Problem
What is the duty of confidentiality? Is it ever appropriate for doctors to violate that duty? If so, why and under what circumstances? If not, why not? When answering these questions, refer to what's discussed in at least one of the Module 4 readings.
MODULE 4 READINGS INCLUDE
A. Understand what the duty of confidentiality is
B. Understand the conditions under which confidentiality should (arguably) be broken
C. Understand why Kipnis thinks the duty of confidentiality is absolute or unqualified
D. Familiarize yourself with the rules for exegetical and expository writing
E. providing two readings you can give reference to below
Guided Reading: "A Defense of Unqualified Medical Confidentiality" by KipnisGuided Reading: "A Defense of Unqualified Medical Confidentiality" by Kipnis
The duty of confidentiality is important in medical ethics. Generally speaking, physicians shouldn't disclose a patient's medical information to third parties without the patient's consent. However, most bioethicists and medical professionals agree that, under some circumstances, it's appropriate to disclose information without consent. One such widely agreed upon circumstance is when disclosing information is necessary to prevent others from being significantly harmed. For example, if a psychiatrist has good reason to believe that her patient is likely to commit murder in the near future, then it's arguably appropriate for her to inform the police of her worries, even if doing so requires disclosing information that her patient provided in confidence. Legal cases of this sort include Tarasoff v. Regents of the University of California and Smith v. Jones.
In his article, Kipnis defends a radical position not shared by many physicians or bioethicists. According to Kipnis, physicians' duty of confidentiality should never be broken, even in circumstances like the above. To illustrate the issue he's discussing, Kipnis describes 'The Case of the Infected Spouse.' Though most of us would agree that the physician should inform Wilma that her husband has AIDS, Kipnis maintains that this is the wrong conclusion to draw.
Before getting into his argument, Kipnis distinguishes professional obligations from other sorts of obligations, e.g., from legal obligations and from personal moral obligations. He's careful to note that the duty of confidentiality is specifically a professional obligation.
Guided Reading: "Breaching Confidentiality" by UngerGuided Reading: "Breaching Confidentiality" by Unger
Unger provides the reader with information about the different circumstances where, in Canada, it is standard to report medical information to third parties. By and large, the purpose of Unger's article is to be informative, rather than to present a philosophical argument. In that respect, it's different from most of the articles we read in this course. That said, one thing Unger's trying to do is impress upon the reader the surprisingly large number of circumstances where sharing information without patient consent is standard practice.
When reading Unger's article (particularly the third section of it), it will be helpful to keep the following questions in mind:
A. In the section entitled "Duty to Warn", Unger distinguishes warning from other cases of reporting. What does Unger think is distinctive about warning? What are some cases of reporting that aren't also cases of warning?
B. How is a duty to warn different from a duty to protect?
C. According to Unger, some patient advocates have argued that the existing case law only permits breaching confidence for the sake of warning: it doesn't require warning. From a moral perspective, do you think the distinction between permitting and requiring is important? Are doctors morally required to break confidence in order warn third parties, or is it merely morally permissible to break confidence? Or is warning not even permissible?
D. Assuming that doctors sometimes have a duty to warn, what are the circumstances under which they have that duty? What factors are relevant to determining when the duty to warn is present?