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Bioethics Dilemma

bladerunner060
Posts: 7,126
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2/8/2013 11:44:07 PM
Posted: 6 years ago
Sorry, but this really bothers me, because most people just don't understand what HIPAA is and says. I don't mean to insult, but for you to claim you're trained in HIPAA, then make these points, is bothersome.

If a patient comes in and says "I'm sick". And the test results say that the person has, say, gonorrhea, and the patient says "But that's impossible! My husband and I were virgins!" a medical professional can point out the other ways gonorrhea can be contracted. But if the patient says "Well, it can't be any of those!" then the medical professional is in no way violating HIPAA to say "Well, the only other answer is that your husband cheated on you."

Similarly, a medical professional can explain the results of the genetic testing, and how a marker is necessary from both parents for the disease to manifest, and how the husband doesn't have that marker. Most people would understand what that means immediately, or at least I would. But if the patient says "What does that mean?!", it's not a violation of HIPAA to say "Well, that would mean that either a very strange mutation has happened, or you are not the child's biological father".

"But that would mean my wife cheated on me!" the patient might say, and it would not be a violation of HIPAA, or ethics, to say "Yes, that would seem to be the most likely answer". That's just providing your patient with the information to understand the results of the test.
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royalpaladin
Posts: 22,357
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2/9/2013 5:26:56 AM
Posted: 6 years ago
At 2/8/2013 6:53:37 PM, Heineken wrote:
The answer is a distinct yes. The father is present at the meetings to understand why his child is sick. Hence, he should be made aware why the child is sick.

How does telling the truth about this do anything to help the child with the illness?
Additionally, from a devil's advocate perspective....he might be hanging on to a broken marriage to avoid child support. This could be his ticket out. (Zing!)

That won't happen. See the link I posted above.
royalpaladin
Posts: 22,357
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2/9/2013 5:27:28 AM
Posted: 6 years ago
At 2/8/2013 7:03:19 PM, Wnope wrote:
At 2/8/2013 4:26:34 PM, royalpaladin wrote:
Ok, so suppose you are a genetic counselor who is attempting to understand why a child has cystic fibrosis. You test the child and both of the parents and discover that the mother is a carrier and the father is not, which essentially indicates that the "father" is not biologically related to the patient. Should you disclose this fact to the father?

I say disclose that the mother is a carrier and the father is not a carrier depending on whether that information will be beneficial towards the patient (the child). It also depends on doctor/patient privilege (i.e. is the mother or father a patient of his?).

Unless you've seen the wife cheating with a man, it's not your place to make a conjecture like "your wife screwed around on you." You can give the facts. You can say that it's very rare, even unheard of, for a non-carrier and carrier to have a child who is a carrier.

Regardless of how "obvious" the conclusion may seem, if the information isn't in the data/tests, don't speculate with a subject that could ruin a family.

Makes sense.
royalpaladin
Posts: 22,357
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2/9/2013 5:28:38 AM
Posted: 6 years ago
How is the child not "his"? I noted that parenthood is about the bonds you form, and not about genetics. He is still the father even if he is not genetically related to the child.
tmar19652
Posts: 727
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2/9/2013 5:46:34 AM
Posted: 6 years ago
I don't mean to shift the thread, but if he is not the father, should he have to pay child support? What are your opinions.
"Politics is supposed to be the second-oldest profession. I have come to realize that it bears a very close resemblance to the first." -Ronald Reagan

"The notion of political correctness declares certain topics, certain ex<x>pressions even certain gestures off-limits. What began as a crusade for civility has soured into a cause of conflict and even censorship." -George H.W. Bush
Polaris
Posts: 1,120
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2/9/2013 1:17:46 PM
Posted: 6 years ago
At 2/8/2013 11:29:53 PM, bladerunner060 wrote:
At 2/8/2013 11:26:56 PM, bladerunner060 wrote:
At 2/8/2013 11:25:41 PM, Polaris wrote:
At 2/8/2013 11:23:40 PM, bladerunner060 wrote:
So yes, you would be allowed to say it under HIPAA, even if it's an assumption.

"Health care professionals have a legal and ethical duty to keep medical
information private. Physicians and nurses, along with hospitals and insurers, are
required by law and professional codes to practice confidentiality. The practice of
confidentiality limits "the disclosure of nonpublic information within a fiduciary,
professional or contractual relationship." (Majumder, 2005) Achieving confidentiality
requires restricting information to persons belonging to a community of authorized
recipients...

In some instances a health care provider may be required to breach patient confidentiality. Psychotherapists are required by state law to report child abuse and neglect about which they learn in the course of therapy. State law may also require that therapists warn potential victims of patients" violent intentions. Tarasoff v. Regents of the University of California (1976) imposed a duty to warn on California mental health providers. Generally speaking, however, psychotherapists are expected to keep their patients" secrets. They are not permitted to reveal infidelity, closeted sexual orientation, or ruined finances."

