In Case 12 a doctor, Dr. M, has learned he is infected with HIV, should he disclose to his patients that he has HIV or even discontinue his practice of performing surgery on patients? In a study that was taken 2.5 times for every one hundred surgeries performed about one-third of those procedures the patient is touched with the surgeons’ blood. In the same study they have found that for every one hundred surgeries that a surgeon performs with HIV only three patients will contract HIV from the surgeon.
Dr. M does not have an obligation to refrain from performing surgery due to the low risk of contracting HIV from him and with any surgery there are risks, such as death that have to be taken into consideration. While Dr. M doesn’t have the obligation to terminate his profession of a surgeon he does hold the obligation to disclose to his patents he is HIV positive. If he discloses this to them this allows for the patent to decide whether or not to continue the procedure with him.
When he discloses this information to them he will also need to provide the facts and information to them of the low risk they have of contracting the virus from him. Just as Dr. M is obligated to disclose his information of the virus he carries to his patients so does this patents hold the same responsibility to provide that information to him. The patient providing this information to their surgeon is more critical then the surgeon providing it to them for the simply fact a surgeon has more exposure to blood than a patient does.
For most patients the fear of the unknown is the worst disease of all but at times information is hard to attain. As a health care provider you should never allow the fear of not knowing what disease you have that could be passed along to your patients be in their minds. With the chosen profession of being a physician imposes a set of duties and obligations, which raise additional questions and concerns. As a physician you have accepted the obligation of do no avoidable harm, be as skilled and knowledgeable as possible, recommend and do what is best for the patient, and be honest with them. Along with these duties they also assume the responsibility and challenge of providing the facts that the patient needs in order to give a voluntary informed consent for the surgeon to perform surgery on them.
As a surgeon they need to know whether it will impair their ability to perform their tasks safely and competently. They also need to know if it will pose any significant risk to their patients now or in the future. If the surgeon is or will become impaired they need to resolve the impairment. If this is not possible they may need to limit or change the kind of surgery they perform.
The risk of HIV acquisition from an infected surgeon appears much lower than the risk bacterial infections, even those with deadly potential. These rates vary by surgeon and institution. It is not in the practice for surgeons to disclose their personal health information to potential patients. Similarly, most surgeons don’t openly disclose the number of similar cases they do annually, another factor associated with complication rates. Given this practice, it seems inappropriate to require disclosure of a lower-risk condition. That may change as risk-adjusted institutional and even surgeon-specific data become publicly available. Until then disclosure of HIV status seems inappropriate.
It may arouse anxiety unnecessarily and have no practical effect on risk reduction. It may be that some patients would be more fearful of a low risk of HIV infection than of a serious adverse drug reaction, postoperative hemorrhage, or sepsis, but that is not a strong argument for routine disclosure. It is a reason to answer a direct question truthfully. While there may be an understandable hesitation to answer a patient’s pointed question about their surgeon’s HIV status, medical ethics and respect for persons demand an honest answer, just as they would to a question about training, experience, or complication rates. Therefore, surgeons should pose to patients the risks real and potential in a generic way and how they should be managed.
Obtaining fully informed consent is morally necessary in order to acknowledge and respect an individual patient’s autonomy. Truth disclosure is an integral part of this acknowledgement. Accusations of paternalism may arise from decisions to restrict information to patients. The caring professions require patients’ trust in order to deliver care effectively. Being seen to care for a culture of openness may enhance patients’ trust in the professions while the appearance of concealment would certainly diminish it. In a society with an increasing culture of openness, and where the right to information from governments and official bodies is receiving attention, it would seem desirable to provide comprehensive information about risks. Patients have a right not to be harmed by their medical practitioner.
This right is cherished in the concept of non-maleficence. While it is the duty of a doctor to do good to patients (benevolence), a particular treatment may not help all individuals. Thus, the least that a doctor should do is to do no harm. By not informing patients of their exposure, transmission might not be recognized, thus patients would be harmed by the denial of appropriate treatment. Moreover, if patients are infected, they constitute a transmission risk to those around them.
Health care providers should not adopt the paternalistic approach of deciding for their patients what level of risk is acceptable, but should consider patients’ views. Autonomy and truth disclosure are important influences on this decision. In deciding whether to inform patients, a balance must be struck between their desires to know of past exposure to risks, and the professional view that when risks are negligible, patients need not be informed. It is strongly suggested that patients’ needs should be given greater weight.
Courtney from Study Moose
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