1) Dr. M may very well have an obligation to refrain from performing surgery due to the liability. Yes the chance of contracting HIV through surgery is low, it is still a huge risk if you are that one patient that does. Ethically speaking he should be upfront with the hospital and patients. However, not many patients would be willing to chance contracting it over a surgery. He does have the right to privacy as well, and not for his HIV to be blasted through the community. Unfortunately this is a career that doesn't come with out hard work, time, and dedication. It's a shame to see skills wasted but he should probably refrain from doing this job. 2) Yes, the patients have the right to know. 3). The same case flipped in reverse as Dorothea L is the patient who is infected with HIV has a moral obligation to tell the surgeon but not legal. As a practicing healthcare provider you should always maintain universal/ standard precautions. A heads up from the patient is nice too!
I agree with you that the patient doesn't have a legal obligation but it is more of a moral obligation. Because if standard precautions are taking the rate of transmission is almost zero.
In the case of Carlos, the patient with HIV who's sister will be taking care of his dressing changes, I don not believe the physician has the right to disclose his HIV status. there are other steps that can be taken to ensure her safety without violating his privacy. As recommended, the physician can assist the patient in finding wound care specialists to assist him. Also, if the emphasis is on educating the sister on how to have good hand hygiene and and how to protect herself from any blood borne illness then she will hopefully take the steps that a health care provider would take to protect herself.
case 12 1) I do believe that the physician has the obligation to either stop doing surgery or to inform his patients and give them the opportunity to make the choice for themselves if they would like him to do the surgery. 2) if a patient has HIV they absolutely have the obligation to inform their medical provider. It is our job to care for patients without discrimination and to not disclose their medical information so there is no reason to not inform us. of course we will folly standard precautions anyway, but in the incidence that there is an exposure this needs to be on the table.
Case 12--- I feel that Dr. M should have to inform all of his previous patients that he has learned that he was infected with HIV. Giving the patients the heads up to get themselves tested. Unfortunately I think that even if Dr. M was the best surgeon there is that he would be obligated to step down from this position due to how it could be easily transmitted to one of his patients. There are many more jobs that this surgeon could do with out performing surgery. If he was not obligated to step down from his position of doing surgery, I do think that he should be obligated to inform his patients, then it should be up to the patient to follow through with the surgery with him or to go to another practitioner. By all means the patient is obligated to tell any healthcare provider that the have HIV, we as practicing healthcare providers still provide care for patient without judgement. We do take precautions on all patients but we still need to know what we are dealing with. Se still would place no judgement but we need to protect ourselves as well.
As far as patients having to report that to doctors I don't believe patients should have to do that because it could cause surgeons to not want to treat patients and preform their procedures. As far as Dr. M stepping down to me that seems like a drastic measure for a virus that isn't easy to contract.
Case 12 Dr. M doesn't have an obligation to stop doing surgical procedure the odd's of a patient getting infected is low. It also states on a surgical consent that infection of any kind is a risk of the procedure. Safety measures are taken to do their best to prevent these contaminations such as double gloving and safety zones were the sharps for a procedure is placed are always used it is a standard of care. As far as disclosing this to the patient once again I don't believe you would have to do this as well because it is his medical information which he is allowed to keep private. HIV is a scary thing to contract but it isn't the death sentence that it used to be. It isn't easily contracted and the risk of it being contracted in the OR is small. As far as the patient telling the Dr. I also believe that she isn't obligated to either. We are always supposed to use standard precautions. In the operating room we obviously use above standard precautions we double glove wear masks, gowns, and eye protection. Being exposed to that is a risk we take coming into work everyday.
Playing devils advocate... Say there is a patient who does not inform the staff that she is HIV infected. Wold you want to be assisting the knife wielding surgeon as he hurriedly tried to beat his personal best time and sticks you with a dirty needle? If the patient had disclosed her status the physician would most certainly take every precaution possible to reduce any risk of exposure, and go slowly.
I wanted to see what you thought since you work in the OR. I agree with you fully. I wonder how many people work in health care and are carriers and don't even know it?
Case 12- 1. Dr. M does have an obligation to refrain from performing surgery since any rate of transmission is possible. Even if it is a low risk, I am surprised the risk management department hasn’t stepped in. If they think it may result in a lawsuit they may force his hand. With today’s technology he may still perform surgery if he is trained with the DaVinci robot. He would not run the risk of contamination and still use his skills. 2. If Dr. M is only performing robotic surgeries, then he would not have a need to inform his patients of his HIV status since he doesn’t pose them any risk. 3. If Dorothea L. is infected and in need of surgery I do believe that she has an obligation to inform the staff. If it were a procedure where there was no contact with bodily fluids that could cause transmission, then I believe she does have some right to privacy. By following Universal precautions, the staff would be safe, but once blood is involved as in surgery, then that opens up the risk. Not only to the surgeon, but the OR staff, and the environmental service staff responsible for cleaning up the OR and handling the bio-hazardous waste. Even with all the proper personal protective equipment, there is still a risk.
