Are there any situations in which medical confidentiality can be breached ethically?

The illness of Tamil Nadu chief minister J Jayalalithaa has raised several questions about privacy of medical information. As a leader of lakhs of people, there is genuine concern about her health. She has been in hospital for two weeks and the hospital is being bombarded with queries by anxious supporters. Are the doctors and administrators at Apollo Hospital at fault for not whetting their appetite for information?

The highest traditions of medical practice are based on four key universally acknowledged propositions: Autonomy, confidentiality, beneficence and justice. The first is intended to ensure that the patient is provided the best possible medical care without any compromise of his or her ability to decide for themselves when tests or therapeutic measures are proposed. Confidentiality guarantees his privacy. Beneficence and justice reduce to an absolute minimum the possibility of harm to him during treatment of the highest standards and at the least cost.

The relationship between the patient and the doctor is unique. The patient confides to the doctor details that he or she will not divulge even to parents, spouse or offspring. This is done of his or her own free will and from the knowledge that such a candid narrative is essential to proper medical care. The patient is assured that the facts will never be divulged to anyone else without his or her express permission.

Confidentiality is thus a cornerstone of good medical care. Breach of this unwritten contract of good faith would make patients wary of telling the doctor information that may be vital to recovery .

Are there any situations in which confidentiality can be breached ethically? If there is a likelihood of harm, spread of disease, or death to others from the patient’s illness, then confidentiality may be violated. Judicial orders can also upend confidentiality. When a disease that could cause an epidemic or death in others is identified, it is incumbent on the physician to inform the public health authorities in the interest of innocent relatives, friends, neighbours and others. Barring such situations or an order by the court to release medical information, breach of confidentiality can invite penal action on the doctor.

Aren’t we entitled to know about the illnesses of our leaders? This is an oft debated subject. Many good reasons can be cited on why it is necessary to release information on a leader’s illness. Good governance is best offered by those in good health. Illness, especially when it involves the mind, can lead to erroneous decisions with far-reaching consequences. The recent demand for the medical reports on Trump and Hillary Clinton in America is aimed at helping voters in the forthcoming election ensure that the new president is not burdened with ill health.

Many have contended that the release of medical information of leaders long after their death serves the purpose of history writing. Medical data are archival documents, it is argued.

And yet, these reasons are not adequate to counter the individual’s right to privacy and the medical injunction on confidentiality. This applies especially in situations where the patient is alive and capable of making decisions.

Industrial giants, powerful politicians, and the rich and the famous have a variety of reasons for keeping information on serious and potentially life-threatening illnesses secret. Leakage of such news could cause major upheavals in the administration of the state or the country . In the case of some businessmen, it could trigger acute lack of confidence in huge industrial complexes with consequent shocks in the share market and more.

At present, if Jayalalithaa or her legal representatives have so willed it, neither her physicians nor Apollo Hospital can disclose her medical data to the public.

(The writer is a well-known neurosurgeon and has written several articles on medical ethics)