Isaacman S H, Closen M L
John Marshall Law School, Chicago.
Postgrad Med. 1989 May 15;85(7):42-4, 53-5, 59. doi: 10.1080/00325481.1989.11700717.
Although physicians have a moral and professional duty to prevent the spread of human immunodeficiency virus (HIV) by seeing that the infected patient's contacts are informed of the risks, they have no legal guidelines on how to approach the problem. Medical organizations recommend that physicians notify an endangered third party if the infected patient refuses to cease high-risk activity and the authorities do not take action. However, many questions remain about practical application of these recommendations. Some federal recommendations place the burden of notifying the third party on the infected patient, then on the public health authority, and finally on the physician. However, these suggestions are not law. Legal precedent has placed responsibility on the physician for warning persons exposed to an infected patient that a risk exists. However, warning someone who is not clearly at risk can also invite a lawsuit. At present, there is no clear public policy to give guidance either. By considering the infectivity of the virus, injury potential of the infection, and the exposed person's relationship with the patient, the physician can better weigh the risk of breaching patient confidentiality versus ignoring the health dangers to the third party. Thorough counseling of the patient about infectivity, careful documentation of all conversations and efforts, and use of good judgment are the best tools that physicians have at present for handling this legal void.
尽管医生有道义上和职业上的责任，通过确保告知受感染患者的接触者相关风险来防止人类免疫缺陷病毒（HIV）的传播，但对于如何处理这个问题，他们没有法律指导方针。医疗组织建议，如果受感染患者拒绝停止高风险行为且当局未采取行动，医生应通知处于危险中的第三方。然而，关于这些建议的实际应用仍存在许多问题。一些联邦建议将通知第三方的责任首先置于受感染患者身上，其次是公共卫生当局，最后才是医生。然而，这些建议并非法律。法律先例已将警告接触受感染患者的人存在风险的责任置于医生身上。然而，警告并非明显处于风险中的人也可能引发诉讼。目前，也没有明确的公共政策提供指导。通过考虑病毒的传染性、感染的潜在伤害以及接触者与患者的关系，医生可以更好地权衡违反患者保密义务的风险与忽视第三方健康危险的风险。对患者进行关于传染性的全面咨询、仔细记录所有谈话和努力，以及运用良好的判断力，是医生目前处理这一法律空白的最佳工具。
