7-STEP MORAL DECISION-MAKING PROCESS_HISPANIC MAN

A twenty year old Hispanic male was brought to a hospital emergency room, having suffered abdominal
injuries due to gunshot wounds obtained in gang violence. He had no medical insurance, and his stay in
the hospital was somewhat shorter than expected due to his good recovery. Physicians attending to him
felt that he could complete his recovery at home just as easily as in the hospital and he was released
after only a few days in the hospital. During his stay in the hospital, the patient admitted to his primary
physician that he was HIV positive, having contracted the virus that causes AIDS. This was confirmed by
a blood test administered while he was hospitalized. When he was discharged from the hospital, the
physician recommended that a professional nurse visit him regularly at home in order to change the
bandages on his still substantial wounds and to insure that an infection did not develop. Since he had no
health insurance he was dependent on Medicaid, a government program that pays for necessary
medical care for those who cannot afford it. However, Medicaid refused to pay for home nursing care
since there was someone already in the home who was capable of providing the necessary care. That
person was the patient's twenty-two year old sister, who was willing to take care of her brother until he
was fully recovered. Their mother had died years ago and the sister was accustomed to providing care
for her younger siblings. The patient had no objection to his sister providing this care, but he insisted
that she not be told that he had tested HIV positive. Though he had always had a good relationship with
his sister, she did not know that he was an active homosexual. His even greater fear was that his father
would hear of his homosexual orientation and lifestyle Homosexuality is generally looked upon with
extreme disfavor among Hispanics. The patient's physician is bound by his code of ethics that places a
very high priority on keeping confidentiality. That is, information about someone's medical condition
that he or she does not want known cannot be divulged by the physician. Some would argue that the
responsibility of confidentiality is even greater with HIV/AIDS since disclosure of someone's
homosexuality normally carries devastating personal consequences for the individual who is forced "out
of the closet." On the other hand, the patient's sister is putting herself at risk by providing nursing care
for him. Doesn't she have a right to know the risks to which she is subjecting herself, especially since she
willingly volunteered to take care of her brother? If you were the physician, what would you do in this
case? Would you breach the norm of confidentiality to protect the patient's sister, or would you keep
confidentiality in order to protect he patient from harm that would come to him from his other family
members, especially his father?

Step #1: Getting the facts

 During gang combat, he was seriously hurt. Although it is unknown, it is safe to presume that he
is a
member of a gang As a matter of fact, he is likely to fear disapproval and retaliatory from his gang
members, particularly among the younger ones.

if it is discovered that he is HIV positive

• The patient is an HIV-positive young guy who is also an active homosexual.

• He had serious stomach wounds but is recovering well.

• Homosexuality is frowned upon in Hispanic cultures.

• The patient has asked his doctor to keep his HIV status a secret.

• He is uninsured and unable to pay for in-home nursing care.

• Professional home nursing care is not covered by Medicaid.

•The patient's sister is willing and able to provide the nursing care that her brother requires. She's a
wonderful person.

• The patient has stated that he does not want his HIV status to be revealed to his sister. She

is completely oblivious to the fact that he is an open gay.

• The patient's sister would be changing her brother's huge wound bandages, and she would be very
careful.

 His HIV-infected blood has undoubtedly come into contact with you. It's tough to say if she'll say
yes or no.

As a result of this interaction, you have become infected with the virus. in a mother's care for her
brothers and sisters manner.

• The patient is afraid of his father rejecting him if his homosexuality is disclosed, which is true.

Given how homosexuality is viewed in Hispanic society, this is reasonable.

STEP #2: Who are the stakeholders

 He is a twenty-year-old Hispanic man.

 Fathers
 Twenty two years old
 Physician
 Nurse practitioner
STEP#3: Articulate the values involved

 The way the ethical issue is articulated establishes two moral standards with regard to this
troubling situation. This problem stems from a conflict between the physician's obligations to his
patient and his sister. He is required to be compassionate toward both, yet the definition of
compassion varies depending on who is in issue in the situation. As a conclusion, two principles
emerge as the most important. The first is the commonly recognized belief that patients have a
right to have their medical information kept private, especially information that may be used
against them if exposed. A second principle, the physician's obligation to alert interested parties
other than the patient if they are in immediate and severe danger, comes into play.

