Bioethics for clinicians:
8. Confidentiality
Irwin Kleinman, MD; Françoise Baylis, PhD; Education
Sanda Rodgers, LLB/BCL, LLM; Peter Singer, MD, MPH Éducation
Abstract
Dr. Kleinman is from the
PHYSICIANS ARE OBLIGED TO KEEP INFORMATION about their patients secret. The under- Departments of Psychiatry at
standing that the physician will not disclose private information about the patient Mount Sinai Hospital and the
provides a foundation for trust in the therapeutic relationship. Respect for confiden- University of Toronto and
tiality is firmly established in codes of ethics and in law. It is sometimes necessary, from the University of
however, for physicians to breach confidentiality. Physicians should familiarize Toronto Joint Centre for
themselves with legislation in their own province governing the disclosure of cer- Bioethics, Toronto, Ont.; he
tain kinds of information without the patient’s authorization. Even when no specific is Chair of the Ethics
legislation applies, the duty to warn sometimes overrides the duty to respect confi- Committee at Mount Sinai
dentiality. The physician should disclose only that information necessary to prevent Hospital. Dr. Baylis is
harm, and should reveal this information only to those who need to know it in or- Associate Professor in the
der to avert harm. Whenever possible any breach of confidentiality should be dis- Office of Bioethics Education
cussed with the patient beforehand. and Research, Faculty of
Medicine, and in the
Résumé Department of Philosophy,
Dalhousie University, Halifax,
LES MÉDECINS DOIVENT GARDER SECRETS les renseignements sur leurs patients. Dans la NS. Ms. Rodgers is Dean of
relation thérapeutique, la confiance passe par le fait de savoir que le médecin ne Common Law, University of
divulguera pas de renseignements confidentiels sur le patient. Les codes d’éthique Ottawa, Ottawa, Ont.
et la loi établissent fermement le respect de la confidentialité. Parfois, les médecins Dr. Singer is Sun Life Chair
doivent toutefois divulguer des renseignements confidentiels. Les médecins de- in Bioethics and Director,
vraient se familiariser avec les lois de leur province qui régissent la divulgation de University of Toronto Joint
certains types de renseignements sans l’autorisation du patient. Même lorsqu’au- Centre for Bioethics,
cune mesure législative en particulier ne s’applique, l’obligation de prévenir l’em- Associate Professor of
porte parfois sur celle de respecter la confidentialité. Les médecins ne devraient Medicine, University of
dévoiler que les renseignements nécessaires pour prévenir tout préjudice et les Toronto, and Staff Physician,
communiquer seulement à ceux qui ont besoin de les connaître pour éviter le The Toronto Hospital,
préjudice en question. Il faut dans la mesure du possible discuter d’avance avec le Toronto, Ont.
patient de toute divulgation de renseignements confidentiels.
Series editor: Dr. Peter A. Singer,
University of Toronto Joint Centre
M
r. T is 35 years old and is married. He has had unprotected sex with
for Bioethics, 88 College St.,
prostitutes on 2 occasions. Although he is asymptomatic, he becomes
Toronto ON M5G 1L4; fax 416
anxious about the possibility of having contracted a venereal disease 978-1911;
and consults his physician. After conducting a thorough physical examination and
providing appropriate counselling, Mr. T’s physician orders a number of tests.
The only positive result is for the HIV blood test. The physician offers to meet This article has been peer
with Mr. T and his wife to assist with the disclosure of this information, but reviewed.
Mr. T states that he does not want his wife to know about his condition.
Mr. U is a 42-year-old professional who is living with his 14-year-old son This series began in the July 15,
and is involved in an acrimonious divorce. He is receiving drug therapy and 1996, issue. Subsequent articles
will appear monthly.
weekly psychotherapy sessions for depression. Mr. U tells his psychiatrist that
his wife makes him so crazy that at times he wants to kill her. He is concerned Can Med Assoc J 1997;156:521-4
that in the heat of a confrontation he might act on this impulse. However, he
recognizes that killing his wife would be devastating to his son, for whom he
feels a great deal of affection and devotion.