I know the feeling Jocelyn. I was caring for a patient with Hep c and while giving him a bath, a blister on his hip burst in my face, getting in my mouth and eyes. I had to go through testing for a year afterwards. I am with you about the Ebola suits. Hep C+ patients are move prevalent because of the UN-controllable drug abuse going on in our country. I don't think it's going to get any better, only worse.
1. I believe, even if the risk is low, he needs to refrain from doing any further surgery. A risk is a risk. There are other options such as the DaVinci robot to combat the exposure issue. 2. Dr. M has the moral and ethical duty to make his former patients and current patients aware of his HIV status. 3. With the risk of possibly contacting HIV by an innocent stick or contamination, I would hope Dorothea L. would disclose her HIV status. She does have a right to privacy, but also has to duty to protect the health of her surgeon, surgical staff and other members of her healthcare team.
Case 12, using Casuistry to argue case (against what I actually believe) Dr. M does not have the obligation to refrain from performing surgery. He is a skilled surgeon with much experience, he is not going to cut himself and expose his patient. He also is not obligated to disclose his HIV status to his patients. If he discloses the information to his patient about his HIV status, he will cause the patient unnecessary worrying. The statistics show that there is only a 3 in 1000 chance that an HIV infected surgeon’s blood mixing with the patients could cause the patient to contract HIV. Despite the statistics that surgeons cut themselves 2.5 in every 100 surgeries, Dr. M. is not one of those surgeons. His skills are impeccable, he will exercise extreme extra caution and will not have any mishaps. His patient will recover much better without the constant worrying if they were exposed or not. Is Dorthea L. obligated to notify Dr. M of her HIV status before he operates on her? Absolutely not. The surgeons and OR staff use universal precautions, and, if they are practicing medicine as they are supposed to, they will not be exposed to her blood. Their gloves, gowns and masks will keep them safe. If they did get blood on them, it would be poor medical procedure, and Dorthea L. should actually b upset because they are putting her at risk to be exposed to infections or bloodborne pathogens they might have.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
CDC. (2012). HIV/ AIDS 101. Retrieved from http://www.cdc.gov/cdctv/diseaseandconditions/hiv/hiv-aids-101.html
Yes, the risk is very low. What if the surgeon had Hepatitis, wouldn't the risk of a patient contracting that be even higher? Is that a reason for a surgeon to quit his practice? Having HIV carries such a stigma, that neither the physician or the patient would want to disclose this. They could probably keep this to their self completely and go with the thought that the risk is so low, that there's no harm likely to happen. This probably happens all the time, and people are just unaware
Case 12 1) I believe he should step down from direct surgery and stick to only robotic. The risk is low, but it's another risk that if a person was given complete informed consent should be made aware of all risks. That would be one of them. 2) The physician likely would never disclose this to his patients because it would ruin his practice. He wouldn't need to if he sought other branches of surgery to practice in - such as I mentioned above, robotic. 3) Dorothea should inform the doctor merely because typically before a patient undergoes any type of medical treatment, including surgery, a complete Health and Physical is performed. All aspects of the patient's medical and surgical history is disclosed. It's how the health care professional can best take care of the whole person. Confidentially is always kept with the medical field as well as universal precautions.
Great point Gloria, I didn't even consider robotic surgery. I agree if he did disclose his HIV status, his practice would surely be ruined. I know I would opt for a different surgeon if I knew.
I think if he is clear about the risks and his patient gives him consent to do the procedure, he should be allowed. We don't know how he acquired his disease, so I don't think he should use his career. This could also apply to nurses that are carriers.
Great Points by Gloria and Chris! robotic surgery is a great option. On the other hand, losing your career from an exposure from work would be terrible.
This was a tough one! I can see both sides to the issue. I know I would want to know if my surgeon was HIV positive, and in result I would most likely refuse to be operated on by him or her. That brings up an issue of fairness and discrimination against the physician as well however. I can see where a physician only wanting to do his job would be discriminated against, but at the same time, other’s safety is at risk. We are not talking about a staph or MRSA infection; this is a life threatening infection that is irreversible. I suppose I am playing devil’s advocate with myself, but I am truly torn on a definite yes/no answer for these case questions however I will argue one side.
