What do you do if an AIDS patient is dying but does not want the family members to know the diagnosis?
This was an ethical dilemma that I faced some time ago. This young man was admitted with pneumonia and expressly told the doctors not to disclose his illness to family and friends. As doctors, we were bound to uphold confidentiality. Should this be absolute at all costs, no matter what?
As was expected, his condition quickly deteriorated and he lapsed into coma. Close friends and relatives soon arrived at the hospital, each one enquiring on what was wrong.
Needless to say, a decision had to be made quickly enough on what to reveal or, more important, what not to reveal. We decided that, as the patient had nominated a next-of-kin, that this person would be the proxy for determining the future management and course of action. The patient had voluntarily nominated a person to make decisions on his behalf, so, by inference, this person should be told of his actual disease.
However, after much discussion, the medical team agreed that, as it was unlikely that the patient would survive another 24 hours, telling the next-of-kin was not going to affect decisions on management anyway. It would have been different if there were possibilities that treatment could realistically prolong his life; then the next-of-kin would have needed to be told of the diagnosis in order to obtain permission for the next course of action.
The patient eventually passed on a few hours later and relatives were told that he died of pneumonia due to an underlying cause for which the doctors were not under the liberty to disclose.
In this case, the duty to maintain doctor-patient confidentiality was maintained. This duty is not absolute always as pointed out above. Also, as AIDS is a notifiable disease, health authorities needed to be informed and further action necessary if there is a suggestion that the patient had infected others.