关于艾滋病毒/艾滋病检测和隐私的问题和解答。另请参阅我们的页面 艾滋病毒/艾滋病歧视 和 其他艾滋病相关问题.

马萨诸塞州有哪些法律管辖 HIV 检测的知情同意？

In 2012, Massachusetts changed the HIV testing part of the law (M.G.L. c. 111, § 70F) to require only “verbal informed consent.”  However, a physician, health care provider, or health care facility may not do any of the following without first obtaining a person’s 书面 知情同意：

  • 向第三方透露某人已接受艾滋病毒检测；或者
  • 向第三方披露某人的艾滋病毒检测结果。

重要的是要记住，这项法律仅禁止医疗保健提供者披露艾滋病毒状况。

A competent adult has the right to decide whether he or she wishes to undergo any medical treatment or testing.  Without informed consent, the provision of medical treatment is considered to be a “battery,” a legal claim based upon nonconsensual physical contact with or intrusion upon a person’s body.

什么类型的同意才算充分？

Consent to an HIV test only needs to be done orally, but disclosure that a person took an HIV test or the results of an HIV test requires written  informed consent and must be HIV-specific, not general.

书面知情同意意味着一个人必须签署一份特定的授权书，授权医疗保健提供者进行艾滋病毒检测和/或披露艾滋病毒检测结果。

仅向医疗保健提供者提供一般性授权披露医疗记录和信息是不够的。该授权必须明确授权披露HIV检测结果，并说明请求披露信息的用途。

对于未获得书面知情同意的医疗保健提供者可能受到哪些处罚？

A health care provider or facility that tests for HIV or discloses an HIV test result without written informed consent violates a Massachusetts law (M.G.L. c.  93A) that protects consumers from unfair and deceptive trade practices.  Under this law, a person may receive compensatory damages for harm such as emotional distress, attorneys’ fees and, under certain circumstances, multiple damages — damages up to three times the amount of a person’s actual damages.  A physician may also be liable for medical malpractice or battery.

未成年人可以给予知情同意吗？

根据马萨诸塞州法律，未成年人（未满18岁）通常被认为缺乏同意接受医疗治疗的法律行为能力。然而，鉴于向青少年提供HIV检测的重要性，目前有两部法律授权未成年人无需父母或法定监护人同意即可同意接受医疗治疗或检测，例如HIV检测。

立法者和法院都承认未成年人在某些情况下能够独立决定自己的医疗保健的重要性。

哪些法律管辖未成年人和知情同意？

Massachusetts law (M.G.L. c. 112, § 12F) provides that a minor may give consent to medical or dental care if he or she is:

  • 已婚、丧偶或离婚；
  • 孩子的父母；
  • 武装部队成员；
  • 怀孕或认为自己怀孕；
  • 与父母或法定监护人分居并管理自己的财务；或
  • “Reasonably believes himself to be suffering from or to have come in contact with any disease defined as dangerous to the public health [by the Department of Public Health] pursuant to Chapter 111.” The list of such diseases includes HIV.  The minor may only consent to care relating to the diagnosis or treatment of that disease.

A physician or dentist is not liable for performing a procedure without informed consent if the physician relied in good faith on the patient’s statement that he or she is over 18 years of age.

Medical or dental records and other information about a minor who consents to treatment are confidential and may not be released except with the consent of the minor or upon a judicial order.  The statute, however, creates an exception to the confidentiality of a minor’s medical information when the physician or dentist “reasonably believes” that the minor’s condition is “so serious that his life or limb is endangered.”  In this case, the physician or dentist 必须 将未成年人的情况通知父母或法定监护人。

法院对未成年人和知情同意有何看法？

除第112章第12F条的规定外，法院还裁定，如果未成年人具备足够的智力和成熟度，能够理解治疗的风险和益处，无论其经济独立性或生活状况如何，他们都可以就医疗治疗提供知情同意。这被称为“成熟未成年人”规则。

法院通常会评估未成年人的年龄、经验、教育、培训、判断力、行为和举止，以评估在特定情况下未成年人是否有能力理解待遇的性质和后果。

法院将特别考虑该人距离成年年龄（18 岁）的接近程度、治疗或测试的益处（对于 HIV 抗体测试而言，益处至关重要）以及治疗或测试的复杂性。

马萨诸塞州是否有报告法律要求向公共卫生部报告 HIV 或艾滋病诊断结果？

Yes. All states require that certain health conditions be reported to public health authorities in order to track epidemiological trends and develop effective prevention strategies.  Massachusetts requires that licensed health care providers and health care facilities licensed by the Department of Public Health report HIV and AIDS cases by name to the Massachusetts HIV/AIDS Surveillance Program.  AIDS cases have been reportable by name since 1983.  In 1999 HIV cases became reportable using a unique identifier code.  Due to funding conditions by the federal      government, however, Massachusetts was forced to require HIV reporting by name beginning January 1, 2007.

