Dr Diane Mullins, RCSI Tutor in Psychiatry, St Itas Hospital, Portrane

Breaking patient confidentiality

Introduction
Confidentiality is a time-honoured principle of medical ethics. It extends after
death and is fundamental to the doctor/patient relationship. While the concern of
relatives and close friends is understandable, the doctor must not disclose
information to any person without the consent of the patient

The professional duty of confidentiality covers not only what a patient may reveal
to the practitioner, but also what the practitioner may independently conclude or
form an opinion about

There are four circumstances outlined by the Medical Council where

confidentiality may be breached in the absence of permission from the patient
1. When ordered by a Judge in a Court of Law, or by a Tribunal established by an
Act of the Oireachtas

2. When necessary to protect the interests of the patient

o Psychiatrists, among others, who believe that a child has been the victim of
physical or sexual abuse must make an immediate report to an appropriate
agency. Confidentiality is limited on the grounds that potential or actual harm
to vulnerable children outweighs the value of confidentiality in a psychiatric
setting

3. When necessary to protect the welfare of society

o Where others may be at serious risk if not aware that a patient has a
communicable infection, a doctor should do his best to obtain permission
from the patient to tell them, so that appropriate safeguards can be put in
place. If the patient refuses to consent to disclosure, those who might be at risk
of infection should be informed of the risk to themselves

4. When necessary to protect the welfare of another individual or patient

o The duty to warn potential victims of their patients expressed intention to
harm the victim (i.e. Tarasoff, 1974). Tatiana Tarasoff was killed by Prosenjit
Poddar who earlier confided to a psychologist employed by the University of
California that he intended killing the woman. The psychologist notified the
campus police who detained Poddar briefly. The psychologists superior
directed that no further action should be taken. The deceaseds parents took a
case against the University of California. The Court held that the plaintiffs
parents had a cause of action against the University for breach of duty to
exercise reasonable care to protect their daughter. It is thus recognised that in
exceptional circumstances there may be a duty to breach confidentiality