Instruction: Read the situation carefully. Apply the Seven Step Reasoning Model

to determine the best ethical choice to make. Write your answer in the space

provided below.



"Please Don't Tell!"



A twenty-year-old Hispanic male was brought to a hospital emergency

room, having suffered abdominal injuries due to gunshot wounds obtained in

gang violence. He had no medical insurance, and his stay in the hospital was

somewhat shorter than expected due to his good recovery. Physicians

attending to him felt that he could complete his recovery at home just as easily

as in the hospital and he was released after only a few days in the hospital.



During his stay in the hospital, the patient admitted to his primary

physician that he was HIV positive, having contracted the virus that causes

AIDS. This was confirmed by a blood test administered while he was hospitalized.

When he was discharged from the hospital, the physician recommended that

a professional nurse visit him regularly at home in order to change the bandages

on his still substantial wounds and to ensure that an infection did not develop.



Since he had no health insurance, he was dependent on Medicaid, a

government program that pays for necessary medical care for those who

cannot afford it. However, Medicaid refused to pay for home nursing care since

there was someone already in the home who was capable of providing the

necessary care. That person was the patient's twenty-two-year-old sister, who

was willing to take care of her brother until he was fully recovered. Their mother

had died years ago, and the sister was accustomed to providing care for her

younger siblings.



The patient had no objection to his sister providing this care, but he

insisted that she not be told that he had tested HIV positive. Though he had

always had a good relationship with his sister, she did not know that he was an

active homosexual. His even greater fear was that his father would hear of his

homosexual orientation and lifestyle. Homosexuality is generally looked upon

with extreme disfavor among Hispanics.



The patient's physician is bound by his code of ethics that places a very high priority on keeping confidentiality. That is, information about someone's

medical condition that he or she does not want known cannot be divulged by

the physician. Some would argue that the responsibility of confidentiality is even

greater with HIV/AIDS since disclosure of someone's homosexuality normally

carries devastating personal consequences for the individual who is forced "out

of the closet."



On the other hand, the patient's sister is putting herself at risk by providing

nursing care for him. Doesn't she have a right to know the risks to which she is

subjecting herself, especially since she willingly volunteered to take care of her

brother?



If you were the physician, what would you do in this case? Would you

breach the norm of confidentiality to protect the patient's sister, or would you

keep confidentiality in order to protect the patient from harm that would come

to him from his other family members, especially his father?



Perhaps as good a question as "what would you do" in this situation is the

question, "how would you decide what to do" in this situation? The process of

making a moral decision can be as important as the decision itself, and many

ethical decisions that people encounter are so complex that it is easy to exhaust

oneself talking around the problem without actually making any progress

toward resolving it. The response to many moral dilemmas is "where do I start?'

and the person who is faced with these decisions often needs direction that will

enable him or her to move constructively toward resolution and "see the forest

for the trees."



In order to adequately address the ethical dilemmas that people

encounter regularly, the following is a model that can be used to ensure that all

the necessary bases are covered. This is not a formula that will automatically

generate the "right" answer to an ethical problem. Rather it is a guideline that is

designed to make sure that all the right questions are being asked in the process

of ethical deliberation.

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