Does Dr. M. have an obligation to refrain from performing surgery? I feel like the key word here is “obligation”. To that I will say no. His obligation is to SAFELY perform the surgery the patient needs in order to survive or improve life or whatever it may be. By SAFELY I mean sterility, and using all precautionary measures to ensure everyone’s safety from contamination. With the physician having the knowledge of his disease, I would expect him/her to practice even more carefully and if accidentally cut would immediately take measures to prevent cross contamination. To answer question two in the case study, no I do not feel like the physician needs to disclose his virus to his patients for the same reasons as mentioned in question one. To continue on to question three, my answer is still no. A patient has the same confidential rights as the physician. The physician should be practicing in a manner that would protect him and the patient of transfer of body fluids in every case, every time.
I can see your points. Although I must say that I do clench my teeth when I am taking care of a patient and after asking about their health history, they fail to tell me that they are hep c +. I feel like more and more we are seeing patients come in with that. I do my best to follow universal precautions, but in a delivery we deal with all types of bodily fluids. I may just start wearing the Ebola suits to every delivery to keep me safe!
I believe that Dr. M has a moral and ethical duty to tell his patients and discuss the risk that he imposes on them. It ia then their decision to allow him to perform the surgery of find another surgeon. This would be along with discussing the risks of the surgery. Why would you not tell them about yourself but warn them of the other dangers associated with surgery. If he gets consent from the patient, then he should be allowed to perform the surgery. The patients should also inform the surgeon of any potential blood pathogens they carry such as hepatitis and HIV. We all know to use universal precautions but it is nice when the patients tell us so we slow down and take our time taking care of that patient. We are so conditioned to work fast that errors and needle sticks do occur. I know that when a patient informs me, I am very aware of what I am doing with that p[patient.
1) Dr. M may very well have an obligation to refrain from performing surgery due to the liability. Yes the chance of contracting HIV through surgery is low, it is still a huge risk if you are that one patient that does. Ethically speaking he should be upfront with the hospital and patients. However, not many patients would be willing to chance contracting it over a surgery. He does have the right to privacy as well, and not for his HIV to be blasted through the community. Unfortunately this is a career that doesn't come with out hard work, time, and dedication. It's a shame to see skills wasted but he should probably refrain from doing this job.
ReplyDelete2) Yes, the patients have the right to know.
3). The same case flipped in reverse as Dorothea L is the patient who is infected with HIV has a moral obligation to tell the surgeon but not legal. As a practicing healthcare provider you should always maintain universal/ standard precautions. A heads up from the patient is nice too!
I agree with you that the patient doesn't have a legal obligation but it is more of a moral obligation. Because if standard precautions are taking the rate of transmission is almost zero.
DeleteYes it seemed to be a very low transmission rate, so yes moral obligation yes. Legally he should have just as much privacy about his health too.
DeleteIn the case of Carlos, the patient with HIV who's sister will be taking care of his dressing changes, I don not believe the physician has the right to disclose his HIV status. there are other steps that can be taken to ensure her safety without violating his privacy. As recommended, the physician can assist the patient in finding wound care specialists to assist him. Also, if the emphasis is on educating the sister on how to have good hand hygiene and and how to protect herself from any blood borne illness then she will hopefully take the steps that a health care provider would take to protect herself.
ReplyDeletecase 12
1) I do believe that the physician has the obligation to either stop doing surgery or to inform his patients and give them the opportunity to make the choice for themselves if they would like him to do the surgery.
2) if a patient has HIV they absolutely have the obligation to inform their medical provider. It is our job to care for patients without discrimination and to not disclose their medical information so there is no reason to not inform us. of course we will folly standard precautions anyway, but in the incidence that there is an exposure this needs to be on the table.
Case 12---
ReplyDeleteI feel that Dr. M should have to inform all of his previous patients that he has learned that he was infected with HIV. Giving the patients the heads up to get themselves tested. Unfortunately I think that even if Dr. M was the best surgeon there is that he would be obligated to step down from this position due to how it could be easily transmitted to one of his patients. There are many more jobs that this surgeon could do with out performing surgery. If he was not obligated to step down from his position of doing surgery, I do think that he should be obligated to inform his patients, then it should be up to the patient to follow through with the surgery with him or to go to another practitioner.
By all means the patient is obligated to tell any healthcare provider that the have HIV, we as practicing healthcare providers still provide care for patient without judgement. We do take precautions on all patients but we still need to know what we are dealing with. Se still would place no judgement but we need to protect ourselves as well.
As far as patients having to report that to doctors I don't believe patients should have to do that because it could cause surgeons to not want to treat patients and preform their procedures. As far as Dr. M stepping down to me that seems like a drastic measure for a virus that isn't easy to contract.
