Topic: Society

"The Ethicist" and the HIV-positive Housemate

The Scoreboard generally avoids poaching the ethics queries and answers that appear in the weekly column of my better-known competitor and colleague, Randy Cohen, a.k.a. “The Ethicist.” I often disagree with his analyses of the real-life ethical dilemmas raised by his readers, because Cohen has a tendency to let his ideological agenda items crowd out his ethics. Still, I often agree with him, and always enjoy Cohen’s style. He’s an entertaining writer. But a reader recently asked if a housemate had an ethical obligation to tell those he was living with that he was HIV positive, positing that he did not. Cohen agreed. He and the writer are both wrong, and there are important principles involved.

Cohen, like the writer of the letter, concentrated on the risk to other housemates posed by the HIV positive individual, and reasoned that because it was negligible, no obligation existed:

There is a duty to be careful with personal objects like a razor or a toothbrush so that other people do not inadvertently use them and to be cautious about minor mishaps. (If someone who is H.I.V. positive cuts himself, for instance, he should be sure to put on a Band-Aid.) And he should consult his physician about how to generally protect the people he lives with. That is, he must respond to his roommates’ reasonable health concerns while preserving his medical privacy.

But the important principles involved are not just safety and privacy, as Cohen seems to believe, but also autonomy, candor, trust, fairness, and the Golden Rule. The HIV positive housemate may have no liability-based obligations to disclose his condition, but the perception of risk is subjective. Sorry, Randy, but where infection to disease is concerned, I want to be able to make my own decisions about what precautions are reasonable, and not to leave my health in the hands of someone who is more concerned about his privacy than my welfare.

The threshold question has to be this: would the individual’s housemates want to know that they are living with someone who is HIV positive? Might they perceive a risk that they should be able to avoid if they choose not to accept it? The HIV-positive individual has no right to dictate their risk tolerance, or even to unilaterally conclude that a decision not to continue living with someone infected with a virus is wrong. Cohen’s advice doesn’t pass the Golden Rule test. If the individual would only ask, “Would my housemates want me to share this information with them?” the answer would be obvious, and the ethical course clear.

The issue is not whether the interest of housemates in an individual’s HIV status is supported by law, or whether the housemates could require him to disclose his HIV status. These are legal questions, and Randy Cohen, according to the heading on his column in the New York Times Magazine, is “The Ethicist.” That means he should answer the query based on what is right: fair, candid, responsible, respectful….and trustworthy. Most of all, trustworthy. People must trust the people they live with, and the trust must flow both ways. Ethics often requires anticipating possible ethical dilemmas that may arise in the future. If the HIV-positive individual has a kitchen accident like my webmaster recently did, and takes a hunk of his finger off with a potato peeler, accusing profuse bleeding, presumably then he must reveal his infection. And the questions from his housemates will be, “Why didn’t you say anything before? Don’t you trust us? Shouldn’t we know about something like that? What else haven’t you told us?”

Legitimate questions all. Can a decision to withhold information still be trustworthy if people are less likely to trust the individual when they discover the secret? I don’t think so.

To be fair, The Ethicist does say that revealing the HIV status to the housemates would be “admirable”—-the preferable way to handle the situation, in his view, but not ethically “required.” But that means assigning a ridiculously small value to each individual’s right to autonomy, and to make informed choices about where and how he or she wants to live, and whom with: “The danger such a person presents to housemates is slight,” writes Cohen, “ but it would be good if they could act with knowledge of their circumstances.”

It would be good, all right. In fact, it is essential. Nobody should withhold such knowledge. I want to “act with knowledge of my living circumstances.” You do, and so does Randy Cohen. And yet he argues it is ethical for an individual to withhold that from us, allowing his privacy interest to trump our legitimate needs. With all due respect to “The Ethicist,” that isn’t ethics.

That’s politics.

We could have many arguments about what personal information a housemate should or shouldn’t reveal. Religious view, sexual orientation, political views, ethnic origins, and personal wealth all would fall on Cohen’s side, in my view. Criminal convictions, major psychiatric issues, weapon ownership, fugitive status, super-powers and secret identities are among the facts that a housemate may have an ethical obligation to reveal. Several of these are right on the line.

But not HIV-positive status. Ethics requires disclosure, even if the law does not.

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