Confidentiality

This morning's lecture on patient confidentiality just began. It's one of several lectures we will have on bioethical issues. It has been particularly interesting when the lecturers (all of whom are bioethicists) make the point that doctors do not always obey certain expectations of laypeople. Truthtelling in medicine, for example, is a relatively new idea. We've had several quotes from famous physicians -- from Hippocrates to individuals just a few decades ago -- who insisted that there was no need (nor any benefit) to telling a patient about a serious diagnosis. It was believed that telling the patient this bad news would merely worsen his or her condition. Instead, it was commonly accepted to warn the patient's family and let them take care of the issue. We were asked, "Would you rather (a) be honest with your patient or (b) provide the best health outcome for your patient?" There was some pretty strong debate on that question.

Patient autonomy is another bioethical issue. We usually hold autonomy to a pretty high standard, but the lecturers brought up numerous situations in which most of us agreed that patient autonomy could potentially be superceded. And now we're talking about confidentiality; as usual, we're finding some situations in which confidentiality is paramount and others in which we defer to the principles of justice, beneficence, or "doing no harm." And we're barely scraping the surface of the issues we'll face in the clinics and hospitals. It's an intimidating feeling.