Re-examining ethical obligations in the intensive care unit HIV disclosure to surrogates 英文参考文献.docVIP

Available online /content/11/2/125 Commentary Re-examining ethical obligations in the intensive care unit: HIV disclosure to surrogates Anthony T Vernillo1, Paul R Wolpe2 and Scott D Halpern3 1New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York, New York 10010, USA 2University of Pennsylvania, Departments of Psychiatry, Medical Ethics, and Sociology and Center for Bioethics, Philadelphia, Pennsylvania 19104, USA 3Division of Pulmonary, Allergy, and Critical Care Medicine; Center for Clinical Epidemiology and Biostatistics; Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA Corresponding author: Anthony Vernillo, atv1@ Published: 18 April 2007 Critical Care 2007, 11:125 (doi:10.1186/cc5720) This article is online at /content/11/2/125 ? 2007 BioMed Central Ltd Abstract fever, chills, fatigue, and shortness of breath. Her blood cultures rapidly grow Staphylococcus aureus, and an Physicians treating newly incapacitated patients often must help navigate surrogate decision-makers through a difficult course of treatment decisions, while safeguarding the patient’s autonomy. We offer guidance for intensive care physicians who must frequently address the difficult questions concerning disclosure of confidential information to surrogates. Three clinical vignettes will highlight the ethical challenges to physician disclosure of a critically ill patient’s HIV status. Two key distinctions are offered that influence the propriety of disclosure: first, whether HIV infection represents a ‘primary cause’ for the patient’s critical illness; and second, whether the surrogate may be harmed by failure to disclose HIV status. This balanced consideration of the direct duties of physicians to patients, and their indirect duties to surrogates and third-