Academic journal article The Hastings Center Report

Commentary

Academic journal article The Hastings Center Report

Commentary

Article excerpt

The ease with which families and health care professionals abandon their usual commitment to individual autonomy, honesty, and respect for persons where a patient is older and perceived to be at peril is illustrated in this case by the conduct of Mr. G's cardiologist, his brother-in-law, and his adult children. When what we ethically expect of each of these actors regarding Mr. G's privacy is compared against their actual behavior, the conclusion necessarily is one of paternalism at its worst.

The cardiologist, as treating physician, clearly has both a fiduciary and contractual obligation to hold confidential from third parties any information that comes into her possession through her professional relationship with her patient. Mr. G had not given his express permission for release of information to his brother-in-law, and the cardiologist had neither a factual basis nor a valid ethical justification for inferring such authorization. Even if the cardiologist knew (she did not) about Dr. H's close relationship with the patient, leaping to the assumption that therefore Mr. G would have no objection to opening his medical record to his brother-in-law would be inappropriate. It would have been easy enough, and more respectful, to check directly with Mr. G concerning his preference regarding privacy. If the cardiologist's decision to reveal information to Dr. H was based on their common membership in the medical "fraternity" rather than the patient's clear permission, the disrespect for Mr. G's privacy was even more egregious.

The adult children are somewhat less blameworthy, since they only received information from their uncle concerning Mr. G, rather than revealing information about him to another. Nonetheless, their participation in this conspiracy to bypass their father in the name of protecting him constitutes disrespect for his dignity as a person. At the least, once they had been told the unfortunate news by their uncle, the children should have taken a cue to probe their father directly to plumb what information, if any, he wished to share with them himself. …

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