Discretion often the better part of valor

Ethics Forum. Aug. 2, 2004.

What should physicians do when they discover family secrets?

How can physicians decide when a health-related family secret ought to be kept secret and when family members should be encouraged to share it?

Reply:

It is 1984 in the southern hemisphere, and a 23-year-old medical student is referred to you, a surgeon, for generalized lymphadenopathy. You suggest a biopsy of an axillary node. During the operation it occurs to you to test the student for the newly discovered virus, HTLV3. It is unlikely the test will yield positive results, for it is a rare virus, and thus far confined to North America. Some weeks later the results come back positive.

A number of questions arise. Do you tell the medical student that you have tested him without his consent? At that time and place, there are no existing laws or ethics regarding reporting or disclosure in this case. How do you make the decision? Do you share this sensitive information with other colleagues or religious leaders, in an attempt to deal with your dilemma? How will the information affect the young man? What will the ripples be in his family? How will it affect his career? Is your decision affected by the fact that there is no effective treatment available? Finally, if you decide to tell him, how will you ensure his well-being in the face of this new information?