{"id":3508,"date":"2019-05-30T21:26:38","date_gmt":"2019-05-30T20:26:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3508"},"modified":"2019-06-10T00:00:51","modified_gmt":"2019-06-09T23:00:51","slug":"it-is-time-the-law-stopped-incentivising-confidentiality-bringing-duties-of-care-more-in-line-with-professional-guidance","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/05\/30\/it-is-time-the-law-stopped-incentivising-confidentiality-bringing-duties-of-care-more-in-line-with-professional-guidance\/","title":{"rendered":"It is time the law stopped incentivising confidentiality: bringing duties of care more in line with professional guidance"},"content":{"rendered":"

By Michael Fay and Edward Dove<\/p>\n

ABC v St George\u2019s Healthcare<\/a><\/em> (2017) is an important legal decision, and its return to court in November 2019 will be no less significant for doctors\u2019 duties of care. Currently, a doctor is subject to a duty of care to their patient. A doctor also has a corresponding duty of confidentiality. Medical law, to paraphrase the court in ABC<\/em>, incentivises duties in one direction: towards patients. Historically, this has not been problematic because a doctor\u2019s relationship is only with her patient. But in the era of genomic medicine and genetic screening, doctors \u2013 particularly those working in clinical genomics \u2013 are coming into possession of information that is relevant to both the patient and<\/em> the patient\u2019s relatives. In ABC<\/em>, this information was a diagnosis of Huntington\u2019s disease (HD); the patient received this information but refused to let it be disclosed to his pregnant daughter because he was concerned she \u2018might get upset, kill themselves or have an abortion.\u2019 When she later learned about her father\u2019s condition, and was subsequently diagnosed with HD herself, she sued St George\u2019s University Hospitals NHS Foundation Trust, arguing that the failure of the doctors to tell her about her father\u2019s diagnosis was actionable negligence.<\/p>\n

This argument led to the obvious tension of doctors\u2019 obligation of confidentiality to their patients and a potential duty of care to patients\u2019 relatives. In the High Court, Mr Justice Nicol came down very strongly on the side of the Trust, accepting their nine arguments, five of which (explicitly or implicitly) involved confidentiality. The Trust said the claimant\u2019s case did not engage a public interest in breaching confidentiality; the law of confidence already allowed disclosure in certain situations; conflicting duties of patient confidentiality and disclosure to patients\u2019 relatives would be created; trust and confidence in doctors would be undermined; and pressure would be put on patients to consent to disclosures. The upshot here is that the legal status quo leaned heavily towards the duty of confidentiality.<\/p>\n

This was a theme picked up by the Court of Appeal when they heard ABC<\/em> in 2017. The court recognised that the law incentivises duties in only one way \u2013 towards the patient. Thus, when a patient does not consent to the disclosure of genetic information to others, the law would encourage doctors to respect confidentiality rather than make a disclosure because no legal consequences attached to this course of action. In other words, doctors would not get sued if they took this position. This is despite the law and professional guidance stating that while confidentiality is undoubtedly important, \u2018it is not absolute\u2019 (GMC, 2017). In fact, GMC guidance<\/a> explains that genetic information may be disclosed if it is in the public interest, and doctors will need to balance their duty to care for the patient against their duty to help protect other persons from serious harm (GMC, 2017, para 75). There is obviously huge significance and benefit to keeping patient\u2019s medical information private, but there are also benefits to disclosing genetic information in some instances, such as preventive treatments or interventions, increased surveillance or other investigations, and preparing for potential health problems (GMC, 2017, Royal College of Physicians, 2011).<\/p>\n

The time has therefore arrived for the law to stop incentivising confidentiality over and above balancing the interests of patients and patients\u2019 relatives and making disclosures where necessary. As the Joint Committee on Medical Genetics explained in 2011<\/a>, \u2018providing the tested person with a right of veto over such risk information in all situations may be legally and ethically unsound\u2019. Legal rules must keep pace with the direction of professional guidance and changes to the law to empower doctors to make clinically and ethically appropriate disclosures without patient consent is necessary. It is confusing and unhelpful to have professional guidance that states confidentiality may be breached in certain circumstances but provide no clear legal basis for doing so. A finding of a duty of care when ABC<\/em> returns to court would provide such a basis. The point here is not to create a duty mandating<\/em> disclosure, but rather to create a duty to conduct a balancing exercise, as is set out in the GMC\u2019s guidance, or as we call it in our article, a duty to consider the interests of genetic relatives. The scope and direction of professional guidance has been influential in recent developments in medical negligence (for example, in consent to risks of treatment: Montgomery v Lanarkshire<\/em> [2015] UKSC 11), and it is appropriate that it again guides legal development concerning the disclosure of genetic information.<\/p>\n

 <\/p>\n

Paper title:<\/strong> Familial genetic risks: how can we better navigate patient confidentiality and appropriate risk disclosure to relatives? [Open access]<\/a><\/p>\n

\n
Authors:<\/strong> Edward S Dove1<\/sup>, Vicky Chico2<\/sup>, Michael Fay3<\/sup>, Graeme Laurie1<\/sup>, Anneke M Lucassen4,5<\/sup>, Emily Postan1<\/sup><\/address>\n
Affiliations:<\/strong><\/p>\n
    \n
  1. School of Law,\u00a0University of Edinburgh,\u00a0Edinburgh, UK<\/li>\n
  2. School of Law,\u00a0University of Sheffield,\u00a0Sheffield, UK<\/li>\n
  3. School of Law,\u00a0Keele University,\u00a0Keele, UK<\/li>\n
  4. Faculty of Medicine,\u00a0University of Southampton,\u00a0Southampton, UK<\/li>\n
  5. Wessex Clinical Genetics Service,\u00a0University Hospital Southampton NHS Foundation Trust,\u00a0Southampton, UK<\/li>\n<\/ol>\n<\/address>\n<\/address>\n

    Competing interests:<\/strong> We have no competing interests to declare.<\/p>\n

    Social media accounts of post authors:<\/strong><\/p>\n

    Michael Fay: @MFay_Law<\/a><\/p>\n

    Edward Dove: @EdwardSDove<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    By Michael Fay and Edward Dove ABC v St George\u2019s Healthcare (2017) is an important legal decision, and its return to court in November 2019 will be no less significant for doctors\u2019 duties of care. Currently, a doctor is subject to a duty of care to their patient. A doctor also has a corresponding duty […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,8049],"tags":[],"class_list":["post-3508","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-privacy"],"yoast_head":"\nIt is time the law stopped incentivising confidentiality: bringing duties of care more in line with professional guidance - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/05\/30\/it-is-time-the-law-stopped-incentivising-confidentiality-bringing-duties-of-care-more-in-line-with-professional-guidance\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"It is time the law stopped incentivising confidentiality: bringing duties of care more in line with professional guidance - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Michael Fay and Edward Dove ABC v St George\u2019s Healthcare (2017) is an important legal decision, and its return to court in November 2019 will be no less significant for doctors\u2019 duties of care. 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