Dickens B M, Cook R J
Faculty of Law, University of Toronto, Toronto, Canada.
Int J Gynaecol Obstet. 2000 Sep;70(3):385-91. doi: 10.1016/s0020-7292(00)00286-1.
Ethical principles that require the preservation of patients' confidential information are reinforced by principles found in several areas of law, such as law on contracts, negligence, defamation and fiduciary duty. However, laws sometimes compel disclosures of medical confidences, and more often may justify or excuse disclosures. Legally contentious issues concern patients' confidences regarding possible unlawful conduct, such as pregnancy termination, and the risk of spread of HIV and other infections. This article reviews the various legal bases of the duty of confidentiality, and legal challenges to the ethical obligation of non-disclosure. It addresses the justifications and limits of exchange of patients' health information among healthcare professionals and trainees, and considers legally recognized limits of confidential duties, and the scope of legitimate disclosure. An underlying theme is how to determine whether physicians are ethically justified in employing the discretion the law sometimes affords them to breach patients' expectations of confidentiality.
要求保护患者保密信息的伦理原则，在合同法、过失法、诽谤法和信托责任法等多个法律领域的原则中得到强化。然而，法律有时会强制披露医疗机密，而且更常见的情况是可能为披露行为提供正当理由或免责事由。具有法律争议的问题涉及患者对可能的非法行为（如终止妊娠）以及艾滋病毒和其他感染传播风险的保密。本文回顾了保密义务的各种法律依据，以及对不披露的伦理义务的法律挑战。它探讨了医疗保健专业人员和实习生之间交换患者健康信息的正当理由和限制，并考虑了法律认可的保密义务限制以及合法披露的范围。一个潜在的主题是如何确定医生在运用法律有时赋予他们的酌处权违背患者保密期望时，在伦理上是否合理。
