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Below are some of the threads of discussions on varying Child and Youth Care related topics.
Questions and Responses have been reproduced verbatim.
Listen to thisHello Everyone!
We are Child and Youth Care students looking for some different perspectives
and opinions on an ethical topic we are writing a paper on. Our scenario is:
It comes to our attention that a youth in our residential facility has been
diagnosed with AIDS. This particular youth has boundary issues and often participates
in sexual activity with other youth in the facility. Our question is: Do we
have an ethical responsibility to break confidentiality of one youth to save
the other youth in the group home or are we ethically responsible to maintain
the confidentiality of the one youth no matter the costs?
We are wondering if you have run into the same/similar situation during your
experiences in the field, and if you would mind sharing? We're also wondering
if you know of any legal policies regarding this situation or if you could point
us in the right direction for finding it?
Thank you!! :)
...
Dear Nova Scotia Community College Students,
This is an ethical question that different professionals grapple with, and it
is a very real dilemma. My position is that you have an obligation to inform
the youth that his actions are irresponsible and can likely lead to the infection
of others. If he is aware of this, and has the intellectual capacity to really
understand the consequences of his actions, and still continues to engage in
unprotected sex with others without informing them of his status, he could possibly
even face criminal prosecution. However, his partners have an equal responsibility
to protect themselves when engaging in sex, and HIV is not the only risk they
take, so the responsibility is not all his. The difference is that he knows
that he is infected, and he knows that he might infect them – that is a deliberate
act. If you have done everything possibile to convince him to use protection
and to be honest with his sexual partners, and he still continues to have unprotected
sex, then you have an obligation to tell his partners – but you have to inform
him that you will do so. It is still a risk for you however, because it is an
ethical problem, and new ground is broken in this area all the time, and legal
positions change all the time, so there is no risk-free action for you. You
have to take into consideration your responsibility to have the youth's best
interest at heart, without allowing him to harm others. So in the end, I would
tell. (I'm not assuming it’s a "him", just being brief.)
Werner van der Westhuizen
SOS Children’s Villages, Port Elizabeth
...
I would think that it is your duty to tell the other youth because their life
is at risk. That's just my opinion though, good luck with your final decision.
Rachelle
...
Hi,
Why are you assuming that nobody else in the facility has AIDS? My opinion is
yes you are absolutely bound to keep that information confidential. If there
is an issue in relation to sexual activity between the youth, then that is a
separate (though related) issue in itself that needs to be addressed and policies
should be developed from the place of assuming that everyone could have AIDS!
Regards
John Byrne (Ireland)
...
Any health issues re: blood borne pathogens/ hygiene etc. should be talked about
to/with the staff and then to the youth through the staff. Knowledge here is
the key. There are many things you can do without breaking the HIPPA laws (that
is where you get your law from). I teach universal precaution to the staff where
I work and the knowledge you give to them passes to the residents. I also teach
the school teachers and they in turn teach the students.
www.cdc.gov will help you with information
that is true and factual.
You can also offer free testing to individuals that are interested in finding
out if they are safe. Not just our youth should keep up on the testing. I suggest
the staff get tested if they work with our at-risk youth. Going to the nearest
health department can help with the test and avoid the health insurance game
of denial of coverage because you were tested. (Illegal but sometimes done)
Aids is not the only worry Hepatitis B and C are also a very big threat and
a bigger one to our youth and staff for it doesn't die outside the body like
HIV does.
As for the youth that wants to live his own life and ignore the aids or kill
people before he goes or just doesn't realize what he is doing. Talk to him
(if he told you he has it) and help him to see if you can convince him to use
protection. See if he wants to know all about what he has and the breakthrough
meds that are out there for him.
Along with testing comes free products to protect against unwanted anything.
I caution here by saying staff must be limited to what the job policies are.
If you are tied by rules than outsource your information, give out numbers and
info.
Donna Wilson
...
I have had exactly that experience when I ran a group foster group home, however
the child had hepatitis that is shared via more ways than needles or unprotected
sex. I could not breach confidentiality however, I did create a health and life
skills program that all residents attended and we covered all sorts of communicable
infections from STI's (as they are now called in Ontario instead of STD's),
HIV, AIDS and the various hepatitis strains. I then covered ethics, responsibility
and confidentiality with the kids and asked "what if" questions. If
you were HIV positive would you want others to share this information, what
if you were having sex with other residents ...
