Conflicting Duties to Patients: The Case of a Sexually Active Hepatitis B Carrier

A hemodialysis nurse who is a hepatitis B carrier insists on continuing dialysis nursing and sexual relationships but refuses to inform her lovers. The implications of her stance pose an ethical problem for her physician: whether to keep confidentiality, whereby others may be exposed to her hepatitis, or to breach confidentiality in order to limit her patient care activities and to notify her lovers. Pertinent medical and epidemiologic facts, legal opinions, and ethical considerations are discussed. We propose that the physician's responsibility to keep an immediate patient's confidences outweighs the responsibility to protect others unless there is sound evidence for very certain, severe harm to specific others.