HIV disclosure to surrogate decision makers: privacy versus presumption

Although few would disagree with the latter precept, the ethical and legal permissibility of the former is less obvious [2]. Dispensing with patient confidentiality under the rubric of ‘beneficence’ does not guarantee preferable end-of-life outcomes. Even if the emotional impact of this disclosure has minimal influence on surrogates’ decision making abilities, they are, ceteris paribus, left no better informed of their loved one’s wishes than before. HIV-infected patients may have various rational reasons for refusing to disclose their seropositivity or declining antiretroviral treatment, which are unlikely to be easily divined by most critical care teams. What is known about many of these patients is that they have chosen to keep their HIV status confidential, often at great sacrifice. Surmising that they favor ‘the timely withdrawal of painful or futile interventions’ precisely when these patients can no longer speak for themselves both begs the question and stretches the bounds of human inference.