Confidentiality

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Confidentiality

• Modes of Ethical Reasoning

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Confidentiality

• One of few modern health care ethics precepts
  included in Hippocratic Oath
• Everyone says it is serious
• No one says it is absolute

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Why Is Confidentiality Important?

• What if no bad consequences follow from revealing
  private information?
• Most people would feel wronged even if no bad
  consequences
• Suggests moral reasoning is more Kantian than
  utilitarian (respect for persons)

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Confidentiality and Autonomy

• How is violation of confidentiality a threat to
  personal autonomy?
• Control over intimate relationships

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Most distant
Most intimate
Me
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Most distant
Most intimate
Choose freely to disclose personal information
Me
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Most distant
Most intimate
Me
Choose to withhold personal information
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When to Override Confidentiality?

• High risk of serious harm to identifiable person
• No alternative way to avoid harm
• One takes steps available to minimize harm to
  patient from disclosure

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Overriding Confidentiality

• To prevent harm to a third party (see previous
  justifications)
• To prevent harm to the patient (same criteria as
  justifying paternalism)

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Reporting Law A Special Case

• Law is publicly known
• We have obligations to know what the law is
• Therefore can argue that patient has implicitly
  given consent if now seeking medical care under
  those circumstances
• How valid a justification?

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Approaches to Ethical Reasoning

• Principles
• Cases
• Either-or or both-and?

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Abstract principles
Concrete specific judgments
PRINCIPLES
CASES
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Principles

• Ethical wisdom lies in a small number of concise,
  abstract principles
• From principles can deduce what to do in a given
  case
• Case anecdotes are merely illustrative of the
  correct application of principles

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Cases (Casuistry)

• Ethical wisdom consists of detailed, nuanced,
  concrete judgments about specific cases
• Often uses maxims or rules but these are general
  organizing concepts, not infallible sources of
  ethical insight
• Often a rule or maxim creates a line of cases

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The Truth Line of Cases

• Maxim Dont lie
• Paradigm case George W. and the cherry tree
• Line of cases Each new case differs just a
  little more from the paradigm case as one gets
  farther away a wider variety of other ethical
  considerations compete with the maxim

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Difficult Cases

• Kant Do you tell the truth to the homicidal
  lunatic who asks which way your friend went?
• At intersection of two lines of cases-- Dont
  lie and Protect lives maxims

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Reasoning About Cases

• Differences how two cases which at first glance
  seem identical actually have features requiring
  different ethical analyses or actions
• Analogy how two cases which at first seem quite
  different actually have common features which may
  point to an ethical resolution

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Abstract principles
REFLECTIVE EQUILIBRIUM
Concrete specific judgments
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Reflective Equilibrium

• Look for best overall fit
• Reason both from cases to principles and from
  principles to cases
• Sometimes a specific case judgment will seem
  better grounded, other times a principle will
• Be willing to revise ethical judgments based on
  new ideas and insights