Warning Third Parties at Risk of AIDS: APA's Policy Is a Reasonable Approach

The author argues that the American Psychiatric Association's AIDS policy on confidentiality and disclosure provides reasonable guidelines for psychiatrists struggling to balance their obligation to maintain the confidentiality of individual patients infected with human immunodeficiency virus (HIV) with their obligation to protect the community's health. The policy states that notification of third parties who may be exposed to infection through the behavior of an HIV-positive patient is ethically permissible if the psychiatrist has exhausted efforts to work with the patient to terminate behavior that places others at risk and if the patient understands the limits of confidentiality. The author points out that judicious notification is within the medical tradition that includes disclosure of a patient's dangerousness in situations involving infectious diseases such as tuberculosis and is supported by the duty-to-warn precedent set by the Tarasoff decision.