HIV infection and AIDS: the ethics of medical confidentiality.

Abstract

HIV infection and AIDS: the ethics of medical confidentiality Kenneth M Boyd Secretary, IME working party, on behalf of the working party Author's abstract An Institute ofMedical Ethics working party argues that an ethically desirable relationship ofmutual empowerment between patient and clinician is more likely to be achieved ifpatients understand the ground rules ofmedical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice ofdifferent doctors and specialties. Matters might be clarified, it suggests, by identifying moralfactors which tend to recur in medical decisions about maintaining or breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. Medical confidentiality and discretion 'All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal' (1). The modern Declaration of Geneva reformulates this clause from the Hippocratic Oath as, 'I will respect the secrets which are confided in me, even after the patient has died' (2). These statements show that the medical profession continues to regard confidentiality as a very important moral duty, but does not consider it an absolute one. The Hippocratic Oath is concerned with discretion as well as with confidentiality, and limits both to what 'ought not to be spread abroad'. The Geneva version, restricted to 'secrets which are confided in me', promises to 'respect' rather than to 'never reveal' them. Both statements, that is, imply that the duty of confidentiality may be qualified by other considerations. Neither version specifies what these considerations might be: but current disciplinary guidelines allow doctors to disclose confidential information in certain exceptional circumstances, when this is judged to be in the interest of the patient

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