You are a Certified Registered Nurse Practitioner (CRNP) working in a Pittsburgh doctor’s office. Presently you are caring for a 29 year old woman who is coming to terms with her diagnosis of HIV. Her name is Sandy. She was diagnosed with HIV a couple of days ago and this appointment is to make a plan of care for how it will be managed.
Upon diagnosis, the patient was put on a number of Anti-Retroviral Drugs that will help slow the progression of the disease. These drugs can also help to reduce transmission rates with new sexual partners. However, the Anti-Retroviral therapy (ART) does not completely eradicate the risk of transmission (Pau and George, 2014)*. Therefore, it is important that the patient shares her HIV status with any future partners. Another concern that the patient should think about is whether she spread the disease before she knew her diagnosis. As you begin talking to Sandy, you note that she has still not told her husband, Greg, about her diagnosis. You advocate for her to tell her husband because this disease spreads through sexual contact and the ART drugs do not eradicate the risk of transmission. Ultimately the appointment came to a close, and Sandy left the office with the Anti-Retroviral Drugs and the knowledge that she was going to have to tell her husband.
A couple of weeks later, Sandy walks into the doctor’s office and following immediately behind her was Greg and he did not look well. As you do your assessment on the Greg, you ask about his symptoms and when they began. At first, nothing seemed very notable and he presented with flu- like symptoms. Then, one thing he says catches your attention. He says the symptoms began two or three days after he was intimate with his wife, Sandy (“What are the symptoms of HIV and when do they appear? – Health questions – NHS Choices”, 2015). His symptoms seem to be lining up with an early diagnosis of HIV, so you draw blood to test Greg and the test returns positive. The first course of action would be to make sure the patient understands his diagnosis and how to live with his disease without passing it along. The next step would be to get him on ART drugs to reduce his risk of transmission and slow the progression of the disease.
As the PCP for both of these patients, you need to examine the situation with principlism-based reasoning, but also with a care based approach. The CRNP should examine the highest principle that must be followed, autonomy, but also help Greg to understand how and why this happened. How would you handle this situation?
Identify Issue that may be an ethical problem
In this scenario, the ethical problem that the CRNP is worrying about is how to facilitate communication between the Greg and Sandy. Sandy needs support in this difficult time and she probably already feels incredibly guilty. Regardless of the Sandy’s guilt, Greg deserves to know what happened.
Gather and synthesize facts
First, Sandy was diagnosed with HIV. Then, she was put on ART drugs and she knew that these drugs would not erase the possibility of transferring the disease. Greg now has HIV. In context, Sandy slept with Greg when she knew that she had HIV. Now, since the disease has been transferred from Sandy to Greg, Greg must go on ART drugs.
In many states, there are laws that focus on the act of endangering someone else through HIV exposure in consensual sexual activity (Galletly & Pinkerton, 2004).
Two Most Relevant Ethical Principles or Theories
In this scenario, Sandy and Greg had consensual sexual activity and Greg acquired HIV. Sandy had the opportunity to tell Greg beforehand and she chose not to. Sandy asserted her right to autonomy and her CRNP needs to maintain her autonomy. Autonomy is the freedom to make your own decisions (Butts and Rich, 2016). However, the CRNP also has to consider Greg’s right to know what happened. Greg is owed an explanation for how this happened because this diagnosis is something that will affect the rest of his life not only medically, but also romantically.
Relevant values, rights and duties of patient and other significant persons
There are many relevant values at play in this scenario. Sandy values peace, stability, and optimism. She loves her husband and liked the peace and stability in her relationship before her diagnosis, so she wanted to preserve these things. She was optimistic that the ART drugs would prevent Greg from contracting HIV. Sandy has the right to make her own decisions and it is not her health care provider’s job to force her to tell her husband. However, in her marriage, Sandy has a duty to Greg to be true to him in good times and bad.
Greg, like almost everyone, values his health. His health is something that is being taken away from him and he has the right to know why. But, even when Greg finds out that his wife gave him HIV, he has a duty through his marriage to love his wife in sickness and in health.
The health care provider in this scenario values compassion, fairness, trustworthiness, and responsibility. She remains compassionate for Sandy, even though her decision endangered someone else. The Sandy’s position was a hard position to be in. The healthcare provider values trustworthiness as well. If her patients cannot trust her, then she will not be able to help them to the best of her ability. If the healthcare provider just tells Greg that he contracted HIV from his wife, then the wife would completely lose trust in the healthcare provider. On the other hand, she values fairness and this situation was unfair to Greg. The healthcare provider also values responsibility. It is her responsibility to navigate this situation to the best of her ability and to facilitate communication with the husband and wife. The healthcare provider has the right to be treated with respect and dignity at all times. The healthcare provider also has the right to suggest treatment options, such as therapy. The healthcare provider has a duty to maintain confidentiality, provide the best possible care, and promote healthy relationships. The healthcare provider must examine all party’s values, rights, and duties to obtain the best possible outcome.
Identify If There Is An Ethical Dilemma Present
It is evident through further examination that an ethical dilemma is present. Sandy deserves autonomy and to have her decisions respected. On the other hand, Greg deserves to know how this happened.
Guidelines from Nursing and Relevant Professional Codes of Ethics
Due to the fact that there is an ethical dilemma, the CRNP cited the ANA code of ethics. The ANA states that if there is a breech in confidentiality the intrinsic trust between the patient and the healthcare provider would be broken (Code of Ethics for Nurses with Interpretive Statements, 2015). The CRNP does not want to break this trust because it could also hurt the patient’s relationship with her husband because they would not be able to have a therapeutic conversation about it. The ANA also has provisions about preserving human dignity and the right to health care (Code of Ethics for Nurses with Interpretive Statements, 2015). Greg has the right to good healthcare. Greg deserves to preserve his dignity through understanding what happened to him. The ANA also maintains health as a universal human right. The ANA Code of Ethics speaks of clean drinking water, health education, and immunizations, but also included is communicable diseases (Code of Ethics for Nurses with Interpretive Statements, 2015). Greg has the right to quality healthcare in the face of disease. Part of health care is psychological health. Greg’s psychological health will be affected if he does not get the understanding that he needs.
Identify and Justify Relevant Interdisciplinary Resources