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3 - The Confidential Relationship

Published online by Cambridge University Press:  24 August 2009

S. A. M. McLean
Affiliation:
University of Glasgow
J. K. Mason
Affiliation:
University of Edinburgh
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Summary

Confidentiality is one of the most cherished aspects of the relationship between doctor and patient. The basis for medical confidentiality and its limits are, however, seldom explored – and, when they are examined it seems that there are surprisingly few hard and fast rules we can rely on. Nevertheless, there are a number of principles on which to draw – including those based on ethics, the law and professional conduct. These will be discussed in turn.

MEDICAL ETHICS

This is a field in which it is particularly difficult to separate a legal from a moral obligation. Put at its simplest, there are some relationships where the need for trust in confidence is so obvious that the parties to that relationship expect their confidences to be respected or, looked at another way, the expectation of trust establishes what is known as a fiduciary duty owed by the doctor to his or her patient.

The reasons underlying the need for confidentiality are complementary. First, if those who are sick do not trust doctors to maintain the information they disclose in confidence, they will not – it is argued – come forward for treatment. This is considered so important that, for example, compulsory notification of an infectious disease may be waived in selected conditions – notably, at present, in the case of infection with the human immunodeficiency virus (HIV).

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Publisher: Cambridge University Press
Print publication year: 2003

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