Ethical Challenges in Short-Term Global Health Training

Jeffrey is a student volunteering for an NGO in East Asia. He wonders whether to tell someone their test results. Click image to start video.

CASE 8: Telling the "Truth"

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Vignette 1: Jeffrey is unsure what to do when a person asks about her blood testing. His own culture places priority on truth telling as a disclosure of all relevant information, particularly when directly asked. Accordingly, he feels compelled to inform this woman of her HIV and hepatitis status. In this area, she might rarely (if ever) see a health care worker, so it might be the only chance for her to learn her HIV and/or hepatitis status. However, in Jeffery’s training, he was told to simply inform potential donors who have evidence of infection with HIV or hepatitis that they are "not a match".

Jeffrey is a student volunteering for a non-governmental organization based in East Asia. He is trained in blood drawing, and part of his job involves screening individuals for hepatitis and HIV prior to blood donation. If the testing returns positive for either condition, he informs the individual that they cannot donate blood.

What should Jeffrey do?

Tell the person about her HIV status; she has a right to know and Jeffrey has a duty to tell.
Even if this were true in Jeffrey’s own culture (and it might not be), Jeffrey should carefully consider whether he should be the one to deliver the diagnosis, or how this diagnosis is discussed, in a different culture. Choose a different answer.
Refuse to disclose the HIV or hepatitis status; no treatment is available in this area anyway.
It might be correct that Jeffrey should not tell the patient of this diagnosis. However, not telling simply because he believes no treatment is available is not the best reasoning because the results have implications for the individual and for others. Choose a different answer.
Tell the person that she was "not a match," and move on.
This would be consistent with his training. However, Jeffrey should consider taking this woman’s question seriously and use the opportunity to learn more about the culture. Choose a different answer.
Excuse himself from the situation, at least temporarily, and seek advice from his local advisor.
This is correct. Jeffrey is appropriately critical of whether, and how, to deliver this news to the woman in this vignette. Before giving (or not giving) any information, he should seek advice from his local advisor.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)