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A Public Health Stranger in the Land of Medical Care

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Posted by Stewart Auyash at 10:11AM   |  5 comments
H1N1 Virus

I don’t need to know if you are sick. Or do I? How about if you have a contagious illness? Perhaps H1N1? 

Fortunately, the latest pandemic has not been as fatal as we had feared. While tragedy has struck some families, the death rate is about the same as or less than seasonal flu. Most of those who have perished had prior illnesses or conditions that left them susceptible to opportunistic infections like H1N1.

In the Ithaca community, tragedy struck a Cornell senior who became the third college student to die from H1N1 in the US.  We do not know if any prior conditions contributed to his death. Yet, headlines in the Cornell Daily Sun this week read:

Hospital Says It Has Not Discussed Whether Any Underlying Condition Contributed to H1N1 Death

The laws are clear: patient privacy is secure and protected. Only the patient or the family has the right to grant access to health information.  Even when the climate of fear permeates the community, our culture and laws value and protect the individual right to privacy. For that we should be thankful. For now.

What about the next epidemic? When the extent of the disease is more widespread, the fatality rates are higher, and underlying conditions are an obvious risk factor? What can we learn from the current epidemic? Shall we do anything different? Dare say, shall we suspend the laws and culture of privacy, for example? They do that in many other parts of the world in order to protect the public's health.

Do I need to know if you are sick? Or did you have an underlying condition, or not? Is the greater responsibility to protect the community or the individual right to privacy?

Stay tuned. The next epidemic is…..

Meanwhile, here is my highly recommended reading for this subject: The Last Town on Earth by Thomas Mullen; a novel about the morality issues of isolation, quarantine, and fear surrounding the deadly 1918 flu pandemic.


5 Comments

I do not think that the epidemic is so bad yet that health privacy laws need to be suspended. It would be of great ease to know for certain that the Cornell student did or did not have an underlying or previous condition, but I still think that it should be the families decision at this time. If a person is sick, they should take care of themselves, and in turn they would be taking care of the community. It would benefit the community to know they the individual is sick while they are out on public, but that is on a person to person basis. Basically, we should not need to know if a person is ill at this point, but it would greatly benefit a healthy person's well being if the ill person let people know. It as simple as saying "I havn't been feeling well lately" upon the first signs of illness, then leaving it up to the healthy person to do what they will with that piece of information.

I think when discussing Private Health Boundaries you are talking about a very tricky situation. Boundaries being the key tricky word. There are boundaries and boundaries are set for a reason. Reason being: to protect peopleís privacy. As Stewart stated, the laws are clear: patient privacy is secure and protected.

I think the right to privacy is a good thing. However if someone were in my living space with a soon to be possible wide spread disease I would want to know. I cannot force them to tell me, nor do they have to tell me. One would hope that they would be honest, but one cannot always be honest and forthcoming to protect someone elseís well being. Nonetheless I do not think society should suspend the laws and culture of privacy. Hypothetically if I was living with HIV I would not want that information diluted out to anyone unless I were the one to dilute such information. I feel that if I had an underlying condition that was fatal and contagious I would act accordingly to prevent the fatality of others. However, not everyone would follow accordingly and it is very probable that I would be infected with the condition. That is where it is tricky. I would want to be protected but I would never want the right to privacy to be lifted off of the table. When dealing with Private Health Boundaries it is evident that it is not possible to have oneís cake and eat it too.

I agree with you that it's a very tricky situation. It's actually hard for me to come up with my own opinion on the issue. I agree that H1N1 hasn't been as bad as everyone thought it was going to be, so I don't believe that the public should know who has swine flu or know what other condition a H1N1 victim had that led to his or her death. I agree that it would have been a relief to some residents and college students in Ithaca if the information was released, but there hasn't been enough cases to justify releasing the information.

Also, when individual's private information is released, there is a stigma associated with it. Such with HIV/AIDS patients, they didn't want anyone to know because they could be discriminated against. No one wants to be looked at as diseased. Maybe if H1N1 gets to the point where it is so bad, action will be be taken to help protect communities from contracting the virus. However, for now, I don't believe we're at the point where anything drastic needs to be done. It's up to each individual to make sure they don't go out if they're sick, try to remain healthy, and take the necessary preventative measures to avoid from getting H1N1.

I 100 percent agree with Hayden! We should not think about suspending health privacy laws because we fear it becoming wide spread. I agree in protecting individuals but if we sacrifice one persons privacy for the greater good then how are we any different from Utilitarian society. It just makes me wonder and question whats next? Do we reveal individuals with HIV/AIDs--that's a pandemic right? Why do we have the right to do that as though they are sexual molesters and their name should be listed on a website. Then what? do we send out a flyer saying so and so lives in your neighborhood and has this disease. I think doing anything of that sort only increases the stigma associated with such diseases and then you know what ends up happening? Individuals who maybe suffering from H1N1 never come to light...yes we do an autopsy if someone dies abruptly but by then it maybe too late. Who knows who the individual may have met with or went? I just do not want anyone to come and tell me we are taking away your personal rights for the greater good. I know in my last blog entry I said we should think about others but WITHOUT negatively affecting me. Taking away my right to privacy is unfair and unethical--and lacks the essence morality.As if our health care system doesn't stink enough!

I believe in times such as these, patient privacy should not be our number one concern. With issues such as major epidemics, the public deserves to know all the details so that they can protect themselves. If a person dies of a disease due to previous conditions or some other underlying issue, the public should know about it. In these conditions, it is important that public knows because public knowledge can decrease the amount of people infected with the virus. The more knowledge people have, the better chance they have of protecting themselves and their families and keeping healthy.
The best way to do this is to have the most information possible. Some of the most valuable information people can gain is knowledge from those who did not successfully beat the disease. It is extremely beneficial to learn from your mistakes. However, if you can't learn from your own mistakes, you can learn from others. The only way to be able to do this is to amend the current patient privacy laws. The laws need to allow the public to have access to patient's information that will be beneficial to them and help them prevent infection. By gaining access to patientís records, public health officials will be able to document their findings. They will be able to identify patterns and trends. These findings will not only be beneficial to this epidemic but it may be useful for preventing the next as well.
Changing public health laws, specifically patient privacy laws will be challenging. They have been in effect since 1974 and it will be difficult to change the majority consensus that they should no longer be in effect. However, amending these laws will be extremely beneficial to public health and will be a huge step in the right direction for preventative health care measures, specifically in regards to epidemics.



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