THE HIV-POSITIVE PSYCHIATRIC-PATIENT AND THE DUTY TO PROTECT - ETHICAL AND LEGAL ISSUES

A small, yet significant, percentage of HIV-positive patients have a c oncomitant psychiatric or neurological disorder associated with impair ed judgment. Clinical problems such as psychoses, certain personality disorders, and dementias are associated with disinhibition of impulses and diminished capacity for self-monitoring. These deficits in reason ing and judgment may prevent the patient from comprehending the signif icance of their HIV status and the consequences of sexual behavior or needle sharing. There are indications that the Tarasoff duty-to-protec t may apply to this situation. Method: Available data about the preval ence of HIV risk behavior and HIV infection among psychiatric patients are reviewed. The applicability to these situations is described. Res ults: When an HIV patient engages in high risk sexual behavior with id entifiable partners and refuses to notify them of their HIV status, ph ysicians and mental health professionals may have a legal and ethical duty to warm. Conclusion: A decision model for this clinical dilemma i s presented. Clinical strategies for these patients may include ongoin g supervision and monitoring as well as possible quarantine.