Releasing the treating psychiatrist from confidentiality

Confidentiality is one of the oldest and most universal traditions of medicine. This rule is beneficial to the patient, who can disclose his or her secrets to his or her therapist without reluctance, to the physician, who enjoys a privileged relationships with his or her patient and to society at large, interested in public health and unrestricted access of all citizens to treatment. Nevertheless, each one of these beneficiaries claims the right to break this rule. The patient considers that the confidence is his or hers and may be disposed of at his or her discretion. The psychiatrist claims that he or she cannot remain silent and passive when the absence or delay of treatment of a reluctant patient can result in a disaster. Finally, society advocates the existence of a hierarchy which places the protection of society above the interests of the individual. Originally, breaches in confidentiality allowed by the legislator were chiefly intended to enable the patient to enjoy his or her rights or to facilitate treatment. Moreover the physician was encouraged to limit released data to those which were necessary for the purpose stated in the request for information. Unfortunately, the extent of the breaches is increasing. Some of the exceptions, like the obligation to report child abuse or imminent danger to others (Tarasoff) are usually readily accepted. This article details cases which give concern inasmuch as the disclosure of information exposes the patient to diverse restrictions. For example the right to confidence is waived by the patient under external pressure as a condition to obtain employment, access to military service or a driver's licence.(ABSTRACT TRUNCATED AT 250 WORDS)