Do MDs have a legal/ethical right to tell a patient's spouse of their STD?

[mac_kin]

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[mac_kin]

2

 

[Bacchus]

You have to tell his wife if he is willingly having sex with her and not disclosing his status. You can't intervene in stopping unprotected sex regardless of her sero-status if she is willingly taking the risk. However, if he doesn't disclose but you know they are sexually active, you must tell his wife or any other partners he has or had while HIV positive.

 

[aSagacious]

From Aids.gov:

Many states and some cities have partner-notification laws—meaning that, if you test positive for HIV, you (or your healthcare provider) may be legally obligated to tell your sex or needle-sharing partner(s). In some states, if you are HIV-positive and don’t tell your partner(s), you can be charged with a crime. Some health departments require healthcare providers to report the name of your sex and needle-sharing partner(s) if they know that information—even if you refuse to report that information yourself.

Some states also have laws that require clinic staff to notify a “third party” if they know that person has a significant risk for exposure to HIV from a patient the staff member knows is infected with HIV. This is called duty to warn. The Ryan White HIV/AIDS Program requires that health departments receiving money from the Ryan White program show “good faith” efforts to notify the marriage partners of a patient with HIV/AIDS.

 

[mmmcdowe]

Legally, you can't directly tell them (at least in most places), you just report. Even then it is only for some stds I believe, with the most prominent being hiv. I struggle with it ethically though, especially if they are in the building, because who knows how long, if ever, it will take to do so.

 

[isoquin]

Interesting ethical issue. I'm not going to get into state specifics, but the basis is generally that you have a responsibility to notify people who are about to be harmed. If a schizophrenic patient says he's going to go home and kill someone, we are generally obligated to report/warn. Clearly this is a more obvious case. Let's blur it a bit: what if instead of murder he would just rather inject their target with a disease? Move away from the crazy guy. What if someone with a transmittable STD tells you they will knowingly have unprotected intercourse with an uninformed partner? What's the difference between the last two scenarios. Intent, perhaps, but the end result is the same.

OK so we have a general idea that allowing patients to knowingly spread disease is bad. Now what? Well, depends on the disease. For a cold, we probably wouldn't do much. For things like TB, we actually report those illnesses, and we will even go to such lengths as to quarantine someone against their will if needed. But again, this is a clearer scenario.

The way I've heard most doctors reason through STD notification is to first encourage the patient to bring up the topic with their partner (with or without the help of a doctor, if needed), then report to a local/county/state board and let them handle the issue. It's my understanding that we can inform a partner that they are in danger, but we cannot say "hey your partner mac_kin has tertiary syphilis," even if they only have one sexual partner and notification is as good as naming them.

 

[ChubbyBaby]

You have to tell his wife if he is willingly having sex with her and not disclosing his status. You can't intervene in stopping unprotected sex regardless of her sero-status if she is willingly taking the risk. However, if he doesn't disclose but you know they are sexually active, you must tell his wife or any other partners he has or had while HIV positive.

Terrible advice.

You can't tell any single individual any private medical info about another person.

If there's some random state disclosure laws it's disclosure through an institutional process.

 

[VenusinFurs]

Yeah, holmes, you tell the health department and they notify sex partners in most states. It varies from state to state. Chlamydia and gonorrhea are usually not reportable. I think syphilis typically is. But under no circumstances would you tell the wife directly; I've come across that question in UWorld enough times .

TB infection is not always reportable. For example, with latent TB infection you can't even force people to take prophylactic INH in most circumstances. I know there's some random law in New York with hospital workers that you have to put up the number of hospital workers that had a positive TB test in each individual unit or some bull**** like that, but you can't id them by name.