Truth-Telling and Confidentiality in Medical Practice

Central Questions: Is there a duty to always tell patients the truth? Is there a duty to never tell others about patients?
Underlying Principles: Autonomous decision-making, doing good (beneficence), and acting like a parent (paternalism).

Historical View: Historically, the AMA didn't explicitly address truth-telling until 1980. Some physicians prioritized nonmaleficence (avoiding harm) over truth-telling, believing the truth could be harmful.
Arguments for Deception/Withholding Truth:
- To prevent harm, unsettling, or depression in patients, especially if no treatment exists.
- Beneficence may sometimes require lying.
Arguments Against Deception/Withholding Truth:
- Deception can also cause harm; no guarantee it produces more good than harm.
- "Deception breeds distrust" in the medical profession.
- Prevents patients from preparing for death or making life-altering decisions.
- Autonomy: Patients have a right to know to make informed decisions.
Patient Preferences: Most people prefer to be told the truth about their diagnosis, though some argue patients don't truly want the "whole truth."
Modern Approach: Value truth-telling but insist upon sensitivity and clear communication.
Exceptions for Deception: Some argue it's acceptable only as a last resort with strong justifications, or for minor deceptions with great benefits.

Definition: The duty of health professionals not to disclose information imparted by patients.
Obligations: Implied by oaths (e.g., Hippocratic Oath) and the "Duty of Fidelity."
Arguments for Confidentiality (Consequentialist):
- Promotes patient trust, leading to more truthful disclosures.
- Essential for doctors to fulfill their duty of beneficence.
- Prevents negative consequences for patients (discrimination, ruined relationships, shame).
Arguments for Confidentiality (Non-Consequentialist):
- Respects patient autonomy and their right to privacy.
Exceptions to Confidentiality:
- Legal exceptions override privilege (e.g., contagious diseases, gunshot wounds, abuse, duty to warn).
- Moral duty to prevent harm to others might justify breaching confidentiality (e.g., Tarasoff case).
Modern Challenge: Computerization of records increases risk of improper access and hacking.

Kantian Ethics: Lying and breaching confidentiality are generally considered morally wrong as they violate duties and promises.
Act-Utilitarianism: Evaluates each case individually; lying or breaching confidentiality is permissible if it minimizes suffering and maximizes happiness for all involved.
Rule-Utilitarianism: Focuses on general rules; rules promoting truth-telling and confidentiality are often argued for because they generally increase happiness and decrease suffering. However, exceptions may exist (e.g., danger to life).
Virtue Ethics: Emphasizes virtuous character (honesty, fidelity, compassion) in physicians. A compassionate physician might deceive to prevent harm.
Doctrine of Double Effect: Could be used to justify lying if the act (lying) has both a bad effect (patient lacks truth) and a good effect (patient doesn't suffer), and certain conditions are met.