Zonana H
Yale University School of Medicine, New Haven, Connecticut 06519.
Hosp Community Psychiatry. 1989 Feb;40(2):162-4. doi: 10.1176/ps.40.2.162.
The author argues that the American Psychiatric Association's AIDS policy on confidentiality and disclosure provides reasonable guidelines for psychiatrists struggling to balance their obligation to maintain the confidentiality of individual patients infected with human immunodeficiency virus (HIV) with their obligation to protect the community's health. The policy states that notification of third parties who may be exposed to infection through the behavior of an HIV-positive patient is ethically permissible if the psychiatrist has exhausted efforts to work with the patient to terminate behavior that places others at risk and if the patient understands the limits of confidentiality. The author points out that judicious notification is within the medical tradition that includes disclosure of a patient's dangerousness in situations involving infectious diseases such as tuberculosis and is supported by the duty-to-warn precedent set by the Tarasoff decision.
作者认为，美国精神病学协会关于保密与信息披露的艾滋病政策，为那些努力平衡维护感染人类免疫缺陷病毒（HIV）的个体患者的保密义务与保护社区健康义务的精神科医生提供了合理的指导方针。该政策指出，如果精神科医生已竭尽全力与患者合作以终止使其行为对他人构成风险的行为，且患者理解保密的限度，那么向可能因HIV阳性患者的行为而面临感染风险的第三方通报情况在伦理上是允许的。作者指出，明智的通报符合医学传统，在涉及诸如肺结核等传染病的情况下，该传统包括披露患者的危险性，并且得到了塔拉索夫案判决所确立的警告义务先例的支持。