Then explaining our responsibility about not being able to breach confidentiality
but being worried about everyone's health and safety while being the "keeper
of information". This created lots of opportunity for dialogue and the
child who was having risky sex discontinued with residents and to my knowledge
began to take better care of his own health. Hope that helps.. thanks for asking
the question.. I will be interested in seeing how others respond..
Theresa
Ontario , Canada
...
My understanding is that when a person knowingly infects another person he is
charged. It's like having shooting someone with a time delayed gun I suppose.
I have heard of people being charged for this. I am sure the internet will have
the actual details.
If you were the infected person's unsuspecting partner ... what you would you?
If you do nothing then you are an accomplice for putting the other person's
life at risk. I have a right to know and then I will decide whether or not to
take the risk. No one has the right to play God with the future and life of
another human being ... no one. I ask again ... if someone with HIV/AIDS wanted
to have sex with you .... wouldn't you want to know? And what if you didn't
know and found out from someone else besides the infected person ... how would
you feel? Wear the other persons shoes and then decide what the right thing
to do is.
Vivian Smith
...
Hi,
Confidentiality is a hard one!
For me there is something around always respecting confidentiality, unless it
puts the individual, or others at risk of harm. I would consider, given the
diagnosis of AIDS, and the resulting behaviour, that this can be seen as potentially
putting others at risk of harm.
My instinct would be to first of all approach the individual, explain the potential
risks to others from his behaviour, and to state clearly the boundaries in terms
of confidentiality. This allows for the individual to make concrete choices
re their behaviour, whilst being clear of potential consequences of it?
Marie
...
Hi there,
It is of course both partners' equal responsibilty take precautions when having
sex. So even if the partner who knows that he is HIV+ does not tell his partner,
his partner should also know to take precautions.
Werner van der Westhuizen
SOS Children’s Villages, Port Elizabeth
...
I cannot find the original question raised by "Nova Scotia Community College
Students" about a resident with HIV (whether or not the person has AIDS...)
-- but I wanted to send them a long reply that I wrote when this same question
was asked in January of 2004, on this discussion group.
The 2004 original was a very long reply, but I have the entire thing in my files
and would be happy to send it to anyone (privately) if you want to e me to request
this: jweiser@phototherapy-centre.com
I will paste parts of that reply below here, so feel free to contact me if you
want the whole thing...
2004 original reply:
I have been counselling youth who have HIV, for over a dozen years now, and
I have a few things to share on this topic:
Although a particular kid might be infected, you are just as likely to have
many other kids (OR STAFF or FRIENDS!) who have HEP or HIV but just don't know
it yet!!
Let me explain: you never know for sure WHO has a virus (HIV, HEP- C,etc) until
people are tested and so many are walking around actually having both viruses,
with no symptoms, and no-one knows, not even
them!. That's the precise reason for "universal precautions"!! You
are right that we need to be careful around "blood accidents" with
those who you already know have one of these viruses, but it's even MORE important
to still also be EQUALLY careful with anyone we might think to share a needle,
or sex, with, who we assume do NOT have them (maybe they don't "look like"
the type, whatever that is -- or maybe they say "I was tested; I'm OK")!
Hep C's different, but with HIV, even when the nurse says "your results
are negative", that doesn't mean you don't HAVE it; it only means that
as of a few months ago, you didn't have it (!) -- but you could have got it
recently but it's too soon for there to be enough "traces" of it to
be seen in the test results (ain't THAT a shock,
eh!). So, for example, with HIV, if I got infected today, I would likely still
test negative (as if I don't have it) for several weeks -- and likely a couple
months -- before I would turn up as being "positive" (having it) on
a blood test! So I could infect you without even knowing I could -- because
I honestly did not know it was there even while not showing up on a test!!!
yes!!
