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.