Written by yxtlavi
"This is a state-prescribed legal infectious disease, and you have the responsibility to tell your wife."
The bar clicked, the phone hung up again, and only a hollow "beep-beep-" sound remained on the other side.
This is the tenth time that marriage doctor Li Weiling has called this man. In the marriage examination, the man tested positive for HIV, and Li Weiling called him for the first time to inform, but what he didn't expect was that the other party had already known; As expected, he didn't plan to talk to his wife at all.
"Since his wife came to the marriage examination with him, it means that she has long been a little suspicious. It is important for her to know the truth." Thinking like this, Li Weiling called for the eleventh time.
"I followed him for three months when I found out for HIV during the marriage test."
"The patient's partner cannot be directly informed of the test results" is a fact that almost all marriage examiners know. "We have legal training every year, and the hospital teaches us how to protect ourselves." Lv Yan from a third-class hospital in Guangdong said.
Article 62 of the Tort Liability Law stipulates that medical institutions and their medical personnel shall keep the privacy of patients confidential. Where patients' privacy is leaked or their medical record information is disclosed without the patient's consent, causing harm to the patient, tort liability shall be borne for infringement.
At the same time, Article 9 of the Maternal and Child Health Care Law requires that "after premarital medical examination, a physician shall provide medical advice on a person suffering from a designated infectious disease during the infectious period or the relevant psychiatric illness during the onset period; A man and a woman intending to marry shall postpone their marriage."
That is to say, even if the other party detects an infectious disease, the doctor cannot directly inform his partner, but can only notify him/herself. The original meaning of the marriage examination is to confirm the physical condition of the two people, and then enter the next stage of life, if you cannot inform your partner, the meaning of the marriage examination seems to pass.
In this regard, Li Weiling chose to "follow the good seduction" and guide the patient to take the initiative to talk to her partner.
"Basically, I need to make more than 20 phone calls a day." Li Weiling said, "All those who are detected with infectious diseases or need to postpone marriage, I will call back and tell the other party to suspend sexual life, don't rush to get married, and treat it first." Most of the patients who answered the phone were reluctant to inform each other of their condition, and Li Weiling would first tell whether the other party did not understand the condition or was worried about affecting the relationship with her partner.
Taking chlamydia infection as an example, Li Weiling will emphasize that this is a "mutual infection" disease, so patients will often cooperate with treatment. "If it's a more serious infectious disease, I'll call them back and explain it to them in person."
Photo: Visual China
What impressed Li Weiling the most was that she once detected a case of HIV during a marriage test. "They were married when they came to the marriage test, and the woman had plans to get pregnant. If you get pregnant rashly, it is too dangerous for the woman and the baby."
This case was followed for nearly three months, and Li Weiling constantly called the man, calling dozens of times. "At first, men would push back and say they didn't have time, but then they simply stopped answering my phone. Finally, I said to him, 'If you don't come, I'll call your wife again to remind her that the marriage report is out, and you can ask your husband how the result is.'" 」
Of course, Li Weiling will not do this, "there is no way to do it." In the end, the man returned to the marriage examination place with his wife again, confessed to his wife in front of Li Weiling, and then both parties signed the informed document. "That girl was emotionally broken." Li Weiling said.
As for whether the two divorced or continued to be together, Li Weiling is not clear. Even if the girl is eventually infected with HIV, Li Weiling is not responsible, "but let her know that it is important to us." Li Weiling said.
The control of infectious diseases through "notification" after marriage examination is not an isolated case. According to a survey conducted by a maternal and child health hospital in Fangchenggang City, between 2011~2012, 21 HIV-positive patients in their area were screened through marriage testing, and none of them informed their partners of their condition before the intervention, nor did they use condoms. [1]
Doctors took the initiative to contact patients, constantly emphasized the need for treatment, and informed partners, and finally 17 cases voluntarily informed partners of their condition and insisted on condom use; 13 confirmed patients voluntarily treated with antiviral therapy; The 5 pregnant women were unwittingly pregnant and all delivered in the designated mother-infant occlusion unit. Newborns are artificially fed after birth, all are treated with antiviral drugs, and all test negative for HIV by the age of one. [1]
Voluntary marriage test: TA's privacy, TA's health, what is important?
In order to increase the rate of marriage examination, Li Weiling and they simply put the marriage examination place in the Civil Affairs Bureau.
"You have to pass by us to get your license," Li Weiling said with a smile, "Everyone who comes for the medical examination will make small talk and ask, when are they going to get their license?" She silently noted the time in her mind. And once a problem is detected, she can also remember who that person is and when she is going to get it.
"I'll call them right away and ask them to go to treatment." Six months later, a year later, Li Weiling will continue to call to ask about the current treatment and give advice on whether it is suitable for marriage or childbirth.
Li Weiling's district currently has a marriage examination rate of more than 90% (with the number of registrations as the denominator), and hundreds of couples pass through her every day. She is like the "person in charge" of the new people's body, and she has done far more than the prescribed thing.
But another contradiction emerged. When informing the results of the marriage examination, how should the patient's privacy be guaranteed?
