Confidentiality
Respect for autonomy does not only entail the
right of competent patients to consent to treatment. Their entitlement to
exercise control over their life and future corresponds to the duty of surgeons
to respect their privacy — not to communicate information revealed in the
course of treatment to anyone else without consent. Generally speaking, such
respect means that surgeons must not discuss clinical matters with relatives,
friends, employers and others unless the patient explicitly agrees. To do
otherwise is regarded by all of the regulatory bodies of medicine and surgery as
a grave offence incurring harsh penalties. For breaches of confidentiality are
not only abuses of human dignity; they again undermine the trust between surgeon
and patient on which successful surgery and the professional reputations of
surgeons depend.
Important
as respect for confidentiality is, however, it is not absolute. Surgeons are
allowed to communicate private information to other professionals who are part
of the healthcare team — provided that the information has a direct bearing on
treatment. Here the argument is that patients have given their implied consent
to such communication when they explicitly consent to a treatment plan.
Certainly, patients cannot expect strict adherence to the principle of
confidentiality if it poses a serious threat to the health and safety of others.
There will be some circumstances when confidentiality either must or might be
breached in the public interest. For example, it must be breached as a result of
court
orders or in relation to the requirements of
public health legislation. It may be ignored in attempts to prevent serious
crime or to protect the safety of other known individuals who are risk of
serious harm.