Kevin's Watch

I thought that it might be fun for people to bring forward real life ethical questions from time to time for discussion.

This is one that came up at work that we wrestled with for awhile before a very odd solution arose and saved us.

You work in a hospital.

One day you go to a run down little greasy spoon diner downtown for a burger. The place looks rough but usually has good food. While there you spot a patient from your hospital working there. You know for a fact, beyond any shadow of any doubt, that he has an active tuberculosis infection and that he is noncompliant with his course of medicine.

Now, this patient's medical privacy is protected by the law. It is illegal for you to tell the owner of the restaurant or the county health department (who inspects restaurants to make sure that they are run in healthy ways) about his medical condition.

On the other hand, a concern for public health and simple decency makes you want to call the county.

What is the right thing to do in this situation?

anonymous call to the county reporting him. his privacy does not outweigh the publics safety.

Chalk me up for following the law. Way I see it, if you can't accept the responsibility, you shouldn't hold the position. Likewise, if you feel that strongly about it, break the law and resign your position. If you do it secretly and without consequence, I don't see much difference between him and (unspecific) you, morally. Only one gets to feel superior.

Me, I'd talk to him (no law against that). Doubt he likes slinging hash much. Might be the only job he can find. Help him get a different one. Of course, he might not be the most reasonable type, considering he won't take a simple antiobiotic regimen. Maybe plaster up a few TB awareness posters (harassment, but at least it's non-specific).

morals or safety?

while you getto feel the warm glow of moral superiority i save the county from a tb outbreak.

i'm not going to feel bad about it.

Then find a different line of work. Or at least take responsibility for your actions.

the law is dangerous. you can wait for it change. spend time lobbying against it. in the meanwhile the whole county is infected.

the laws are ass backwards, like most criminal laws. the onus is to protect the criminal or the Typhoid Mary. we have lost are way and do not do enough to protect the society as a whole.

so call me SgtGhandi.

Which is the lesser evil? Breaking his rights. I vote tell the restaurant. Rather that than an outbreak.

The law isn't dangerous. The law is. People are dangerous, and none moreso than those who would break the law and their own commitments as they see fit in the name of personal conviction, especially if they are unwilling to take responsibility for doing so.

By the same logic, torture is ok. It too supposedly saves the many at the sacrifice of one, one who is also usually deemed unworthy of protection. I could go on with this, but since it would quickly turn into a Bush thread...

tell you what, tonight I'm sure glad we don't all meet in person and discuss these things....

duchess of malfi wrote:I thought that it might be fun for people to bring forward real life ethical questions from time to time for discussion.

This is one that came up at work that we wrestled with for awhile before a very odd solution arose and saved us.

You work in a hospital.

One day you go to a run down little greasy spoon diner downtown for a burger. The place looks rough but usually has good food. While there you spot a patient from your hospital working there. You know for a fact, beyond any shadow of any doubt, that he has an active tuberculosis infection and that he is noncompliant with his course of medicine.

Now, this patient's medical privacy is protected by the law. It is illegal for you to tell the owner of the restaurant or the county health department (who inspects restaurants to make sure that they are run in healthy ways) about his medical condition.

On the other hand, a concern for public health and simple decency makes you want to call the county.

What is the right thing to do in this situation?

I'm assuming it's illegal to tell anyone? like friends, family and/or total strangers?

Interesting question. I tend to agree with Syl, albeit for different reasons perhaps.

It's not my duty to protect the public (or to follow the law for that matter). If he chooses to do it, I'm not resonsible for is choice. And I'm certainly not responsible for the negligence of the department of health or whoever.

It's my personal conviction that what he chooses to do is up to him. Now, I might speak to him myself and try and change his mind, but that's about as far as I'd feel obligated to go I guess.

I have no problem breaking the law because of personal convictions, dangerous as that may be, but I do have a problem with breaking personal convictions merely for the sake of the law.

--A

I would probably report him and resign from my position. The way I see it, law is a construct of society, but tb is a danger for the health of people, and health is NOT a construct of society. If I were forced to choose between the two, I'd choose to protect health over law.

I'm with Syl on this one too. I would think I had a duty to do something, and that something would involve talking to the person with TB. If that didn't work, I would inform whoever investigates restaurants that there is a problem with a member of staff there, but wouldn't say which person or what the problem is.

This law has changed recently in the UK. Previously there was no reason whatsoever that patient's medical details could be disclosed to anyone. Everything was confidential. However, now, if you suspect that a child is being abused, that confidentiality no longer binds. In fact, you have a duty to bring your suspicions to the relevant authority. I assume, therefore, that various scenarios have been looked at where confidentiality should be overturned, and a decision reached that the only reason that stands is the welfare of a child.

(On the same subject, earlier this year a pharmacist who saw a customer shoplifting in his chemist, reported him to the police. The PHARMACIST was prosecuted because he knew the shoplifter's name and address only through prescriptions.)

Typical of the British.

--A

I would start by talking with the patient and appeal to their sense of responsibility. However, I would make it clear - if they did nothing - I would do something.

This is comparable to the law in Virginia that allows medical workers who accidentally get contaminated by blood products of a patient to mandate aids testing for that patient.

Is it against the patient's privacy to inform the local health department that that person was there?

I'm not sure what the law is here in Illinois, but the county has been in an on-going case with a woman, and now her son about how to treat TB.

It'd be tempting to alert someone, because the result is immediate - the threat to restaurant customers is removed.

On the other hand, if the public begins to distrust the sanctity of medical information, the result is not immediate ... but could in the end be more catastrophic.

The correct answer is to alert the hospital administrator. He/She pays people to sort out messes like this, and he/she has a staff of lawyers as well.

They may decide to alert the authorities, or they may decide to keep it to themselves. But whatever their decision is, it is made with more skill and wisdom than any decision you would make.

If i'd sworn the (sp?) Hypocratic oath, i'd like to think i'd keep it.

sgtnull wrote:morals or safety?

while you getto feel the warm glow of moral superiority i save the county from a tb outbreak.

i'm not going to feel bad about it.

Ditto.

I'm forced to agree with Syl. Patient confidentiality is crucial, and violating that opens a huge can 'o worms.

I would go to the hospital administrator and let him/her and the hospital's lawyers deal with it.

Cail wrote:I'm forced to agree with Syl.

A hot shower will make you feel clean again.