On the balance of privacy and the right to know, Lu Yan is like the opposite of Li Weiling. Unlike as a doctor who specializes in marriage examination, Lu Yan's job is an obstetrician and gynecologist in the third year, and he will also meet a small number of people who come for marriage examination.
"Our hospital is very privacy-conscious." For example, some patients and Lu Yan said that they had been infected with hepatitis B or syphilis, hoping not to mention it in front of their husbands, and Lu Yan would emphasize this matter especially when handing over the shift.
"The gynecology department also does not allow male family members to come in, so if there is a disease in the marriage test, I will only inform me." A patient's husband once asked Lu Yan after he left the consultation room, and Lu Yan replied, "I have made the specific situation clear with your wife, you can communicate."
The gynecology clinic of a hospital (not Lu Yan's hospital) reads "Men stop" Picture: Visual China
Lu Yan's adherence to principles is the same as in the face of his friends. A male friend of Lü Yan and his wife came to his hospital for examination, and eventually the friend's wife tested positive for syphilis and was recently infected, while the friend was negative. So far, Lu Yan has not told his friends about this.
"There was a long mental struggle, but I knew I couldn't say it." He only told his friend's wife the results alone. After antibiotic treatment, she later turned negative.
In Lu Yan's eyes, protecting patients' privacy is to gain trust, and trust is the basis of treatment. "It's also a protection for doctors." Lu Yan said.
In marriage examinations, there has been a debate on how to deal with the conflict between the right to privacy and the right to know. The results of the marriage examination are disclosed only to the person concerned, and the person with whom he or she wishes to enter into marriage is not aware of his or her state of health, which is therefore criticized.
Before 2003, when a man and a woman registered their marriage, they needed to have a premarital medical examination certificate or medical evaluation certificate, otherwise they would not be registered, and in this process, both parties could see each other's physical condition at a glance, which is why there have been recent calls for the resumption of compulsory marriage examination. At the "Two Sessions" in 2019, People's Congress deputy Feng Qiya suggested that compulsory marriage testing be resumed nationwide to protect the right of marriage partners to know. [2]
Picture: Some netizens believe that for family considerations, it is necessary to inform each other of the results of the marriage examination
At present, in the United States, Canada, Japan, the United Kingdom and other places, marriage testing takes a voluntary form, and the results are known only to the examinee and the doctor, and no one has the right to interfere with whether or not to register. [3]
However, it is worth noting that in Japan, marriage examination has become a national custom, and Japanese couples often take the initiative to come for medical examination again when preparing to give birth; In Russia, although voluntary marriage testing is practised, it can be punishable by up to 5 years in prison if one person hides AIDS from their spouse and transmits it to the other party. [3]
Xu Guodong, a professor at Xiamen University Law School, once said that marriage between individuals is not a private matter, but a national matter related to national public health security and population strategy, so he suggested that people with infectious diseases should be banned from marriage until they are cured. [2] The Regulations on the Prevention and Treatment of HIV/AIDS in Yunnan Province clearly stipulate that HIV-infected persons and patients should promptly inform their spouses or sexual partners of HIV infection; If the person does not inform him/herself, the medical and health institution has the right to inform him.
Photo: Regulations on HIV/AIDS Prevention and Control in Yunnan Province
Conversely, scholars who are more supportive of the protection of privacy argue that the "Duties of Marriage Examination and Health Practitioners" has clearly stipulated that "the parties themselves should explain the abnormal situation to the other party", and the right to privacy should take precedence over the right to know. [4] In between, a more moderate view has been argued: the conflict between the right to privacy and the right to information does not always exist, and the right to privacy should only be compromised if protecting one party's right to privacy directly infringes on the other's right to life and health. [5]
Under what circumstances should the two rights be ceded, under what circumstances should they be informed, and how they should be informed are things that doctors are practicing repeatedly. There is no real textbook for clinical practice, and every doctor understands it differently.
In Lu Yan's eyes, "informing" should be limited to the parties, and as a doctor, he should provide medical guidance to the parties; In Li Weiling's eyes, a step further is responsible for both husband and wife, and it is more worthy of her status as a doctor.
In the text, Li Weiling and Lv Yan are pseudonyms
Curator: yxtlavi|Executive Producer: Gyouza
Source: Visual China
Resources:
[1] SHEN Zhiyi, PANG Jiashan, LIN Shurong, LONG Xiangxia, LIN Xiting, MA Shaojuan. Analysis of intervention effect of HIV-positive population in marriage test[M].2014.
[2] Xu Guodong. The Civil Code of the People's Republic of China should retain the provisions of the Marriage Law prohibiting the marriage of some sick patients[M].2020.
[3] DING Xue, CHENG Chi, LV Jiannan, ZHAO Jun, CHEN Yongchao, YANG Ting, SONG Li, LIU Ying, WANG Fang. Experience and enlightenment of premarital health care services abroad[M].2016.
[4] ZHENG Yuyuan, ZHOU Ying. Legal conflict and choice in marriage examination system[J].Frontiers of Social Sciences,2022,11(4):1390-1395.)
[5] Meng Meng. The conflict and balance between privacy and the right to know in marriage examination[D].2019.)