N330 Legal and Ethical Issues in Nursing

Case:  Jim is a 34-year-old man who is well-known to the community health centre that he and his family have attended for several years. He is married and has two young children. His wife is eight months pregnant. He is a computer salesman and spends much time away from home travelling to clients across the country.  A few weeks ago, Jim presented to the clinic complaining of generalized fatigue and lethargy. He had recently lost five kilograms and had noticed some unusual lesions on his inner thighs. As part of the blood screening done at that time, an HIV test was undertaken. This turned out to be positive. Given his clinical picture, it was likely that he had already developed AIDS.  Jim’s primary care nurse is present when his physician relays the bad news to Jim. Clearly distraught, Jim admits that he has had sexual intercourse with a number of women during his business trips, and on several occasions did not bother to use a condom. Fearful of the effects that this revelation would have on both his family and his business contacts, Jim pleads with his caregivers to keep this information, and his diagnosis, confidential. Given his wife’s pregnancy, he feels this knowledge might cause her undue harm. He assures them that he and his wife have not had intercourse since her pregnancy. He refuses any treatment for his AIDS-related symptoms, since this would make the diagnosis obvious to everyone. Instead, he asks that his family, including his wife, be told that he has terminal and incurable cancer. Jim’s physician (who is also his friend) says that he will respect Jim’s wishes for now.  Questions: Did the clinic have the right to test Jim for HIV without his knowledge or consent? Should the healthcare team keep Jim’s diagnosis confidential from his wife? If the primary care nurse disagrees with the decision of the physician, what can she do?