A Defense of Unqualified Medical Confidentiality

Abstract

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties.

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

“…Here careful consideration of different ethical aspects of the case is replaced by a court ruling that gives no room for ethical considerations once appropriate sections of the law can be applied. Thus, a strongly felt professional ethical obligation not to breach confidentiality (Kipnis, 2006) is impossible to uphold without facing criminal charges. Perhaps not surprisingly, Swedish physicians have called for the redress of the research group on the grounds that the Helsinki Declaration has priority over national legislation (Johnson & Fernell, 2006).…”

Confidentiality, anonymity and amnesty for midwives in distress seeking online support – Ethical?

“…This would consequently undermine the delivery of appropriate care [16][17][18] . However, midwives are professionally accountable for patient care, their own health and fitness to practise.…”

Clinical Genetics and the Problem With Unqualified Confidentiality

“…In making this claim, we challenge two assertions Kipnis relies upon in his argument for upholding unqualified confidentiality: 1) that unqualified confidentiality combined with attempts at "creative" means to elicit disclosure to at-risk third parties is the most effective way to minimise harm; and 2) that under unqualified confidentiality, individuals will actually become more likely to take responsibility for their own actions and health (Kipnis 2006 Dilemmas like these are experienced by many professionals in clinical genetics, with studies reporting that almost half of genetic counsellors and 60% of clinical geneticists have had a patient who refused to notify an at-risk relative Falk et al 1998). Despite these figures, failure to tell third parties has been estimated to occur in only a fraction of the total number of consultations, and breaching confidentiality to warn at-risk relatives occurs very rarely (Clarke et al 2005).…”