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Originally Posted by Skeptic Ginger
(Post 12994242)
No it does not. That's idiotic. I don't care if the guy with the STD doesn't want to tell his sex partners. He can't do that.
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I agree; it’s completely unethical for a person with an STD to fail to inform their partners. Doctors, on the other hand have competing ethical obligations:
1. Their duty to maintain the confidentiality of their patients
2. Their duty to warn third-parties of potential harm.
The first trumps the second except in cases where the threat of harm is particularly severe. In the case of HIV, yes, the doctor should inform a spouse if the patient refuses to. But it shouldn’t be the first thing the doctor does. The doctor should counsel the patient to do it himself, provide resources to help the patient disclose, etc. As a last resort, the doctor should inform the spouse. In Texas, such spousal disclosure is allowed but I don’t think that’s universal.
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No one moved any goal post. You don't have enough knowledge to recognize STDs and HIV are treated the same as far as partner notification goes. There are some differences with testing and informed consent but not with post diagnosis requirements to inform partners.
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No they aren’t treated the same, not from the clinician perspective. Yes, we report all STDs to the State. However, we don’t have that spousal exception to confidentiality. Aside from the law, the level of risk and harm between HIV and say, gonorrhea, doesn’t justify breaching the confidentiality of the patient. In those cases, the State’s partner tracing and notification programs take care of that.
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So you'd let an exposed person go un-notified if the legislators in all their practicing medicine without a license wisdom wrote a flawed law? :rolleyes:
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So you’d break the law to tell someone their husband has gonorrhea? I don’t think you’d put your license and career at risk.
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Fortunately most medical providers recognize flawed laws and aren't afraid to stand up.
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Most? Are you trying to tell me that most providers break the law on a regular basis? No they don’t.
And let’s bring this back along the lines of the OP. If you were treating a well-known public figure, a womanizer who has HIV, would you Duty to Warn him? Would you make a public statement that he has HIV?
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Here's your problem. You seem to think there are laws with all the little details on how a medical provider should do this or that. There are no such laws. They would be impossible to write.
So guess what? It's up to the provider. We went around on this at the beginning when you tried to tell me what my scope of practice was. In this state nurse practitioners are independent medical providers. It's up to me to know what my scope of practice is. The details are not spelled out in the law.
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Now c’mon . . . You cannot possibly think that the only limit to what an NP can do is what they themselves think they can do? Scope of practice is actually spelled out quite well in the law. An NP’s scope of practice is limited to the certifications they hold.
I really don’t understand where you get this idea that a license = do whatever you want. That’s not even true for doctors. And to bring this back to ethics: Doctors and all other medical providers have an ethical duty to stay within the limits of their training and experience. It would be a grave disservice to the patient for a Family Med doctor to attempt to treat complex psychiatric cases, for example, unless the doctor is dual certified or has extensive other training and experience in psychiatry.
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You didn't appear to recognize the ethical dilemma in prescribing placebos.
Your posts reflect one who is very poorly informed about the difference between ethics, medical judgement and law.
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No. You seem to think those are all separate things. They aren’t; they are all entangled. Ethics, law, evidence-based standards, clinical experience, training . . . Those are all things that inform professional judgement.
I’m going to start a new thread on this because I think it’s an important area. I hope you will join me there so we can continue the judgement/ethics conversation. But for now, let’s try to get back to the topic:
1. Professional judgement is the exercise of applying the training and experience of a professional in accordance with the ethics and standards of their profession.
2. The ethics code is clear about diagnosing public figures the clinician doesn’t know. There is absolutely no gray area about that; the guidance is clear, well-articulated and supported by good arguments.
3. The “duty to warn” ethics exception applies when there is a specific danger to an identifiable person or group of people. There is no specific danger articulable here.
4. There is no evidence-based or consensus-based clinical standard of practice to assess mental illness and/or dangerousness of subjects based solely on public domain information, without an in-person assessment.
Therefore: A professional is not free to exercise their judgement to comment on a public figure’s mental illness or dangerousness they’ve never personally assessed.
You’ve argued that these professionals may not be part of the organizations that enforce ethics codes. That only means they can’t be censured. Do you argue that ethics codes shouldn’t apply to all members of the profession, regardless of membership in any particular organization?
