Wednesday, December 1, 2010

Review of Lesson Six

Dear JLI Student,

Thank you for joining us for the sixth and final lesson of Medicine and Morals: Secret Code. The following is a brief summary of the lesson:

There are various reasons given by secular ethicists for the importance of confidentiality. In all, these concerns are mostly limited to a professional relationship, e.g., doctor and patient, lawyer and client, etc. Judaism, however, views confidentiality as an obligation incumbent on all. It is forbidden to disseminate even true information about others, even if the information is innocuous. The violation is far more egregious in the case of negative information. This is true even if the subject has not asked that the information remain private. The default position of Judaism is that no one is allowed to share information about others without express permission.

However, when maintaining confidentiality will result in harm to an innocent person, whether physical or financial, it is obligatory to breach confidentiality and reveal the details to the innocent person. Thus, when a parent is diagnosed with Huntington’s Disease and does not want to share this information with his children that plan on marrying, the doctor must breach confidentiality and warn the children in order to protect their prospective spouses. The need for an individual to know that he or she has HD is not sufficient reason to breach confidentiality because there is in any case no known treatment, so there is no direct benefit to having this information. However, a prospective spouse would want to take this information into account in deciding whether to marry someone, and therefore, one would be obligateded to breach confidentiality in order to make sure that the prospective spouse could make an informed decision.

Even when a physician is permitted and obligated to reveal medical information to a third party, it is always better if the physician can convince the patient to reveal this information themselves. Only when this is not successful should the physician do so.

However, if the physician will suffer financially by breaching confidentiality, because of a lawsuit, loss of job, etc., then a more nuanced approach is needed. If the harm to the innocent party is non-life threatening, then the physician has no obligation to incur financial loss and may keep the secret. If however there is a real threat to life, then the physician must disregard his/her financial loss and reveal the information to save the life of the innocent party.

This brings the fall course to a close. Thanks so much for joining us for Medicine and Morals. It has been an amazing journey. Our upcoming winter course will be Towards A Meaningful Life. I hope you will join us then for this fascinating course. Stay tuned for details.


Rabbi Shmuly Altein

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