Our ethics lecture was really interesting yesterday. As a disclaimer, I have made a lot of this information up. But the concept we discussed is still viable.
The case we were given was...controversial. A HIV-positive woman tells her doctor that she doesn’t want to tell her husband about her HIV-positive status.
However, this woman is pregnant. And her child will need to take anti-viral medication for 6 weeks after birth. And, of course, she wants to hide the reason that their child is taking medication for 6 weeks. So, she asks the doctors to prescribe the baby medication without telling the father.
When I first heard this, I was appalled. And a bit angry. What is she doing hiding her HIV+ status from her husband? And as our class got going, I realized there were things I hadn’t even thought of.
What are the father’s legal rights? Does he have a right to know what medication his child is taking? Is it ethical to give medication to a child without telling both parents (especially when both parents are in his life)?
While it is legal for the woman to have sex with her husband without disclosing her HIV+ status – what do you do as her doctor? It rubs me the wrong way to just let him go about his merry way. After all, one of our “callings” as a doctor is to “prevent” right? Not doing a great job of that if we don’t tell him. But is it even legal for us to tell him? Should we be compelled to tell him?
The case becomes more complicated when you consider that the woman feared for her life. Her husband had been violent in the past with her. She was convinced that if her husband found out, he would kill her. Undoubtedly bad for the baby’s health. Even if he didn’t kill her, she was certain she would be disowned from her multi-generational home. Her family was extremely Catholic, located in a Southern state and associated HIV+ with promiscuity. Also, bad for the baby.
My brain is about to explode now. Who is my loyalty to? The baby, the mother, or the father? What if all three of them are my patients? Should we just side with the baby since it’s, well, a baby, and they are different than adults? They need more protection than mom and dad. But if we don’t take care of dad, he might get complications from untreated HIV. If we take care of dad, then we no longer take care of mom because she is either dead or excommunicated (supposedly). And if either parent is incapacitated, the baby is unlikely to get the care it deserves. Well, crapbox.
The decision that was made left me feeling uncomfortable, but convinced I had no better answer. The decision was to not tell the dad. The rationale was that he probably already had HIV. The wife had no other risk factors for HIV, so it was probable that she originally contracted it from her husband.
And the questions didn’t even stop once the decision is made!
What if the dad asks a doctor directly: “What is this medication I am giving my child?” Should the physician lie? And if the physician doesn’t lie and tells the dad the truth – can you imagine the dad’s reaction? He’d probably go get a lawyer and sue the pants off any doctor/hospital he could find involved in withholding this information from him. What would your reaction be to information like that?
Intellectually, I knew that everything was grey, but not this grey. Making decisions that leave me feeling crappy does not sound fun. But I’m actually really excited for ethics. I can’t believe I’m going to be allowed to make decisions like this. Really scary and really awesome all at the same time.