ethical obligation to inform the patient's partner?


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    #36
    thomasdylan
    Closed Accounts Posts: 514 ✭✭✭thomasdylan


    igCorcaigh wrote: »
    The other partner is also knowingly taking a risk by not using protection. It's not an assault.

    People with HIV who've deliberately spread HIV to sexual partners have been convicted of assault and GBH in the UK.


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    #37
    Paddy Cow
    Closed Accounts Posts: 6,576 ✭✭✭Paddy Cow


    thomasdylan wrote: »
    There are situations where patient confidentiality can be broken and this could be one.
    I think a doctor can advise their patient to tell any potential partners they are HIV positive but legally I don't see how they could contact them.


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    #38
    Martina1991
    Registered Users Posts: 2,540 ✭✭✭Martina1991


    thomasdylan wrote:
    Person presents with cough, weight loss to ED, CXR suggestive PCP, HIV test positive, CD4 count 20. Person admitted to hospital, person says they have long term partner/spouse but has also had unprotected sex with prostitutes which is where they think they picked it up. Partner is frequently attending patient in hospital, patient says they don't want their partner to know diagnosis and will not tell them even though they have always had unprotected sex. Is there an ethical obligation to inform the patient's partner?
    If your long term partner was in hospital and they refused to tell you what was wrong with them wouldnt that raise suspicion.

    What about the ethical obligation to inform the prostitutes that may be effected, to use your example.


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    #39
    thomasdylan
    Closed Accounts Posts: 514 ✭✭✭thomasdylan


    Martina1991 wrote: »
    If your long term partner was in hospital and they refused to tell you what was wrong with them wouldnt that raise suspicion.

    What about the ethical obligation to inform the prostitutes that may be effected, to use your example.

    PCP is AIDS associated pneumonia, patient probably tells partner they are being treated for pneumonia which is true.

    Certainly the prostitutes should be informed that a client of there has been diagnosed with HIV. The client doesn't have to be named and there is no breach of confidentiality. The difficulty here is tracking/contacting the prostitutes.

    I've answered your questions but you didn't answer mine. There aren't really an guidelines for this kind of stuff, there's lots of disagreement over this stuff in the UK. For me, in the hypothetical situation I mentioned, you have someone who has knowingly been exposed to a very treatable illness who is unaware of this and her condition will progress without treatment. I'm sure lots of people will disagree though.


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    #40
    Martina1991
    Registered Users Posts: 2,540 ✭✭✭Martina1991


    I still believe the doctor should obey doctor patient confidentiality and urge their patient to inform any other party effected.


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    #41
    igCorcaigh
    Moderators, Recreation & Hobbies Moderators Posts: 11,115 Mod ✭✭✭✭igCorcaigh


    thomasdylan wrote: »
    PCP is AIDS associated pneumonia, patient probably tells partner they are being treated for pneumonia which is true.

    Certainly the prostitutes should be informed that a client of there has been diagnosed with HIV. The client doesn't have to be named and there is no breach of confidentiality. The difficulty here is tracking/contacting the prostitutes.

    I've answered your questions but you didn't answer mine. There aren't really an guidelines for this kind of stuff, there's lots of disagreement over this stuff in the UK. For me, in the hypothetical situation I mentioned, you have someone who has knowingly been exposed to a very treatable illness who is unaware of this and her condition will progress without treatment. I'm sure lots of people will disagree though.

    I can sympathise with your point here.

    One thing to take into consideration though, is what effect will a change in the law have. Will people be less inclined to have a HIV test if they know that the result could be disclosed to other people?


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    #42
    decky1
    Registered Users Posts: 975 ✭✭✭decky1


    lots of talk there about std what if it was Cancer?


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    #43
    Miike
    Registered Users Posts: 2,021 ✭✭✭Miike


    decky1 wrote: »
    lots of talk there about std what if it was Cancer?

    Then a doctor has no right to break the patients confidentiality, it's cut and dry. The choice comes down to the patient to inform whoever they deem necessary.


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    #44
    MadDog76
    Closed Accounts Posts: 5,162 ✭✭✭MadDog76


    decky1 wrote: »
    lots of talk there about std what if it was Cancer?

    Cancer isn't contagious......


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    #45
    Gael23
    Registered Users Posts: 12,089 ✭✭✭✭Gael23


    Miike wrote: »
    Then a doctor has no right to break the patients confidentiality, it's cut and dry. The choice comes down to the patient to inform whoever they deem necessary.

    Cancer poses no risk to anyone else. The only reason there might be in a case where a patient had a career, then they would need to know in order to do their job properly.


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