Ms. V is 29 years old and has epilepsy. Her driver’s licence was revoked when
the ministry of transportation was notified of her history of seizures. Ms. V men-
← For prescribing information see page 594 CAN MED ASSOC J • FEB. 15, 1997; 156 (4) 521
© 1997 Canadian Medical Association (text and abstract/résumé)
8. Confidentiality
Irwin Kleinman, MD; Françoise Baylis, PhD; Education
Sanda Rodgers, LLB/BCL, LLM; Peter Singer, MD, MPH Éducation
Abstract
Dr. Kleinman is from the
PHYSICIANS ARE OBLIGED TO KEEP INFORMATION about their patients secret. The under- Departments of Psychiatry at
standing that the physician will not disclose private information about the patient Mount Sinai Hospital and the
provides a foundation for trust in the therapeutic relationship. Respect for confiden- University of Toronto and
tiality is firmly established in codes of ethics and in law. It is sometimes necessary, from the University of
however, for physicians to breach confidentiality. Physicians should familiarize Toronto Joint Centre for
themselves with legislation in their own province governing the disclosure of cer- Bioethics, Toronto, Ont.; he
tain kinds of information without the patient’s authorization. Even when no specific is Chair of the Ethics
legislation applies, the duty to warn sometimes overrides the duty to respect confi- Committee at Mount Sinai
dentiality. The physician should disclose only that information necessary to prevent Hospital. Dr. Baylis is
harm, and should reveal this information only to those who need to know it in or- Associate Professor in the
der to avert harm. Whenever possible any breach of confidentiality should be dis- Office of Bioethics Education
cussed with the patient beforehand. and Research, Faculty of
Medicine, and in the
Résumé Department of Philosophy,
Dalhousie University, Halifax,
LES MÉDECINS DOIVENT GARDER SECRETS les renseignements sur leurs patients. Dans la NS. Ms. Rodgers is Dean of
relation thérapeutique, la confiance passe par le fait de savoir que le médecin ne Common Law, University of
divulguera pas de renseignements confidentiels sur le patient. Les codes d’éthique Ottawa, Ottawa, Ont.
et la loi établissent fermement le respect de la confidentialité. Parfois, les médecins Dr. Singer is Sun Life Chair
doivent toutefois divulguer des renseignements confidentiels. Les médecins de- in Bioethics and Director,
vraient se familiariser avec les lois de leur province qui régissent la divulgation de University of Toronto Joint
certains types de renseignements sans l’autorisation du patient. Même lorsqu’au- Centre for Bioethics,
cune mesure législative en particulier ne s’applique, l’obligation de prévenir l’em- Associate Professor of
porte parfois sur celle de respecter la confidentialité. Les médecins ne devraient Medicine, University of
dévoiler que les renseignements nécessaires pour prévenir tout préjudice et les Toronto, and Staff Physician,
communiquer seulement à ceux qui ont besoin de les connaître pour éviter le The Toronto Hospital,
préjudice en question. Il faut dans la mesure du possible discuter d’avance avec le Toronto, Ont.
patient de toute divulgation de renseignements confidentiels.
Series editor: Dr. Peter A. Singer,
University of Toronto Joint Centre
M
r. T is 35 years old and is married. He has had unprotected sex with
for Bioethics, 88 College St.,
prostitutes on 2 occasions. Although he is asymptomatic, he becomes
Toronto ON M5G 1L4; fax 416
anxious about the possibility of having contracted a venereal disease 978-1911;
and consults his physician. After conducting a thorough physical examination and
providing appropriate counselling, Mr. T’s physician orders a number of tests.
The only positive result is for the HIV blood test. The physician offers to meet This article has been peer
with Mr. T and his wife to assist with the disclosure of this information, but reviewed.
Mr. T states that he does not want his wife to know about his condition.
Mr. U is a 42-year-old professional who is living with his 14-year-old son This series began in the July 15,
and is involved in an acrimonious divorce. He is receiving drug therapy and 1996, issue. Subsequent articles
will appear monthly.
weekly psychotherapy sessions for depression. Mr. U tells his psychiatrist that
his wife makes him so crazy that at times he wants to kill her. He is concerned Can Med Assoc J 1997;156:521-4
that in the heat of a confrontation he might act on this impulse. However, he
recognizes that killing his wife would be devastating to his son, for whom he
feels a great deal of affection and devotion.
Ms. V is 29 years old and has epilepsy. Her driver’s licence was revoked when
the ministry of transportation was notified of her history of seizures. Ms. V men-
← For prescribing information see page 594 CAN MED ASSOC J • FEB. 15, 1997; 156 (4) 521
© 1997 Canadian Medical Association (text and abstract/résumé)
