Objectives

1. Deine confidentiality and privacy in healthcare, and identify applicable laws,regulations, and institutional policies.

2. Explain why privacy and conidentiality are important in the clinical setting andthe harms that may result from breaches of them.

3. Describe behaviors or actions that respect, promote, diminish, or violate patientrights to privacy and conidentiality in healthcare settings.

4. Identify challenges that arise in protecting conidentiality and privacy, particularlybetween the desire to honor patient conidentiality and the duty to warn at-riskthird parties.

5. Identify how to respect conidentiality and privacy in the ethics consultationprocess.

Case

Al lies unconscious following an automobile accident and is on a ventilator in the ICU. He is35 years old and teaches economics at a local university. Al learned he was HIV+ 5 years ago.Since that time, Al has taken anti-HIV medications regularly and has received treatment froma local HIV clinic. According to medical records and the patient’s report, the medication hasbeen effective in reducing his viral count to undetectable levels. Prior to this accident, Al hadbeen experiencing no serious symptoms of the HIV infection, although on a few occasions hereported some physical fatigue. Al has a history of substance abuse, but has been drug free forover 5 years.

Al’s critical care team is considering a tracheostomy. However, Al’s family does not knowabout his HIV status. In fact, Al has discussed at length his refusal to disclose his status to hisfamily members with his primary physician. He cited the way they treated him after they foundout he had been using drugs, as well as how they treated his friends. He is certain that, if hisfamily members knew he was HIV+, they would cut off all contact with him and he would losetheir support.

How should the healthcare team proceed? Should a physician disclose Al’s HIV status to hisfamily?