The Issue of Absolute Medical Confidentiality

This essay challenges conventional wisdom, also it is broadly held that confidentiality may be breached when doing so it can deter harm to a possible third party. When analyzing Kipnis’ altercation in “A Defense of Unqualified Medical Confidentiality” I understand that it provides an efficient view on absolute confidentiality. Kipnis’ thesis states that “ethical and legal duties to report make it less likely that endangered parties will be protected” (Kipnis, 8-9). Wherefore, confidentiality should never be ruptured, meaning a potential patient is less inclined to say anything that may disservice another individual or individuals. Doctors have a professional obligation to prevent public peril yet do not honor it by breaching confidentiality. Conscious of whatever is said, has the likelihood to be disclosed and is not secured by confidentiality. This angle bears greater harm to a third party due to the fact it will not under any condition, give them the chance to be guarded from being told this specific information or given the chance to take the correct steps to be covered. According to Kipnis, must confidentiality be broken, then physicians need to give the patient(s) a type of ‘Miranda warning’ from the very first meeting & state that, convinced articles could be shared as a consequence of such disclosure. Notwithstanding, Kipnis disputes that performing such an action would further make it to where, sure knowledge, would not be communal in the first place.

Kipnis administers three precedents in which individuals go to immense lengths to avert discovery that the first example is an example of the therapy for homosexual contingencies.

Gay servicemen solicit alternative psychologists out of pocket, despite possessing free military services in clinics, for the panic of their sexual orientation being exposed. Correspondingly, the second illustration entails how Japanese men will go to the extent of travelling to Hawaii for treatment rather than getting treated for HIV in Japanese clinics all for the avoidance of dismay within their own culture. The third case exhibited is the general motivational principle, this is a principle in which is characterized as a way to de-motivate individuals from perpetrating atrocities by displaying consequences (Kipnis, 9).

According to Kipnis, the general motivational principle categorizes individuals into two groups. The first faction are the patients who would be consenting to have a report created and the second faction are the patients who are not willing to bear a threat being reported (Kipnis, 2006). In regards to the first group, qualified confidentiality is futile due to the fact they would consent to disclosure at any rate. Regarding the second group, qualified confidentiality drives this group not to disclose any information on any level at any time.

In “The Case of the Infected Spouse”, Kipnis contends that circumstances of absolute confidentiality would be best preserved, as a result of the physician being conscious of the threat posed towards Wilma. By being receptive to this threat, the physician has the obligation to look out for Wilma by means of attempting to persuade Andrew to come clean to Wilma himself. Elements of HIV precautions such as, safe sex methods, and exceptional hygiene could also be underlined by the medical practitioner whom is aware of the information given, when communicating to Wilma. Kipnis concludes that a ‘Miranda type warning’ should be implemented on dates of service via all patients in regards to confidentiality. Reflecting back on the illustration of the infected spouse, the ‘Miranda warning’ proposed on Kipnis’ behalf, involves warning Andrew and Wilma up front that, confidentiality is unconditional. Furthermore, elaborating on what can and also cannot occur because it is absolute and lastly, explain why it is crucial for confidentiality.

Duty to Warn

The conventional altercations for qualified confidentiality as stated in lecture is a conflict of professional standards between respect for patient privacy and the well-being of the third party. Generally, the task to protect virtuous third parties far outweighs the obligation of confidentiality and with that being said -- arises the question, should confidentiality be severed to secure the third parties’ life and/or well-being?

In a correlating article, “Please don’t tell”, authors Fleck and Angell both consider that there is a burden to inform and that confidentiality is not absolute. On the other hand, Fleck understands certain conditions must be met in order for the ‘duty to warn’ aspects to be met. Evaluating the “Please don’t tell” article, Fleck considers that the duty to warn is unsatisfactory due to three conditions in the scenario of the article. The first underlying condition, is that there is no imminent risk of significant and or irreversible harm in the case of Consuela and Carlos.

Fleck covers an example in which 247 surgeons exhibit surgery on 247 HIV tainted subjects, with a single paper cut on a surgeon’s finger, solely 1 in 247 surgeons had a genuine likelihood of being infected with HIV, reinstating the fact that Consuela, was not exposed to a serious threat. The second underlying condition that is unsatisfactory to the duty to warn for Fleck is that, there is no opportunity to avert a breach of confidentiality. Rather than telling Consuela of Carlos’ HIV status, Fleck considers an alternative to teach her to care for him with universal precautions. The third and final underlying condition Fleck disputes is the proportionality between the harm precluded by the breach of confidentiality and the ruin linked with such a breach. Fleck regards that, if Consuela were enlightened of Carlos’ HIV status, her and/or her family would refuse to care for her brother (Angell, Fleck, 1991).

