Confidentiality of the Medical Act - Between Patient Preferences and the Collective Risk

Abstract

Respecting confidentiality and autonomy is the basis of the doctor-patient relationship. The health care professionals involved in the provision of medical care, have the moral obligation to maintain the professional secrecy, except the situations that involvs a risk for the public health. We present the case of a 43-year-old patient who was admitted to the Pneumology Clinic with non-specific symptoms: fever, chest pain, significant weight loss and she was detected with a serologically positive result for the human immunodeficiency virus (HIV) and diagnosed with pneumonia associated with human immunodeficiency syndrome (AIDS). The patient expressed the preference to keep this information secret from her family. Shortly after hospitalization, the patient's condition deteriorates and she dies. What should the doctor do in this case, from the ethical point of view? To communicate the diagnoses to the family or to respect the patient's preferences expressed during life? How should the doctor manage the medical information after the patient's death? These are the main ethical dilemmas of the case, which require the identification of the best solution to the conflict generated by respecting the risk-benefit balance. The epidemiologist and the general practitioner must be informed, because they can recommend to the family additional tests to diagnose a possible HIV infection. The general practitioner will only communicate the patient's diagnosis if the disease is confirmed to the other family members. In medical practice, the well-being of an individual patient can be exceeded in the favor of the community's well-being. Respecting confidentiality is outweighed by the public interest in preventing serious damages.