SO... what I'm trying to say here is that:
a) ALL of us (& youth especially) should be educated to understand that
anyone could have either virus and truly not know (even if they WERE recently
tested!) -- and therefore we/they ARE easily able to put others at risk through
normal pleasant activities (or violence, though this is MUCH more rare) and
b) therefore we should all instead be living with the approach that it is possible
that ANY of our youth (AND CO-WORKERS too) likely could have both viruses and
just don't know it yet -- With that perspective in mind, "universal precautions"
become understandable as just good "common sense"-- and then
c) just go on with life, keeping this in mind re: those you know, strangers
you don't yet (someone who needs first aid that you meet suddenly, etc...).
I guess my point is that it's not just this one youth you have to be worried
about -- it's all of us, everyone "out there" in the world (even doctors
or nurses themselves, grandparents, kindergarteners, parents, clergy, and others
you'd never ever suspect -- i.e., not just the "usual" kind you think
might have it!)
1) treat everybody -- all your youth (and co-workers) -- friends & family
too -- with the same degree of caring concern re: blood-borne viruses (that
anybody could have it and just not know yet), and
2) make sure all your youth who are engaging in any kind of "risky behaviour"
are at least told the info above, even if they choose not to listen -- at least
you won't feel as bad then, when one of them turns up infected, because at least
then you know you did your best yourself.
3) protect yourself as best you can re: ALL youth in your care (& ditto
co-workers!), as you will NEVER know who has these things and who doesn't, regardless
of their test results!, and
4) realize that Hep-C is "caught" only by blood exchange and so unless
your kid is sharing needles or having unprotected sex with family members you
are likely safe in this particular situation -- BUT...what do you know about
Hep-A and B, re: similar concerns (i.e. they are easier for us to catch other
ways than blood!)??
As they say in this field of work, "Knowledge is power... silence is death...
and ignorance totally inexcusable..."
Judy Weiser (long-ago Child and Youth Care but still love the profession!)
...
I have been in the field for ten years I have not experienced that situation
however I have heard situations in the news where an individual knew they had
AIDS but still became intimate and infected their partners. They were charged,
if this individual is of sound mind and is aware clearly of his disease which
sounds like he is if he is being intimate with his peers, then I believe it
our obligation as Child Youth Workers to also advocate and protect other clients
who also live in the capacity in which we work. I will sacrifice my job so that
the integrity I made a commitment to in serving all individuals within our vulnerable
population and if that means breaking confidentiality in your particular scenerio
I would.
Good Luck.
Keisha M
...
Hi,
In May 2007 I put this same question on this discussion board as in the past
we have had youth in our program who have had communicable diseases such as
sexually transmitted infections (STIs) and who have been HIV positive. Our confidentiality
policy was not giving us the needed direction to be helpful in all areas of
this dilemma with those who may be affected. We felt that the youth who were
participating in these activities were at risk of being harmed, as STIs and
HIV are life altering, if not fatal.
Our intake package includes a paragraph stating that any residential facility
has the potential to have youth who have communicable diseases and Youth Care
Workers are trained in taking universal precautions. We also have discussions
and do programming with the youth about communicable diseases and the precautions
to use.
Our question put on this discussion board was if we know that a youth has engaged
in an activity with another resident that has put him/her at risk of being infected
with a communicable disease, who's responsibility is it to inform the youth,
and who's jurisdiction would this fall under (i.e., the facility's or the Department
of Community Services)?
We received many helpful responses from people to our question and as a result
of our enquiries, our province Nova Scotia, Canada established a committee that
would further review and refine the provincial policy for residential care regarding
the concerns surrounding communicable diseases, including HIV and sexually transmitted
diseases that can cause life lasting harm.
We saw this as a positive action plan and we on the front line were invited to send on our thoughts in writing as well for the committee to consider when shaping the policy. This committee is facilitated by the Provincial Ombudsman's office and is comprised of representatives from various public and private sectors. Two days ago representatives from our organization met with our legal counsel. We were informed that while it is important to protect the privacy of our residents we are not under statutory obligation to do so. We are permitted to disclose information if we feel there is significant risk to someone's health. So, we are permitted to disclose if someone has a communicable disease if they are participating in behaviour that puts other people at risk of harm.
