Business Law and Ethics : Physicians and Professional Secrecy

Introduction

Our law enforcement officials have a duty to protect citizens as well as discourage crimes from taking place. Our health care officials also have a duty to provide the best care possible to those who need it. Often enough, there have been many cases where both parties have come in contrast with each other on different levels of professionalism. The ultimate debate arises when doctors and law enforcement take into account the respect and privacy of patients. One of the issues that will be discussed in the paper focuses on the importance of doctors having to report gunshot wounds to the police. Many issues of ethics and morality come into play when judging which party is in favor. In our opinion, we believe that physicians should report patients that come in with gunshot wounds for reasons of discouraging criminal acts, protecting our society, and preventing future violence from taking place. This paper will explore the many moral, ethical and legal responsibilities of a physician, and analyze why it is important for them to report gunshot wounds to the police. Contrary to the Code of Ethics of Physicians and the Medical Act, we believe there is a pressing issue for public concern that is being strongly overlooked in this matter. We will explore the areas of human rights, professional secrecy, civil responsibilities, as well as patient consent in order to justify our claim.

The Law

Article 9 of The Charter of Human Rights and Freedom states that, "No person bound to professional secrecy should disclose confidential information and that the tribunal will ensure professional secrecy is respected." We strongly believe this statement should not apply to gunshot wounds because it depicts that the law would only be protecting one person over society as a whole. A gunshot wound should not be bound by professional secrecy since; even professionals can determine a gunshot wound and it is not revealing a patient's confidential information other than his condition. When a gun has been discharged the government has an obligation to protect society. In essence, the most important issues to consider in disclosure of confidential information are that the police have a specific role as well in protecting the well being of society. The police are responsible for assessing the risk posed by members of the public who are armed. Therefore, they have a need to consider the risk of further harm to those in the surrounding area. With the upscale growth of firearm violence throughout the country, police say hospitals have become safe havens for people who break the law, but some doctors say patient confidentiality trumps the need to report gunshot wounds.

Most physicians recognize the narrow public health and safety obligations to report a patient's communicable diseases, gunshot wounds, signs of child abuse, or serious violent intentions--socially motivated exceptions to traditional pledges of confidentiality.

As these social issues immerge, we believe it is best for society to inform the authorities of any crime. Many argue that a patient with a gunshot wound may himself have been part of gunfire and would therefore be discouraged from obtaining medical help if physicians were to report the wound. However, shouldn't a law protect society over one individual? When a patient is brought to the hospital for a gunshot wound it is crucial to take into account that the criminal is perhaps still at large and may harm someone else; that is, if the law enforcement is not informed. Forty-five American states have some form of law providing for mandatory reporting of gunshot or other wounds.

The Code of Medical Ethics states that the information disclosed to a physician during the course of the patient-physician relationship is confidential to the utmost degree, however they have permitted disclosures.

Furthermore, article 20.1 of the Professional Code of Physicians, argues, "A physician, in order to maintain professional secrecy, must keep confidential the information obtained in the practice of his profession." Again, we understand the importance of non disclosure of important information relevant to any patients privacy, however when their condition becomes a matter of public order it is important that those in the public should be protected against any harm that might be caused otherwise. In the case of a gunshot wound, the person being reported may or may not pose a risk to the public. There is no clear intervention that can be undertaken to mitigate or eliminate this undefined, and probably indefinable, risk. In other words, it would only be fair to disclose any of the confidential information when the need for maintenance of confidentiality is outweighed by a reasonable concern for public safety.

We can look at article 20.5 of the Professional Code, which states that:

... May not divulge facts or confidences which have come to his personal attention, except when the patient or the law authorizes him to do so, or when there are compelling and just grounds related to the health or safety of the patients or of others..."

By addressing this statement, we can divulge the importance by law, of disclosing such relevant information to the police. Similarly, the Professional Code of Physicians states a set of articles (21.4 to 21.7) whereby if the victim, for any reason was a witness to the discharge of a firearm and was shot in the process, the doctor must divulge certain information to the authorities.

By law, patients have a right to expect that their doctors will hold information about them in confidence. This is an important element of a relationship of trust between doctors and patients. However, it is extremely important to take into account the issue of consent. If the patient cannot give consent, or is in disagreement, information can still be disclosed if there are grounds for believing that this is the public interest or disclosure is required by law. Disclosures in the public interest are justified where:

* A failure to disclose information would put the patient, or someone else, at risk of death or serious harm.

* A disclosure may assist in the prevention, detection or prosecution of a serious crime.

If there is any doubt about whether disclosure is justified, the decision to disclose information without consent should be made by, or with the agreement of, the chief person in charge.

Personal information may be disclosed in the public interest, without the patient's consent, and in exceptional cases where patients have withheld consent, where the benefits to an individual