Allen, Anita L., "Confidentiality: An Expectation in Health Care" (2008). Scholarship at Penn Law. Paper 195. "http://lsr.nellco.org......;

A psychotherapist revealing infidelity to a partner is completely and utterly different than this situation, and you know it.

All information provided to a psychotherapist in the course of psychotherapy is PHI.

This is an utterly different scenario, wherein a child was tested and a father was tested. The results of that test reveal infidelity; there is no breach of HIPAA to point out the genetic results of the test.

Point to the specific PHI that the geneticist is revealing from the mother to the father...there isn't any. The PHI in question is coming from the kid, and the father, and the father is entitled to that test result. Informing him of what the results mean is no different than explaining what a hematocrit level is.

Once again, "Your wife cheated on you" is not a medical diagnosis. "Your child's cystic Fibrosis is genetic", however is. Infidelity may be inferred from medical information, but it is not up to the physician to make that inference.
bladerunner060
Posts: 7,126
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2/9/2013 2:54:43 PM
Posted: 6 years ago
At 2/9/2013 1:17:46 PM, Polaris wrote:
At 2/8/2013 11:29:53 PM, bladerunner060 wrote:
At 2/8/2013 11:26:56 PM, bladerunner060 wrote:
At 2/8/2013 11:25:41 PM, Polaris wrote:
At 2/8/2013 11:23:40 PM, bladerunner060 wrote:
So yes, you would be allowed to say it under HIPAA, even if it's an assumption.

"Health care professionals have a legal and ethical duty to keep medical
information private. Physicians and nurses, along with hospitals and insurers, are
required by law and professional codes to practice confidentiality. The practice of
confidentiality limits "the disclosure of nonpublic information within a fiduciary,
professional or contractual relationship." (Majumder, 2005) Achieving confidentiality
requires restricting information to persons belonging to a community of authorized
recipients...

In some instances a health care provider may be required to breach patient confidentiality. Psychotherapists are required by state law to report child abuse and neglect about which they learn in the course of therapy. State law may also require that therapists warn potential victims of patients" violent intentions. Tarasoff v. Regents of the University of California (1976) imposed a duty to warn on California mental health providers. Generally speaking, however, psychotherapists are expected to keep their patients" secrets. They are not permitted to reveal infidelity, closeted sexual orientation, or ruined finances."

Allen, Anita L., "Confidentiality: An Expectation in Health Care" (2008). Scholarship at Penn Law. Paper 195. "http://lsr.nellco.org......;

A psychotherapist revealing infidelity to a partner is completely and utterly different than this situation, and you know it.

All information provided to a psychotherapist in the course of psychotherapy is PHI.

This is an utterly different scenario, wherein a child was tested and a father was tested. The results of that test reveal infidelity; there is no breach of HIPAA to point out the genetic results of the test.

Point to the specific PHI that the geneticist is revealing from the mother to the father...there isn't any. The PHI in question is coming from the kid, and the father, and the father is entitled to that test result. Informing him of what the results mean is no different than explaining what a hematocrit level is.

Once again, "Your wife cheated on you" is not a medical diagnosis. "Your child's cystic Fibrosis is genetic", however is. Infidelity may be inferred from medical information, but it is not up to the physician to make that inference.

To a certain extent, I agree, unless the father forced the clinician down that road by continuing to ask questions.

However, the point was that "Your wife cheated on you" is not PHI in this context, either, and is not subject to HIPAA protections. If the wife confessed, that confession is PHI, but this is the obvious and most likely inference that only requires PHI of people that the father has a right to.
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Polaris
Posts: 1,120
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2/9/2013 5:38:48 PM
Posted: 6 years ago
At 2/9/2013 2:54:43 PM, bladerunner060 wrote:
At 2/9/2013 1:17:46 PM, Polaris wrote:
At 2/8/2013 11:29:53 PM, bladerunner060 wrote:
At 2/8/2013 11:26:56 PM, bladerunner060 wrote:
At 2/8/2013 11:25:41 PM, Polaris wrote:
At 2/8/2013 11:23:40 PM, bladerunner060 wrote:
So yes, you would be allowed to say it under HIPAA, even if it's an assumption.

"Health care professionals have a legal and ethical duty to keep medical
information private. Physicians and nurses, along with hospitals and insurers, are
required by law and professional codes to practice confidentiality. The practice of
confidentiality limits "the disclosure of nonpublic information within a fiduciary,
professional or contractual relationship." (Majumder, 2005) Achieving confidentiality
requires restricting information to persons belonging to a community of authorized
recipients...

