HIV Home Test Kit and Confidentiality: Ethics and Issues on Home Self-Testing Kits
Most of us has done different kind of testing in clinic, including HIV tests. Doing such tests can be quite embarrassed when the healthcare profession helps you do the test and notice what you think. In 2012, US Food and Drug Administration panel of outsides experts claimed that in home testing HIV could be reasonably safe and effective. In fact, I think testing at home is a good idea because a home test kit can quickly determine if you are infected with HIV.Also, doing the test at home undoubtedly can give you privacy. However, is the home HIV test really a great idea?
CNN News Regarding Home Testing
This test kit is relatively easy to use for any tester, and I am not going through all steps of how to use this kit at home. One of the reasons that testers prefers to do the test at home is because they want to keep their HIV states in confident. Indeed, it is controversial to have privacy, especially when the testers get their result in negative. The testers would not be embarrassed to show their feelings to others about their HIV states.
The moral question now turns to be whether if a tester does the home test and result in positive. Surely, he should notice professions such as counselors about his result and his concern. Also he needs to get some help from the public about the result. However, the tester with positive result also has a right not trust anyone because he or she needs to disclose the positive result to the third person.
So, how do we deal with this moral dilemma between safety and privacy?
Confidentiality and Patient's Interest
In many HIV cases, confidentiality is relatively important because some individuals do not want their personal information given out. In the case when a patient discloses his positive HIV state to a counselor or any health profession, his action implies that he trusts the counselor or the health profession. However, the counselor or health profession may face a dilemma that confidentiality may not be absolute in some cases.
Consider this situation. Mary is a counselor of John who is HIV positive. Mary recognizes that it is important to discuss with John regarding the confidentiality and the possible treatment. However, Mary may need to disclose John's HIV state to public health workers, yet her action can cause John not feel comfortable because he thinks Mary should respect his decision.
The above case shows that there is a conflict between autonomy and confidentiality. On the one hand, John believes that Mary would respect his choice and not disclose his HIV status. On the other hand, Mary believes that it is necessary for other public health workers to understand John’s HIV states. So what should Mary do in such dilemma?
CNN also covers the concern of Home Testing
Conflict of interest
In fact, the dilemma in Mary and John's case can turn to be a legal case unfortunately because Mary discloses her patient's HIV states without his notice, yet the court could agree with Mary's action. In the landmark case Tarasoff v. Regents of University of California,the court holds that therapists have a duty to warn third parties, including sexual partners of HIV positive patients, of inherent danger and victimization.
This decision implies that confidentiality indeed is important, but it is less important than public safety. In other words, the therapists may need to disclose their patients' confidentiality in order to consider others' safety.
Moral View: Utilitarianism
Nevertheless, when we think about both Mary's situation or Tarasoff's decision, we could adopt moral standard, namely utilitarianism and Kantian ethical frameworks. While utilitarianism holds the view and question in “how much good will the decision do?” and “how likely is the decision produce the value," Kantian ethics holds that person should never be treated as object and such person must be “be willing to accept the logical implications of the reasons for their actions when these reasons are applied to all relevantly similar cases.” Most of the healthcare professions, including HIV counselors, understand and apply these two major ethical theories to many cases.
So, in Tarasoff's case, the court clearly adopts utilitarianism view because the total amount of happiness is more important than individual's confidentiality. Indeed, patient's confidentiality is important, yet it needs to give up in order to consider the public safety.
In Mary's situation, she believes that the public safety in general is more important than John's confidentiality, although John does not feel comfortable. However, John needs to understand that his HIV states may put others in a risk. If this is the case, Mary's action can be morally justified.
In fact, although most utilitarian are considering the total amount of happiness only, I have to agree with the Tarasoff's final decision. While utilitarianism view holds that public safety is more important than individual's confidentiality, healthcare professions does not only have one duty to their patients but also have other kind of duties to follow, i.e. public safety.
In the situation of HIV patients, the healthcare professions should also notice their patients that they have the obligation to disclose their HIV states because they need to consider the public safety. In other words, HIV positive patients need to have the idea that there is a risk to transfer the HIV virus to his or her sexual partners, other healthcare profession, or even some other people in public. As the judge says in Taraoff, HIV positive patient "owns a duty of care to all persons who are foreseeable endangered by his conduct, with respect to all risks which make the conduct unreasonably dangerous."
So, the at home testing kit may not be a good idea for people who get the positive result yet they do not want to disclose their results to others, although they have privacy.