STEP #4: List the Alternatives

 There are numerous possibilities in this case that require either the patient's or his sister's
cooperation. However, there are two alternatives that do not require compromise and both
imply a value weighting. Informing the sister that her brother is HIV positive is one approach.
Prioritizing the principle of the obligation to warn leads to this alternative. On the other hand, a
second alternative is to decline to provide her that information, respecting the patient's wish for
privacy and prioritizing the confidentiality principle. However, there are other possibilities. For
example, the doctor may give a broad warning to the patient's sister about the importance of
taking adequate care of these wounds. She must always wear gloves and possibly a mask when
working with the bandages. If she obtains blood on her clothes or body, she must wash it with
disinfectant soap right away. To put it another way, she must take the same general precautions
that any medical professional would take when caring for a patient. Another alternative is to
suggest that the patient inform his sister about his predicament. He can then ask her not to
inform any of his other relatives or friends. If he refuses, tell him, "If you don't tell her, I will,"
because this type of scenario should not be kept a secret if someone's health is at stake. The
sibling.

STEP #5: Compare the alternatives with the principles

 In many cases, the principles are capable to satisfy the issue. That could be the case above,
based on how the significance of the principles is assessed. Indeed, recommending universal
measures for the sister without saying why may come close to achieving all of the required
conditions. Nevertheless, there are doubts about how effective those safeguards are. Does she
go after them or ignore them? For the time being, assume that appealing to principles will not
solve the problem.

STEP#6: Weigh the consequences

 When two alternative options are presented, the consequences of one are typically the same as
the consequences of the other. This is the situation here, with the option of notifying or refusing
to inform that sister about her brother's HIV status. The first choice, telling the sister (or
demanding that the patient tell his sister), is likely to result in the following outcomes: The sister
would be properly informed about the risks of caring for her brother, reducing her risk of
contracting HIV and protecting her from a potentially fatal disease. The sibling's HIV status
would be revealed, allowing family and gang members to establish their own conclusions about
his homosexuality. If they make the correct decision, which is likely, he will be severely harmed.
When they make the correct decision, which is likely, he will suffer significant psychosocial harm
at the hands of his gang members, as well as possibly (but not necessarily) at the hands of his
family.

The patient's faith in the physician erodes, and he may refuse to see him or any other until a life-
threatening medical emergency arises. This would be negative since he would need to continue
receiving medical care due to his HIV infection.

If the physician, on the other hand, declines to share the information, the following events may
occur:

The sister would be oblivious of the risks she is putting herself in, leaving her vulnerable to
infection with no treatment. It's disputed how much danger she's in, but others argue that if
she's in it long enough, she'll die.

The doctor-patient interaction is preserved. If the sister is told to take general precautions as an
alternative, the following results are possible:

She may or may not take reasonable precautions in caring for her brother. She can neglect the
precautions and put herself in risk unintentionally. If the doctor advises her about the
precautions in stern terms in order to assure her compliance, she may wonder why the doctor is
so concerned with her following his instructions. Indeed, one of the physician's motives may be
to persuade her to ask her brother some of those questions in order to lower her risk of
contracting HIV.

In general, the HIV status and homosexual orientation of the patient are kept private.

Trust is built between the physician and the patient. If the sister is encouraged to interrogate
her brother about why these precautions are so vital, he may believe that the physician
prompted her to do so, leaving him feeling misled.

STEP #7: Make a decision

 The last option is the best choice because the patient's HIV status and homosexual orientation
are kept secret and discreet, but the patient's secret may be revealed at some point because of
the safety measure that the physicians want to implement for his sister when caring for his
brother; the sister may question the brother about why the physicians want to implement this
type of percussion, and the brother may reveal his secret at some point.