Breach of Confidentiality in Sexually Transmitted Diseases from the Perspective of Consequential and Deontological Philosophical Schools

Abstract

Background and Aim: Confidentiality is recognized as a fundamental principle in medical ethics, ensuring of which in dealing with patients with sexually transmitted diseases, particularly after the discovery of AIDS, is yet questioned. Absolute keeping of the patient’s secrets may be contrary to the prevention of secondary transmission to sexual partners or to the fetus due to lack of awareness. However, unconditional breach of confidentiality may result in a public distrust in doctors and people’s not referring to them. Confidentiality can, therefore, be regarded as a fundamental principle in ethical excellence which can have some limited exceptions. The present study aimed to evaluate the breach of confidentiality in sexually transmitted diseases from the perspective of consequential and deontological philosophical schools so as to reveal the “moral virtue” in the interested area. Materials and Methods: In the present review study, using such keywords as sexually transmitted diseases, confidentiality, and partner notification – which account for a broad spectrum of medical ethics studies – in PubMed, SID, and Google Scholar databases, the relevant literature were searched and analyzed. Ethical considerations: Ethical principles were observed in searching and citing the literature. Results: Whereas the consequential perspective merely pays attention to the result of the action regardless of its ethical considerations to keep or to breach the patient’s secret, the deontological emphasizes on the observance of ethical principles. Both these schools have however been subject to new perspectives in such a way that we do not seem to observe an absolute confidentiality even in the deontological school anymore. On the other hand, consequential perspectives also do emphasize on observance of the ethical principles, in addition to considering the benefits. It is therefore recommended that in the first step, the doctors lead the patients to tell their partners by telling the truth to the patient. If the patients are not able to tell the issues to their partners, the doctors can help them with the necessary guidance and training. In case some patients are still unable to do it, the doctors, taking the patients’ permission, can do it on their behalf. Since, according to the statutory laws and ethics, doctors have no duty to warn a patients’ sexual partners, if it is more to the benefit of the patients’ sexual partners to “breach the confidentiality” than to “keep the secret”, it is ethically permissible to “breach the confidentiality”. This breach should, however, be just to the extent that is “necessary”, and it should be carried out just to the exigencies of “necessary circumstances”. This at least applies to the identifiable partners of the patients. The criteria of necessity is also identified based on the definite medical traditions. Given that searching for and identifying the sexual partners is not considered as a medical responsibility, if the sexual partners consult a doctor, s/he can share the patients’ secrets with their sexual partners according to the preceding paragraphs. When a patient is not eligible, or when it is of necessity, the doctor ought to notify the patient’s hierarch or parents. Otherwise, what is to the best benefit of the patient should be considered. Conclusion: Being evidently derived from Kant’s deontological philosophy which emphasizes on keeping the secret as an absolute principle, the modern deontological philosophical perspectives- resting on the commonly known axioms- can allow for breaching of confidentiality at least with the sexual partners of the patients with sexually transmitted diseases in order to promote good and not to harm anyone. Moreover, consequential perspectives also lead us to the breach of confidentiality if it is to the best benefit of the people. To encapsulate the perspectives on the normative ethics, it is appropriate to avoid absolute thinking so as neither to allow for absolute confidentiality of the patients with sexually transmitted diseases as the deontological perspectives do nor to consider the mere benefits of the person as the diagnostic criteria for the ethical actions. Rather, by aggregating the perspectives, while respecting the principle of confidentiality, we should take the best benefits of the community board, and on top of whom the patient’s sexual partner, into account based on what common sense discerns as axiomatic. Please cite this article as: Sheykh Talimi M, Omani Samani R. Breach of Confidentiality in Sexually Transmitted Diseases from the Perspective of Consequential and Deontological Philosophical Schools. Med Ethics J 2016; 10(37): 69-79.