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Editor's Correspondence
August 10/24, 1998

Medical Secrecy or Disclosure in HIV Transmission: A Physician's Ethical Conflict

Arch Intern Med. 1998;158(15):1716-1719. doi:

Stein et al1 emphasize that many individuals with human immunodeficiency virus (HIV) do not disclose their status to sexual partners. Despite the high level of public information concerning HIV prevention, their results show that sexual partners of persons with HIV continue to be at risk for HIV transmission. Sexual transmission of HIV may be considered a potential and long-lasting end-of-life dilemma for partners. Individuals with HIV often face feelings of shame, anger, or frustration. To construct his/her personality, the individual should integrate all these feelings to deal with his/her new reality in the relationship with the sexual partner. If not, he/she will put his/her partner at high risk in relational or sexual contexts. Partners who engage in sexual intercourse implicitly respect principles such as autonomy, responsibility, benevolence, nonmaleficence, and consent. We may hypothesize that individuals who do not disclose their HIV status choose to transgress these principles, considering that partners need to protect themselves, which is their individual responsibility. They choose to use the rule of "double effect." This principle, which is commonly used and criticized2,3 in relation to end-of-life decisions, implies that effects that would be morally wrong if caused intentionally are permissible if foreseen but unintended.2 According to this rule, the transmission of HIV would be considered by those who do not disclose their HIV status as a foreseeable but unintended consequence of sexual intercourse.

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