Bayer R, Toomey K E
Columbia University School of Public Health.
Am J Public Health. 1992 Aug;82(8):1158-64. doi: 10.2105/ajph.82.8.1158.
In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made.
对于患有性传播疾病的医疗患者（尤其是感染人类免疫缺陷病毒的患者），存在两种不同的方法来通知性伴侣和/或共用针头的伙伴可能存在的风险。每种方法都有其自身的历史（包括实施过程中独特的实际问题），并引发了各自的伦理困境。第一种方法——道德上的“警告义务”——源于临床情况，即医生知道被认为处于风险中的人的身份。第二种方法——接触者追踪——则源于性传播疾病控制项目，在该项目中，临床医生通常不知道可能接触过病毒的人的身份。这两种方法之间的混淆导致许多人将本质上是自愿的过程误认为是强制性的，将尊重保密的过程误认为是侵犯隐私。在艾滋病流行的背景下以及这两种方法的变迁中，我们描述了伴侣通知的复杂问题，并强调了做出政策决定的伦理和政治背景。
