Medical confidentiality: an intransigent and absolute obligation.

Abstract

Clinicians' work depends on sincere and complete disclosures from their patients; they honour this candidness by confidentially safeguarding the information received. Breaching confidentiality causes harms that are not commensurable with the possible benefits gained. Limitations or exceptions put on confidentiality would destroy it, for the confider would become suspicious and un-co-operative, the confidant would become untrustworthy and the whole climate of the clinical encounter would suffer irreversible erosion. Excusing breaches of confidence on grounds of superior moral values introduces arbitrariness and ethical unreliability into the medical context. Physicians who breach the agreement of confidentiality are being unfair, thus opening the way for, and becoming vulnerable to, the morally obtuse conduct of others. Confidentiality should not be seen as the cosy but dispensable atmosphere of clinical settings; rather, it constitutes a guarantee of fairness in medical actions. Possible perils that might accrue to society are no greater than those accepted when granting inviolable custody of information to priests, lawyers and bankers. To jeopardize the integrity of confidential medical relationships is too high a price to pay for the hypothetical benefits this might bring to the prevailing social order.

A Defense of Unqualified Medical Confidentiality

“…I will argue in what follows that confidentiality in clinical medicine is far closer to an absolute obligation than it has generally been taken to be; doctors should honor confidentiality even in cases like this one. Although the focus here is on the Case of the Infected Spouse, the background idea is that, if it can be demonstrated that confidentiality should be scrupulously honored in this one case where so many considerations support breaching it, the duty of confidentiality should be taken as unqualified in virtually all other cases as well (Kottow 1986). I shall not, however, defend that broader conclusion here.…”

Client Confidentiality: Ethical Issues in Occupational Therapy

“…such that occupational therapists may be justified in placing confidentiality to their patients above the interests of others with whom they have no special relationship (Kottow, 1986). Indeed, this would seem reasonable given the earlier observation that trust is a central quality of the client-therapist relationship.…”

“…Moreover, where such direct contact between therapist and client does occur, there is no requirement either for the client to voice a specific request for confidentiality or for an explicit pledge on the part of the therapist. Confidentiality is required even if the therapist comes into the possession of information indirectly or by chance (Kottow, 1986).…”

Timing Invitations to Participate in Clinical Research: Preliminary versus Informed Consent

“…The argument that the moral obligation to maintain confidentiality is not absolute has been made by Hayry and Takala (2001), Hook and Cleveland (1999), Tur (1998), Black (1994), and King-Farlow and Langham (1981), among others. Some have argued that the requirement is absolute or should be treated as such (e.g., Kottow, 1986;. The legal obligation to maintain confidentiality is not the focus of my claims or of Habiba and Evans' (2002) discussion.…”