An Ethical Dilemma

Thorny issues requiring difficult decisions are part of our personal and professional lives. Sometimes however patients present us with circumstances that make our obligation to the patient conflict with our moral obligation. Such were the circumstances of my experience with GD. She was a 16-year-old Hispanic teen and 6 weeks pregnant when I met her. Outwardly she was a picture of health like many of the teens we see. But GD carried a heavy burden. About 4 months prior to the visit she had been diagnosed with HIV and had told no one! Only the professionals who had tested and counseled her knew of the diagnosis. Because of fear she had resisted counseling efforts to help her disclose her HIV infection to her partner and his family. She had been living with them for about 4 months. This living situation was a source of support and she feared having no where to go if they rejected her. She was estranged from her family. The stigma of HIV is strong and there is much myth and misinformation surrounding transmission. She felt sure his family would ask her to leave their home. In addition GD feared her partners reaction might be violent. He was very angry when she had told him of her chlamydia infection about a month prior. She did not want to lose him. Circumstances were such that it was highly probable that GD had become infected by a previous partner. (excerpt)