Case No. 4: A man dying of AIDS doesn’t want his family to know of his disease.
A man managed to live with HIV and aids for fourteen years without revealing his condition to his family. He was admitted to the hospital with pneumonia, and instructed his doctors not to disclose his illness to his family or friends. His condition rapidly deteriorated, and he fell into a coma. Several family members arrived at the hospital, including the patient’s brother, who was his health-care proxy agent. Were the doctors obligated to honor the patient’s wishes, or should they have informed his brother of his condition?
“The duty to maintain confidentiality is a strong but not absolute principle,” says Dan Sulmasy of St. Vincent’s. In this case, that duty has to be weighed against the possibility that telling the brother might influence the treatment choices he makes on the patient’s behalf. Say, for example, the man had misled his family into thinking he had cancer or diabetes, leaving the proxy to push for a course of treatment that would be futile. Several ethicists believe that by selecting a proxy, the patient designated at least one person to make decisions for him, and that person (and that person alone) should therefore be informed about his disease. “I think if we expect the health-care agent to act on his behalf, the agent needs to know his condition,” says Kathleen Powderly of the SUNY Downstate Medical Center. But that’s not an absolute principle, either. If the patient has only 24 hours to live, there would be little reason to disclose his condition and go against his wishes; his health-care proxy’s decisions would be immaterial. But if doctors think there are still viable options to prolong the patient’s life, then informing the proxy would become more important.
New York State has especially strong confidentiality laws pertaining to AIDS. Under those codes, doctors are required not to disclose a patient’s condition unless they have reason to believe he may have infected others. Because no person was known to be at risk of contracting the virus in this case, the hospital’s ethicists, lawyers, and doctors agreed that the family didn’t need to know that the patient had AIDS. They told the family that the patient was suffering from an underlying fatal disease that they were not at liberty to disclose.