If we have reason to believe that one of our residents has a communicable disease we are permitted to disclose this information to the resident's suspected sexual partners and the resident's social worker. We would encourage the resident to make this disclosure to the appropriate people themselves but if they did not do this we are permitted to do so. It is important to note that any actions taken would have to be documented completely in the youth's logs.
At present we are reviewing our confidentiality policy and it will be rewritten
to include the guidance we have recently received from our legal counsel. I
hope this information helps with the paper you are writing.
Patsy Thompson
HomeBridge Youth Society
...
Thank you for stressing this Werner -- and I completely agree.
I have often heard it said: "these days it is your own fault if you get
HIV". Now I know there are many exceptions to this statement (being raped,
getting a tainted blood transfusion, etc...) -- however there is a part of me
that totally agrees with that statement because these days people should be
protecting themselves, rather than putting this responsibility onto someone
else instead.
There was a case here in Canada last year where a man was sentenced to prison
for knowingly lying about his positive status and infecting many "innocent"
women". I found this fascinating in where the blame was put, because if
the woman were protecting herself, regardless (i.e., there ARE "female
condoms" and one CAN refuse to have sex if no protection is used by the
other person) -- then whose "fault" is this really?
I do not mean to "blame the victim" but, as I said before, "ignorance
is no excuse". Yes there are "accidents" (condoms break; oral
sex CAN infect, though very rarely; etc) but unless one was forced into a sexual
encounter there is no real excuse for letting oneself become infected.
Even if the person says they don't have it (or "just got back test results
and they are negative"), this means little because: a) they could be lying
and/or b) the test results show one's zero-status up to a few months ago but
since the virus needs to grow a bit before it's detectable in a blood test,
the person COULD be infected, not know it yet, and their test results NOT show
this yet!
So it's good to see what you wrote!
Thanks,
Judy Weiser
...
In response to your question regarding the legalities of disclosing information/breaching
confidentiality.
To knowingly infect a person with HIV/AIDS is a criminal offense. If you are
privileged with the knowledge in your question, then technically you are aware
that a potentially life threatening crime is being committed against another
resident.
Would the nature of the crime play a role in you making an ethical decision?
Would your relationship to the perpetrator play a role in you making an ethical
decision?
From a legal standpoint, if you are aware that a person who is infected with
HIV/AIDS is having unprotected sex with another resident in care, you are within
your legal rights to disclose that information to the other resident.
Ed Langille
...
Further comments on the Aids/ethics query ...
Wow – lots of interesting thoughts on this matter. Just wondering...I happen
to agree with Patsy regarding sharing this information if the client with HIV
is knowingly putting others at risk. I wonder what the legal ramifications will
be if we don't share this information and (even if it is due to ignorance, state
of mind, suicidal ideation, immaturity, etc.) clients are being put at serious
risk. Our youth have enough to deal with without adding (particularly "knowingly")
to their troubles.
Diane Rapkoski
...
Re: Keisha's comment that people DO infect their partners, my point is that
the best way of "protecting your clients" is not to focus on the person
who might knowingly have unprotected sex with them, but rather to educate your
clients that the reason for unprotected sex does not lie solely in only one
person of the two!
Unless the sexual encounter is forced (a completely different situation!), then
the person who is not yet infected is at least equally responsible for the act
of unprotected sex to have happened... THAT is the point I'm trying to make.
It seems the focus here is on people who KNOW they have HIV (whether or not
it has advanced yet to AIDS)...
I suggest that your focus of "protecting your clients" would have
better results if you focused on educating them that the best way to protect
themselves is to assume that EVERYONE they have sex with could well have HIV
but not know it yet. THOSE people are much more dangerous at infecting others,
than the ones who KNOW they have it. THAT is where protecting clients (and co-workers,
and OURSELVES also, I might add!!), begins...
Teaching them that THEY are responsible for what happens to their body and that
there IS choice about who you let "in there"... would seem to me to
be the best protection! There will always be people out there with HIV, who
lie, or don't care, and won't use protection themselves. Your clients need to
know that condoms can do a lot for keeping infections (of MANY kinds) from entering
their bodies -- and that the responsibility for this is their own, not someone
else's...
Judy Weiser