DeleteAlex given that you work in the OR I am surprised at our stance o this.
DeleteLogical thought in other jobs he could do to still utilize his skill yet not expose patients. Did not eve. Think about robotic surgery!
DeleteCase 12
ReplyDeleteDr. M doesn't have an obligation to stop doing surgical procedure the odd's of a patient getting infected is low. It also states on a surgical consent that infection of any kind is a risk of the procedure. Safety measures are taken to do their best to prevent these contaminations such as double gloving and safety zones were the sharps for a procedure is placed are always used it is a standard of care.
As far as disclosing this to the patient once again I don't believe you would have to do this as well because it is his medical information which he is allowed to keep private. HIV is a scary thing to contract but it isn't the death sentence that it used to be. It isn't easily contracted and the risk of it being contracted in the OR is small. As far as the patient telling the Dr. I also believe that she isn't obligated to either. We are always supposed to use standard precautions. In the operating room we obviously use above standard precautions we double glove wear masks, gowns, and eye protection. Being exposed to that is a risk we take coming into work everyday.
Playing devils advocate... Say there is a patient who does not inform the staff that she is HIV infected. Wold you want to be assisting the knife wielding surgeon as he hurriedly tried to beat his personal best time and sticks you with a dirty needle? If the patient had disclosed her status the physician would most certainly take every precaution possible to reduce any risk of exposure, and go slowly.
DeleteGreat point Jocelyn. Alex, good information about safety procedures.
DeleteI wanted to see what you thought since you work in the OR. I agree with you fully. I wonder how many people work in health care and are carriers and don't even know it?
DeleteCase 12-
ReplyDelete1. Dr. M does have an obligation to refrain from performing surgery since any rate of transmission is possible. Even if it is a low risk, I am surprised the risk management department hasn’t stepped in. If they think it may result in a lawsuit they may force his hand. With today’s technology he may still perform surgery if he is trained with the DaVinci robot. He would not run the risk of contamination and still use his skills.
2. If Dr. M is only performing robotic surgeries, then he would not have a need to inform his patients of his HIV status since he doesn’t pose them any risk.
3. If Dorothea L. is infected and in need of surgery I do believe that she has an obligation to inform the staff. If it were a procedure where there was no contact with bodily fluids that could cause transmission, then I believe she does have some right to privacy. By following Universal precautions, the staff would be safe, but once blood is involved as in surgery, then that opens up the risk. Not only to the surgeon, but the OR staff, and the environmental service staff responsible for cleaning up the OR and handling the bio-hazardous waste. Even with all the proper personal protective equipment, there is still a risk.
I know the feeling Jocelyn. I was caring for a patient with Hep c and while giving him a bath, a blister on his hip burst in my face, getting in my mouth and eyes. I had to go through testing for a year afterwards. I am with you about the Ebola suits. Hep C+ patients are move prevalent because of the UN-controllable drug abuse going on in our country. I don't think it's going to get any better, only worse.
DeleteCase 12
ReplyDelete1. I believe, even if the risk is low, he needs to refrain from doing any further surgery. A risk is a risk. There are other options such as the DaVinci robot to combat the exposure issue.
2. Dr. M has the moral and ethical duty to make his former patients and current patients aware of his HIV status.
3. With the risk of possibly contacting HIV by an innocent stick or contamination, I would hope Dorothea L. would disclose her HIV status. She does have a right to privacy, but also has to duty to protect the health of her surgeon, surgical staff and other members of her healthcare team.
As I mentioned in my reply to Gloria's post, I hadn't considered the option of robotic surgery. Very good point for an alternative!
DeleteCase 12, using Casuistry to argue case (against what I actually believe)
ReplyDeleteDr. M does not have the obligation to refrain from performing surgery. He is a skilled surgeon with much experience, he is not going to cut himself and expose his patient. He also is not obligated to disclose his HIV status to his patients. If he discloses the information to his patient about his HIV status, he will cause the patient unnecessary worrying. The statistics show that there is only a 3 in 1000 chance that an HIV infected surgeon’s blood mixing with the patients could cause the patient to contract HIV. Despite the statistics that surgeons cut themselves 2.5 in every 100 surgeries, Dr. M. is not one of those surgeons. His skills are impeccable, he will exercise extreme extra caution and will not have any mishaps. His patient will recover much better without the constant worrying if they were exposed or not.
