Confidentiality and HIV Status

Abstract

Confidentiality is an important ethical principle within health care. In order for confidential information to be revealed, it has to be shown that there are legitimate reasons favouring disclosure which significantly outweigh those supporting confidentiality. This paper examines whether or not such reasons exist in respect of the HIV status of both physiotherapists and patients. Physiotherapists might argue that they need to know if their patients are seropositive, either for the purposes of effective treatment or in order to protect themselves from infection. It is argued that neither of these constitute a ‘need to know’. Except when progression to AIDS has occurred (in which case the diagnosis will be known to the therapist), a patient's HIV status does not determine the choice or effectiveness of therapy. Equally, the adoption of universal precautions provides optimum protection against transmission of HIV, and does not depend on a knowledge of who is or is not seropositive. Patients might wish to know whether or not their physiotherapist is HIV-positive. The sort of therapeutic interaction that occurs between therapist and patient creates an infinitely small risk of HIV transmission, and cannot therefore overturn the presumption of confidentiality. The anxieties which may be felt by some therapists and patients on this issue are best allayed by a process of education and attitude change, not by inappropriate and purposeless breaches of confidentiality. Confidentiality is an important ethical principle within health care. In order for confidential information to be revealed, it has to be shown that there are legitimate reasons favouring disclosure which significantly outweigh those supporting confidentiality. This paper examines whether or not such reasons exist in respect of the HIV status of both physiotherapists and patients. Physiotherapists might argue that they need to know if their patients are seropositive, either for the purposes of effective treatment or in order to protect themselves from infection. It is argued that neither of these constitute a ‘need to know’. Except when progression to AIDS has occurred (in which case the diagnosis will be known to the therapist), a patient's HIV status does not determine the choice or effectiveness of therapy. Equally, the adoption of universal precautions provides optimum protection against transmission of HIV, and does not depend on a knowledge of who is or is not seropositive. Patients might wish to know whether or not their physiotherapist is HIV-positive. The sort of therapeutic interaction that occurs between therapist and patient creates an infinitely small risk of HIV transmission, and cannot therefore overturn the presumption of confidentiality. The anxieties which may be felt by some therapists and patients on this issue are best allayed by a process of education and attitude change, not by inappropriate and purposeless breaches of confidentiality.