The counter argument to Flecks point reflects on the “Please don’t tell” case study, in which Angell concludes that there is a need to warn. Angell considers that, Consuela has the right to medical information that she may accept as being relevant to her decision in providing treatment for herself and that the hospital has an obligation to tell her the risks and repercussions from the involvement with Carlos. In terms of not telling Consuela, she would trust Carlos is HIV free and thus not take the time to learn or care for precautions and would be completely unaware of any underlying medical conditions Carlos may have. Angell also understands that by keeping Carlos’ status as a secret is deceptive in terms of the hospital utilizing Consuela in the place of a healthcare professional that would be correctly informed of the scenario from the beginning (Angell, Fleck, 1991).

Similarly, in “The Case of the Infected Spouse” Fleck and Angell both admit in the obligation to warn. However, based on Fleck’s own criteria, the conditions in the physician’s case to warn Wilma would not be met. Fleck regards that the imminent threat of critical and irreversible harm to Wilma was of not serious danger. Like Consuela, Wilma could be educated on precautions in which to be taught and utilized when being involved with Andrew or significant others. Another valid point in regards to Flecks argument – if Wilma is informed of Andrew’s AIDs status then there is the slight chance Wilma would not consider a reconciliation with Andrew. Prospectively, from the standpoint of Angell, it would be wrong not to tell Wilma of Andrew’s medical status because she has the right to information that she may consider relevant to her care. If Wilma were not to be informed of Andrew’s status, she would be totally unaware and could have already contracted something and could be infected herself. Wilma would need to be aware and understand all precautions for involvement with Andrew or others.

Robertson’s feedback to Kipnis’ exchange is utilized by elaborating on three main issues he has with Kipnis’ defense of unqualified medical confidentiality. The first issue being Kipnis’ evidence for claim that qualified confidentiality averts individuals from seeking treatment is both uncertain and misleading due to the lack of evidence. The second issue that Robertson indicates is a possible third group Kipnis neglects, patients willing to disclose information even if it is data prone to being reported. The final issue Robertson evaluates is that Kipnis’ altercation is considered unrealistic when thousands and or millions of lives are at risk and that absolute confidential information is crucial (Robertson, 2006).

My Position

In my final analysis of the controversies between Kipnis and Robertson, I am lenient to agree more with Robertson on the issue because individuals will abide by their own terms and conditions with inherently being informed on potential breaches of confidentiality. Qualified confidentiality does not always restrain individuals from being discreet or at a minimum from saying things that they should or should not. A decent example given in lecture regarding lawyers, statistics show that individuals will tell the whole story to their lawyer, knowing that the lawyers will have to come up with a way to convey a story in favor of their clients in order to win a case or formulate a deal.

Robertson points out that the motivational model is overly simplistic and to that extent, I agree that ‘Miranda warnings’ could be effortlessly overlooked for patient means. Granted this is not the case for every situation, but with most scenarios a Miranda warning would be the last thing on most patients mind and especially in emergency situations it could be quickly suppressed. Likewise, the motivational principle, regardless of individuals knowing the consequences, individuals are still tempted to do whatever is deemed wrong and live with the consequences throughout.

I concur to a valid key point that Robertson exemplifies – in that of Kipnis avoiding a potential third faction of individuals that would prefer absolute confidentiality yet would still be inclined to disclose knowledge, conscious of the fact the information could be revealed to secure a third party. I perceive that the general civic could settle into this division because a vast majority of individuals typically promote privacy, however, would not object to a physician or healthcare official divulging information in their favor or on their behalf because nearly all individuals, in this digitally modernized era, do not wish for face to face confrontation.

In summarization, when analyzing Robertson’s argument in regards to the stakes being higher, I have concluded the idea that it would be nearly impossible for one to execute sheer confidentiality when speaking for and or about hundreds upon thousands of individuals. The level of managerial difficulty is super complex for just one individual in this case. Not to mention this basis may develop into an even more complex issue when it affects that individual directly or in regards to family and friends/loved ones. Under the control of just one individual it would be difficult to keep unconditional confidentiality under these specific circumstances.