Is Dorthea L. obligated to notify Dr. M of her HIV status before he operates on her? Absolutely not. The surgeons and OR staff use universal precautions, and, if they are practicing medicine as they are supposed to, they will not be exposed to her blood. Their gloves, gowns and masks will keep them safe. If they did get blood on them, it would be poor medical procedure, and Dorthea L. should actually b upset because they are putting her at risk to be exposed to infections or bloodborne pathogens they might have.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
CDC. (2012). HIV/ AIDS 101. Retrieved from http://www.cdc.gov/cdctv/diseaseandconditions/hiv/hiv-aids-101.html
Yes, the risk is very low. What if the surgeon had Hepatitis, wouldn't the risk of a patient contracting that be even higher? Is that a reason for a surgeon to quit his practice? Having HIV carries such a stigma, that neither the physician or the patient would want to disclose this. They could probably keep this to their self completely and go with the thought that the risk is so low, that there's no harm likely to happen. This probably happens all the time, and people are just unaware
DeleteThat's an excellent point, Gloria. I bet you are right. It's somewhat frightening to think.
DeleteCase 12
ReplyDelete1) I believe he should step down from direct surgery and stick to only robotic. The risk is low, but it's another risk that if a person was given complete informed consent should be made aware of all risks. That would be one of them.
2) The physician likely would never disclose this to his patients because it would ruin his practice. He wouldn't need to if he sought other branches of surgery to practice in - such as I mentioned above, robotic.
3) Dorothea should inform the doctor merely because typically before a patient undergoes any type of medical treatment, including surgery, a complete Health and Physical is performed. All aspects of the patient's medical and surgical history is disclosed. It's how the health care professional can best take care of the whole person. Confidentially is always kept with the medical field as well as universal precautions.
Great point Gloria, I didn't even consider robotic surgery. I agree if he did disclose his HIV status, his practice would surely be ruined. I know I would opt for a different surgeon if I knew.
DeleteI think if he is clear about the risks and his patient gives him consent to do the procedure, he should be allowed. We don't know how he acquired his disease, so I don't think he should use his career. This could also apply to nurses that are carriers.
DeleteGreat Points by Gloria and Chris! robotic surgery is a great option. On the other hand, losing your career from an exposure from work would be terrible.
DeleteThis was a tough one! I can see both sides to the issue. I know I would want to know if my surgeon was HIV positive, and in result I would most likely refuse to be operated on by him or her. That brings up an issue of fairness and discrimination against the physician as well however. I can see where a physician only wanting to do his job would be discriminated against, but at the same time, other’s safety is at risk. We are not talking about a staph or MRSA infection; this is a life threatening infection that is irreversible. I suppose I am playing devil’s advocate with myself, but I am truly torn on a definite yes/no answer for these case questions however I will argue one side.
ReplyDeleteDoes Dr. M. have an obligation to refrain from performing surgery? I feel like the key word here is “obligation”. To that I will say no. His obligation is to SAFELY perform the surgery the patient needs in order to survive or improve life or whatever it may be. By SAFELY I mean sterility, and using all precautionary measures to ensure everyone’s safety from contamination. With the physician having the knowledge of his disease, I would expect him/her to practice even more carefully and if accidentally cut would immediately take measures to prevent cross contamination. To answer question two in the case study, no I do not feel like the physician needs to disclose his virus to his patients for the same reasons as mentioned in question one. To continue on to question three, my answer is still no. A patient has the same confidential rights as the physician. The physician should be practicing in a manner that would protect him and the patient of transfer of body fluids in every case, every time.
Great point regarding obligation, I suppose if he follows what he was trained than the need to inform would not be an issue.
DeleteI can see your points. Although I must say that I do clench my teeth when I am taking care of a patient and after asking about their health history, they fail to tell me that they are hep c +. I feel like more and more we are seeing patients come in with that. I do my best to follow universal precautions, but in a delivery we deal with all types of bodily fluids. I may just start wearing the Ebola suits to every delivery to keep me safe!
ReplyDeleteThis comment has been removed by the author.
DeleteI believe that Dr. M has a moral and ethical duty to tell his patients and discuss the risk that he imposes on them. It ia then their decision to allow him to perform the surgery of find another surgeon. This would be along with discussing the risks of the surgery. Why would you not tell them about yourself but warn them of the other dangers associated with surgery. If he gets consent from the patient, then he should be allowed to perform the surgery.
ReplyDeleteThe patients should also inform the surgeon of any potential blood pathogens they carry such as hepatitis and HIV. We all know to use universal precautions but it is nice when the patients tell us so we slow down and take our time taking care of that patient. We are so conditioned to work fast that errors and needle sticks do occur. I know that when a patient informs me, I am very aware of what I am doing with that p[patient.
I agree completely, Chris. I believe both parties have an obligation to full disclosure.
Delete