Academic journal article The Hastings Center Report

When It Comes to HIV Infection, Some Are More Equal Than Others

Academic journal article The Hastings Center Report

When It Comes to HIV Infection, Some Are More Equal Than Others

Article excerpt

As other states do, Illinois gives physicians the privilege--but not the duty--to disclose an HIV infection to a patient's spouse, even if they must override the patient's wishes that they not do so. The law permits a physician to take this extraordinary step only after other efforts fail. First, the physician must attempt to persuade the patient to disclose this information him or herself. If the patient is unwilling or agrees but fails to follow through, the physician may then notify the spouse of the infection.

However, she is under no obligation to do this. If a physician thinks the disclosure might wreck her relationship with the patient, she is free to remain silent. Illinois statute indemnifies physicians against criminal charges (such as violations of confidentiality laws) or civil charges (failure to warn) whether they disclose or not.

Illinois lawmakers know full well that a patient's infection will endanger people who are not legal spouses: men and women live in coupled relationships outside marriage, as do men and men, and women and women. Not long ago, physicians at my university's hospital were upset that a patient refused a recommendation to disclose her HIV infection to her long-time boyfriend, even though he visited her regularly at the hospital. When the woman became unable to make decisions for herself, her surrogate also kept the HIV diagnosis from the boyfriend. Surrogate decision-makers are entitled to diagnostic information to help guide medical decisions for the patient, but the law makes no provision for the at-risk boyfriend.

The Illinois legislature could have extended the privilege of disclosure to any sexual or needle-sharing partner the physician believes is at risk of a patient's unknown HIV infection, but it did not. It chose instead to refract all relationships through the prism of marriage. But why are married spouses alone entitled to this kind of protection? Why not also sexual partners and needle-sharing partners? I don't assume that disclosures like this will stop all HIV infections: some partners will already have HIV unaware, and some partners may continue to expose themselves in sexual relationships and needle-sharing no matter what the risk. …

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