Tuesday, August 07, 2007

Ethics: Privacy vs. Patient "Rights"

An interesting article in Haaretz, of all places, raises the question of whether patients should be told of their physician having HIV infection. "Keeping the Disease Under Wraps" outlines the surgeon's rights to privacy vs. patients interest in knowing his health. You could call it rational thinking vs. emotions as well.

The answer is not straightforward. The risk of HIV transmission is very small--estimated at 1/20,000-- and should be put in perspective of other risks, such as the risk of death from complications of surgery or other infections.

For example, the risk of transmission of Hepatitis C after a needlestick exposure from a HCV positive source is estimated at between 2-10%.

The risk of a serious Staph infection after surgery is generally estimated at 1-2%, and higher if the patient is diabetic, obese, or has some other co-morbidities.

In my previous experience doing Infection Control, the only thing that punitive restrictions do is drive people (be it the public or health care workers) underground so that they refuse to be tested. That is true whether carriers are out of work because of Salmonella, hepatitis, HIV, or Staph infections. No one will be willingly tested if they risk their career and livelihood, even though they have never been implicated in transmission. This is key.

One might also ask how many people might die from lack of access to a skilled surgeon. In the rural area where I live, they are at a premium.

More attention needs to be given to education about relative risks, trying to reduce the emotional charge that HIV/AIDS provokes. Given such a low risk, I would not prevent this surgeon from operating, if there are additional precautions in place, such as double gloving.

What do you think?

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