Questioning Confidentiality

Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.’- Hippocratic Oath

Doctor-patient confidentiality is arguably one of the most important policies enforced in modern medicine. Doctors in the UK may not disclose information about their patients unless extenuating circumstances would put the patient more at risk than if the information was not disclosed.

However, complex issues arise from this policy.

Consider the following:

Mrs. A is pregnant, with what is supposedly Mr. A’s child. Mrs. A and Mr. A arrive at the clinic to test for a specific gene that causes a rare disease, of which it is known that Mr. A is a carrier of. Upon inspecting the genealogical data collected from the foetus, it comes to light that the child is not M.r A’s.

What should the doctor do?

I am going to pose three arguments to answer this question.

Argument 1

The doctor has no right to disclose the information to Mr. A as it is not the doctor’s place to do so. The couple has come to the clinic to test for the rare gene, not to test for the paternity information. Besides, it would be in the child’s and the family’s best interest not to disclose the information as this could lead to a broken home.

Argument 2

The doctor should disclose the information to Mrs. and Mr. A, as it is both of their information. It is likely that Mr. A would want to know and to withhold the information would be dishonest.

Argument 3

The doctor should tell Mrs. A but not Mr. A. The information belongs to Mrs A only as she is the carrier of the baby. It would most likely be in the best interest of Mrs. A and the child not to tell Mr. A as this could lead to a broken home.

Personally, I would agree with argument 1 as the doctor is being called on to identify the presence of the rare disease gene so it is not their place to step in. However, the two concepts of non-maleficence (do not harm) and beneficence (only do good) can be called in to question.

Would it be more harmful to tell the couple, than not to tell them? Who would it harm?

Alternatively, would it be more beneficial and who would it benefit?

In conclusion, the principle of doctor-patient confidentiality is a complex and ambiguous one. I think that there is an argument for more strict and precise guidelines for doctor’s to follow. However, I believe that the solution should be left for the individual discretion of the doctor, who is very likely to act in what they think is the best interests of all parties involved.

By Sophie Maddock

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