Communication
In the Public Interest
The duty of patient confidentiality may be breached by a doctor if there is a serious concern about public safety.
When does a HCP's duty to society outweigh his duty to the patient?
W. v Egdell
In W. v. Egdell, Dr Egdell was asked to assess a patient detained in a special hospital with a history of violent crime. The assessment was requested by the patients lawyers and was to be used in the context of the patient's application to a mental health review tribunal. Dr. Egdell decided that the patient represented a much greater risk to the public than was recognized by his RMO. Once Dr. Egdell's views became known to the patient's
lawyers they withdrew his application to the tribunal, with the effect that the report was not disclosed.
Dr Egdell was concerned about the danger that the patient posed to the public and he made the report available to the hospital authority responsible for the patient's detention, without the patient's consent. The patient's lawyers attempted
to restrain the distribution of the report. They were unsuccessful. The judge decided that the public interest in disclosure overrode the patient's right to confidentiality.
The court held that Dr Egdell's actions were justified.
In some cases it is required (not just justified) for the HCP to breach patient confidentiality where there is a serious risk to public safety:
Tarasoff v Regents of University of California, 131 Cal. Reporter 14 (Sup. Court 1976).
On 27th October 1969, Prosenjit Poddar killed Tatiana Tarasoff. Two months earlier Poddar had confided his intention to kill Tatiana to Dr. Lawrence Moore, a psychologist employed by the Cowell Memorial Hospital at the University of California at Berkeley. On Moore's request, the campus police briefly detained Poddar, but released him when he appeared rational. Dr. Harvey Powelson, Moore's superior, then directed that no further action be taken to detain Poddar. No one had warned plaintiffs (Tatiana's parents) or Tatiana herself of the threat to her life.
It was held that the failure to disclose information to the required persons had resulted in serious injuries to members of the public. The psychiatrist and his employer were held liable for negligence. A client had informed the psychiatrist of an intention to assault a third party, which he eventually carried out. The psychiatrist failed to advise the third party despite having knowledge the intended assault.
In situations like this, relevant medical authorities may disclose information concerning the health status of the patient to the required bodies or individuals that are entitled to the information.
