Confidentiality vs harm to another
Sunil K Pandya
Dr. Bawaskar’s sensitivity in this matter deserves applause (1).
The principle of confidentiality dictates that what is discussed by doctor and patient remains between them and should not be divulged to anyone else without the patient’s express consent.
A major exception to this diktat is harm to another if confidentiality is maintained. In the US case that is now referred to world-wide when this issue is being discussed, Vitaly Tarasoff et al Plaintiffs and Appellants, vs Regents of the University of California et al, Defendants and Respondents (2), the judge’s decision on July 1,1976 was clear.
Prosenjit Poddar, a student from Bengal, had confided to Dr. Moore, his psychologist, his intent to kill Tatiana Tarasoff for having jilted him. The head of the department of Psychology overruled Dr. Moore’s suggestion that Poddar be committed to a psychiatry clinic. Poddar killed Tatiana. In the ensuing trial, the California Supreme Court found that a medical professional has a duty not only to a patient, but also to individuals who are in danger consequent to the acts of that patient.
In the case of Dr. Bawaskar’s patient, there was a manifest, malignant brain tumour, known to carry a very high risk of mortality.
It is the duty of the treating neurosurgeon to convey this sad news to the patient and his family. Since the patient was of marriageable age, it is obvious that with such a tumour, the union would lead to incalculable harm to the prospective bride. The woman and her parents should have been provided details of the illness and prognosis by the patient and his family. An instruction to this effect from the doctor to his patient would have been correct and salutary.
As matters stand, the doctor failed in his duty as physician, friend, philosopher and guide to his patient, his family and to the hapless, now pregnant, wife.
- Bawaskar HS. Can doctors advise beyond the purely professional? Indian J Med Ethics. Published online on July 1, 2019. DOI:10.20529/IJME.2019.035.
- Supreme Court of California. Vitaly Tarasoff et al, Plaintiffs and Appellants, v Regents of the University of California et al, Defendants and Respondents. 551 P.2d 334 (Cal. 1976). 1976 Jul 1 [cited 2019 Jun 20]. Available from: https://www.courtlistener.com/c/Cal.%203d/17/425/.