Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
Center for Bioethics, University of Minnesota, Minneapolis, USA.
AIDS Res Ther. 2015 May 5;12:15. doi: 10.1186/s12981-015-0057-8. eCollection 2015.
Codes of confidentiality play an essential role in the intimate discourses in many learned professions. Codes with various prescriptions exist. The Hippocratic Oath for example, prescribes rewards to the secret keeper, for keeping secret what ought to be kept secret, and punishments for failing. In public health practice, partner notification, arguably is one endeavor that tests the durability of this secret keeping doctrine of the health professional. We present an interest-analysis of partner notification in the context of HIV service rendition. Using principles-based analysis, the interests of the individual, the state/public health, and the bioethicist's are discussed. The public health interests in partner notification, which are usually backed by state statutes and evidence, are premised on the theory that partners are entitled to knowledge. This theory posits that knowledge empowers individuals to avoid continuing risks; knowledge of infection allows for early treatment; and that knowledgeable partners can adapt their behavior to prevent further transmission of infection to others. However, persons infected with HIV often have counter interests. For instance, an infected person may desire to maintain the privacy of their health status from unnecessary disclosure because of the negative impacts of disclosure, or because notification without a matching access to HIV prevention and treatment services is detrimental. The interest of the bioethicist in this matter is to facilitate a resolution of these conflicted interests. Our analysis concludes that governmental interests are not absolute in comparison with the interests of the individual. We reiterate that any effort to morally balance the benefits of partner notification with its burdens ought to first recognize the multivalent nature of the interests at play.
保密规范在许多专业领域的私密话语中起着至关重要的作用。存在着各种规定的规范。例如，希波克拉底誓言规定，对于保守应当保守的秘密的保密者，给予奖励，对于未能保守秘密的保密者，给予惩罚。在公共卫生实践中，伴侣通知可以说是检验卫生专业人员保密原则的耐久性的一种努力。我们在 HIV 服务提供的背景下对伴侣通知进行了利益分析。使用基于原则的分析，讨论了个人、国家/公共卫生和生物伦理学家的利益。伴侣通知的公共卫生利益通常得到州法规和证据的支持，其前提是伴侣有权获得信息。这一理论假设，知识使个人能够避免持续的风险；了解感染情况可以进行早期治疗；知情的伴侣可以调整自己的行为，以防止进一步将感染传播给他人。然而，感染 HIV 的人通常有相反的利益。例如，感染者可能希望保持其健康状况的隐私，避免不必要的披露，因为披露会带来负面影响，或者因为没有匹配的 HIV 预防和治疗服务的通知会造成损害。在这件事上，生物伦理学家的利益是促进解决这些冲突的利益。我们的分析得出结论，与个人利益相比，政府利益并非绝对。我们重申，任何努力在伴侣通知的利益与其负担之间进行道德平衡，都应该首先认识到所涉及的利益的多面性。
