Can patient confidentiality be a bad thing for the health of others? A recent case suggests: yes

As we come to understand genetics further, it is also understood that one patient’s health status could impact upon many more people. Well one woman, whose father was a patient in St. George’s Hospital, London, has experience of this first-hand and is bringing a case as a result.

She contends that doctors should have told her that her father had Huntington's disease (a hereditary condition): had she been informed she would not have had her daughter, who is now eight years old. Both she and her daughter have a 50% chance of developing the degenerative disease, which is fatal.

The woman’s case, initially struck out, has now been referred back by the Court of Appeal, meaning that a new interpretation of duty of care could be enshrined in law.

How does this affect duty of care?

Doctors owe their patients a duty of care. This means that doctors have a general duty to take reasonable care to avoid foreseeable injury to their patients. They also have a duty of patient confidentiality, which means that ordinarily, they may not disclose details of patients’ health to third parties without prior consent.

However, if this case were to succeed, doctors would owe a duty of care not just to their patients but also to anyone who could be affected by that patient’s condition. Typically, this will include family members who share some of that patient’s genetic makeup. Of course, this doesn’t just mean that the definition of ‘duty of care’ changes, but also ‘patient’.

How might this affect people more widely?

As our knowledge of genetics in medicine grows, new ethical issues are produced. If the case succeeds at the Court of Appeal, then patients’ genetic characteristics and in particular their genetically-determined conditions may increasingly become a matter of wider concern, if not actually public record. Doctors might be obliged to disclose details of heritable conditions to interested parties as a matter of good practice. Failure to do so could lead to more cases of this sort, in which patients allege that they would not have had families had they known that they risked passing on serious conditions to their children.