In some instances a health care provider may be required to breach patient confidentiality. Psychotherapists are required by state law to report child abuse and neglect about which they learn in the course of therapy. State law may also require that therapists warn potential victims of patients" violent intentions. Tarasoff v. Regents of the University of California (1976) imposed a duty to warn on California mental health providers. Generally speaking, however, psychotherapists are expected to keep their patients" secrets. They are not permitted to reveal infidelity, closeted sexual orientation, or ruined finances."

Allen, Anita L., "Confidentiality: An Expectation in Health Care" (2008). Scholarship at Penn Law. Paper 195. "http://lsr.nellco.org......;

A psychotherapist revealing infidelity to a partner is completely and utterly different than this situation, and you know it.

All information provided to a psychotherapist in the course of psychotherapy is PHI.

This is an utterly different scenario, wherein a child was tested and a father was tested. The results of that test reveal infidelity; there is no breach of HIPAA to point out the genetic results of the test.

Point to the specific PHI that the geneticist is revealing from the mother to the father...there isn't any. The PHI in question is coming from the kid, and the father, and the father is entitled to that test result. Informing him of what the results mean is no different than explaining what a hematocrit level is.

Once again, "Your wife cheated on you" is not a medical diagnosis. "Your child's cystic Fibrosis is genetic", however is. Infidelity may be inferred from medical information, but it is not up to the physician to make that inference.

To a certain extent, I agree, unless the father forced the clinician down that road by continuing to ask questions.

However, the point was that "Your wife cheated on you" is not PHI in this context, either, and is not subject to HIPAA protections. If the wife confessed, that confession is PHI, but this is the obvious and most likely inference that only requires PHI of people that the father has a right to.

I find it difficult to disagree with this statement.
royalpaladin
Posts: 22,357
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2/10/2013 4:58:03 AM
Posted: 6 years ago
At 2/9/2013 5:46:34 AM, tmar19652 wrote:
I don't mean to shift the thread, but if he is not the father, should he have to pay child support? What are your opinions.

It depends on whether the cheating was justified. If the society in which this occurs is a society in which gender role distribution is treated as a zero-sum game or in which women are severely oppressed, it is justified as an expression of autonomy. It is also justified in situations in which the woman is forced into an arranged marriage for the same reason. In those cases, yes, the father should pay child support.
tmar19652
Posts: 727
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2/10/2013 6:01:34 AM
Posted: 6 years ago
At 2/10/2013 4:58:03 AM, royalpaladin wrote:
At 2/9/2013 5:46:34 AM, tmar19652 wrote:
I don't mean to shift the thread, but if he is not the father, should he have to pay child support? What are your opinions.

It depends on whether the cheating was justified. If the society in which this occurs is a society in which gender role distribution is treated as a zero-sum game or in which women are severely oppressed, it is justified as an expression of autonomy. It is also justified in situations in which the woman is forced into an arranged marriage for the same reason. In those cases, yes, the father should pay child support.

In an arranged marriage yes he should pay child support
Otherwise, no cheating is justified, and I think he should not owe child support.
"Politics is supposed to be the second-oldest profession. I have come to realize that it bears a very close resemblance to the first." -Ronald Reagan

"The notion of political correctness declares certain topics, certain ex<x>pressions even certain gestures off-limits. What began as a crusade for civility has soured into a cause of conflict and even censorship." -George H.W. Bush
royalpaladin
Posts: 22,357
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2/10/2013 6:07:28 AM
Posted: 6 years ago
At 2/10/2013 6:01:34 AM, tmar19652 wrote:
At 2/10/2013 4:58:03 AM, royalpaladin wrote:
At 2/9/2013 5:46:34 AM, tmar19652 wrote:
I don't mean to shift the thread, but if he is not the father, should he have to pay child support? What are your opinions.

It depends on whether the cheating was justified. If the society in which this occurs is a society in which gender role distribution is treated as a zero-sum game or in which women are severely oppressed, it is justified as an expression of autonomy. It is also justified in situations in which the woman is forced into an arranged marriage for the same reason. In those cases, yes, the father should pay child support.

In an arranged marriage yes he should pay child support
Otherwise, no cheating is justified, and I think he should not owe child support.

I offered other cases in which I thought it would be justified. If gender roles are treated as a zero-sum game or women are severely oppressed in society or by the individual (like in an abusive relationship), I think the cheating was justified.

I don't think it would be warranted in most cases in the United States.
royalpaladin
Posts: 22,357
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2/10/2013 6:08:28 AM
Posted: 6 years ago
I think it would be better to have the biological father pay child support. I am not sure why courts do not agree with that position.
Maikuru
Posts: 9,112
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2/10/2013 10:22:36 AM
Posted: 6 years ago
Well, considering the counselor is trying to figure out why the child has the condition in question, he obviously has to disclose the test results. In this case, medical ethics and doing the right thing just happen to go hand in hand.
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