[Professional confidentiality and the family]

The roots of " doctor-patient privilege " or professional confidentiality go back to the Greek island of Cos - Hippocrates' birthplace. The Cos school advocated silence about what the doctor might learn during his visits. In 1868 the Napoleonic Criminal Code sanctioned those who divulged secrets that were entrusted to them by virtue of their profession or estate. The [Belgian medical association's] Code of Professional Ethics extends the bounds of professional confidentiality to include everything that the doctor sees, has knowledge of, learns of, ascertains, discovers, or surprises. Confidentiality as a matter of public policy is relative. It is a tool for the preservation of values, allowing access to health care without fear of divulgation. This leads to possible conflicts of values, conflicts between two duties involving a value that can be protected only to the detriment of another value. The family's rights are specified in Belgium's law on patient's rights, to wit: indirect consultation of the medical file after an individual's death and representation of a patient who is not able to exercise her/his rights her/himself. Silence is nevertheless the rule. The care that an illness calls for generally forces the doctor to make certain disclosures to the patient's family about the state of the illness. This usually goes no farther if the ailment is benign. However, in some sensitive situations (HIV, alcoholism, and divorce), the doctor must bear in mind that the patient may oppose the disclosure of any and all information. A good understanding of the foundations of professional confidentiality, informing the patient, and the doctor's own human qualities should make it possible to get hitherto stalled situations to move forward. The patient remains the doctor's primary focus.