The Department of Public Health has strong security measures in place to prevent dissemination of HIV/AIDS reporting data.  In addition, state regulations prohibit names from being shared with anyone else, including state or federal government entities (for more information, see HIV Reporting in Massachusetts for Consumers available at http://www.mass.gov, in the Diseases & Conditions section under Physical Health and Treatment).

马萨诸塞州的哪些法律保护医疗信息（例如 HIV）的隐私？

如上所述，HIV 检测法规禁止医疗保健提供者在未经书面知情同意的情况下向第三方披露 HIV 检测结果。马萨诸塞州有一项更为通用的隐私法，适用于其他情况。

Massachusetts law (M.G.L. c. 214, § 1B) provides:

每个人都有权免受对其隐私的不合理、实质性或严重的干涉。

法院如何确定是否存在违反这项一般隐私法的行为？

As an initial matter, in order to be protected by this law, a person must have a “privacy right” in particular information.  Courts have ruled that a person has a privacy right in HIV infection status because:

  • HIV 是个人医疗信息；并且
  • HIV 与严重的社会耻辱有关，

然而，仅仅对某些个人信息拥有“隐私权”并不意味着每次披露都是违法的。

在分析是否存在 违反 根据该法规，法院将确定是否存在 合法的 抵消理由 披露。换句话说，法院将在隐私权与被告阐明的其他理由之间进行权衡，以证明尽管隐私受到侵犯，但披露仍然是必要的。

For example, if an employee reveals his or her HIV status to a supervisor, the supervisor may only reveal that information to others for a necessary business reason.  It may be considered a legitimate business reason to discuss the employee’s HIV status with other management personnel in connection with making adjustments to a person’s job duties as a reasonable accommodation.  It would not, however, be a legitimate business reason to tell the employee’s co-workers or non-essential management personnel.

If a day care center or school revealed the identity of a child or student with AIDS to parents or other students, there is a good argument that such conduct violates Massachusetts law.  There is no legitimate interest in disclosing the child’s HIV status, especially since the risk of transmission to others is minuscule.

艾滋病毒感染者是否享有宪法赋予的隐私权？

Many courts have found that a person has a constitutional privacy right to the nondisclosure of HIV status.  Courts have based this right on the Due Process Clause of the U.S. Constitution which creates a “privacy interest” in avoiding disclosure of certain types of personal, intimate information.

只有当披露信息的人是国家或政府行为者（例如警察、监狱官员、州立医院的医生）时，才能主张宪法赋予的隐私权。

Similar to the Massachusetts privacy statute (M.G.L. c. 214, § 1B), courts balance the nature of the intrusion into a person’s privacy against the weight to be given to the government’s legitimate reason for a policy or practice that results in disclosure.

医疗保健专业人员是否有义务向第三方警告客户的艾滋病毒状况？

It is the AIDS Law Project’s view that there is no clear justification for such a breach of confidentiality under Massachusetts law, even if a counselor or physician learns that a client is engaging in unsafe sex or other risky behavior without having disclosed his or her HIV-positive status to a partner.  Providers and consumers alike, however, should be aware that the case law in this area is still developing and remains unresolved.  For a legal opinion on how to handle a specific situation, consult with a supervisor or lawyer.

马萨诸塞州法律允许医疗保健提供者在某些有限的情况下警告第三方可能造成的伤害，这是否适用于 HIV 状况？

艾滋病法律项目的立场是，这些规定不应被理解为适用于艾滋病毒。

Take, for example, the Massachusetts statute that permits licensed social workers and licensed mental health professionals to warn third-parties under certain limited circumstances (M.G.L. c. 112, § 135A). Under certain circumstances, Massachusetts law provides that a social worker 可能，但法律并未强制要求披露机密通信，包括以下情况：

  • 客户已传达 明确威胁要杀人或造成严重身体伤害 对有明显意图和能力实施威胁的一名或多名受害者进行合理识别；
  • 社会工作者知道客户有身体暴力史，并且社会工作者有合理理由相信客户会杀死可合理识别的受害者或对其造成严重的身体伤害。

There are virtually identical statutes for licensed psychologists (M.G.L. c. 112, § 129A) and licensed mental health professionals (M.G.L. c. 123, § 36B).

关于医生，马萨诸塞州最高法院表示 阿尔伯特诉迪瓦恩 1985年，最高法院裁定，医生对患者负有法律义务，未经患者同意不得泄露患者的机密医疗信息，“除非对患者或他人造成严重危险”。但自那时起，法院并没有明确解释“严重危险”的含义和范围。

鉴于马萨诸塞州的具体法规禁止医疗保健提供者非自愿披露艾滋病毒状况，这两项规定均未提供明确的法律依据来违反客户艾滋病毒状况的保密性。

No court has ever interpreted the relationship between the HIV confidentiality statute and other general provisions permitting disclosure of patient information under limited circumstances by doctors or mental health providers.  Therefore, providers who involuntarily disclose a client’s HIV status risk liability for invasion of privacy.

然而，由于这是一个不断发展的法律领域，因此就具体情况咨询律师至关重要。