Issues in Health Care - HIV Disclosure

Definition
Pro's (Need to Disclose)
Con's (No Need to Disclose)
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Definition

This issue basically deals with how much of their personal information health care professionals (HCP's) and others with HIV need to disclose to those around them. The first issue deals with disclosure by HCP to their patients:

Only one case of HIV transmission from health care professional to patient has been documented. The case involved an HIV+ dentist who might have infected a patient. Currently, the debate centers around the argument of disclosure of HIV status. Should HIV+ family practitioners inform their patients about their illness? What about HIV+ surgeons? Nurses? Are current protective measures enough? Many hospitals have a "don't ask, don't tell" policy towards infected employees. In fear of litigation from both HCPs and patients, they turn a blind eye.

The second issue deals with disclosure by other patients to their family, friends, or co-workers:

The only difference in this case is that others are not placed in direct contact with the infected person's bodily fluids. Still, many questions remained to be answered. Do the patient's family and friends deserve to know? What about her or his co-workers? Are they at risk?

Pro's (Need to Disclose)

The main argument for disclosure for HCPs relates to the idea that people have the right to know all risks--no matter how small--associated with their care. In turn, this arugement is founded on the assumption that HIV+ HCPs pose a risk to their patients. Proponents of disclosure argue that no protection is enough. In this age when we're constantly learning new facts about HIV transmission, we cannot afford to take any risks. Every day nurses and physicians across the country stick themselves accidentally with needles. What guarantees are there that they won't accidentally bleed into patients during surgical or invasive procedures?

Similar arguments can be made for disclosure on the parts of other patients. Spouses or partners should know so they can protect themselves from infection. Other family members should know simply for emotional reasons -- they must be prepared to handle the worst.

Con's (No Need to Disclose)

The primary argument against disclosure revolves around the idea that HCPs do not pose a risk to patients in the first place. Without fluid-to-fluid contact, HIV cannot be spread. In addition, physicians and nurses wear gloves when handling needles. Often, in emergency rooms, they double up on gloves. Certain doctors who do not perform invasive proceedures present no risk to patients. Others take more than adequate protection. While there's no guarantee, the emperical evidence indicates that the risk is negligible. While a number of HIV+ HCPs are known to be practicing medicine, only one -- the Florida dentist -- has ever been accused of passing the virus to his paitents.

Again, similar claims can be made for hiding the HIV status of non-HCPs. Most people with AIDS pose no risk to their co-workers. Many might be able to carry out their responsibilities for years after being diagnosed.
(Note: Most would agree that there is no argument for hiding HIV status from spouses or partners.)