Medical confidentiality Vs public interest

Since you have learnt all about medical confidentiality you should be able to apply the basic principles to practical situations. As you already know the medical confidentiality is not absolute in Sri Lanka as in many other countries. This means that there are many instances where the doctors is permitted to breach it. One of these situations is 'protection of public interest'. For instance the doctor who informs a food handler's salmonella carrier status to his immediate supervisor after failing to convince him to do it by himself will not be found guilty for breaching the sacred notion of medical confidentiality if he had taken all the precaution to follow the 'need to know principle'. ('Need to no principle' is divulging the relevant information to the relevant people.)

A New Zealand doctor who was telling passengers of danger of travelling in the bus driven by a man, who had undergone triple bypass surgery, in addition to reporting that fact to relevant authorities, was found guilty of 'professinal misconduct'. The doctor sought a judicial review. The judge said "I think a doctor who has decided to communicate should discriminate and ensure the recipient is a responsible authority" (Duncan v Medical Practioners' Disciplinary Committee [1986] 1 NZLR 513 AT 52, per Jeffries J.)

So breaching medical confidentiality to safe guard the public interests is pretty obvious isn't it?

Is there any situation where preserving confidentiality is in public interest?

One situation is HIV status of a person.

In the very interesting case of X vs Y (All England Law Reports X v. Y [1988] 2 All ER 648, 1988) the judge held that keeping the HIV status of two doctors in confidence was for the public interest. A news paper was about to publish the names of two doctors who were HIV positive. The hospital authorities sought an injunction from the court to the newspaper not to publish there names. The Judge who allowed the injunction said

“I keep in the forefront of my mind the very important public interest in freedom of the press. And I accept that there is some public interest in knowing that which the defendants seek to publish. But in my judgement those public interests are substantially outweighed when measured against the public interest in relation to loyalty and confidentiality both generally and with particular reference to AIDS patients' hospital records.”

So after all at least in some situations keeping medical confidentiality is for the public interest isn't it?

Priyanjith Perera

19 Nov 2012