Ketels Bjorn, Vander Beken Tom
Ghent University, Belgium.
Med Law Rev. 2012 Summer;20(3):399-422. doi: 10.1093/medlaw/fws010. Epub 2012 Jun 29.
Research has shown that HIV-positive patients sometimes refuse to take precautionary measures against sexual transmission as well as to notify their sexual partner(s) of their status. Faced with such a situation, physicians find themselves in a dilemma as they are forced to choose between honouring their duty of professional confidentiality and protecting their patients' partner(s). Recent advice from the Belgian Medical Council (BMC) for the first time accepts that physicians can exceptionally, and under certain conditions, invoke necessity to breach confidentiality and inform usual and occasional sexual partners of HIV-infected patients who refuse to take precautions against transmission. This article sketches the ethical evolution of this position from 1987 up to now in Belgium, and examines whether or not the BMC's opinion on the matter corresponds to the applicable substantive criminal law provisions and whether or not partner notification could also be defended for other sexually transmissible infections (STIs). A case study of the situation in Belgium illustrates how discussions about STIs can deeply influence the evolution of legal and ethical rules about medical confidentiality.
研究表明，艾滋病毒呈阳性的患者有时会拒绝采取预防性传播的措施，也不将自己的病情告知其性伴侣。面对这种情况，医生们陷入了两难境地，因为他们被迫在履行职业保密义务和保护患者性伴侣之间做出选择。比利时医学委员会（BMC）最近给出的建议首次承认，医生在某些特定条件下可以破例援引必要性原则，打破保密规定，告知那些拒绝采取传播预防措施的艾滋病毒感染患者的固定性伴侣和临时性伴侣。本文概述了1987年至今比利时这一立场的伦理演变，并探讨了BMC对此事的观点是否符合适用的实体刑法规定，以及对于其他性传播感染（STI），是否也可以为通知性伴侣进行辩护。对比利时情况的一个案例研究表明，关于性传播感染的讨论如何深刻影响医疗保密法律和伦理规则的演变。
