Confidentiality
Modes of Ethical Reasoning
Confidentiality
One of few modern health care
ethics precepts included in
Hippocratic Oath
Everyone says it is serious
No one says it is absolute
Why Is Confidentiality
Important?
What if no bad consequences follow from
revealing private information?
Most people would feel wronged even if
no bad consequences
Suggests moral reasoning is more Kantian
than utilitarian (respect for persons)
Confidentiality and
Autonomy
How is violation of confidentiality a threat
to personal autonomy?
Control over intimate
relationships
Most distant
Most
intimate
Me
Most distant
Choose
freely to
disclose
personal
information
Most
intimate
Me
Most distant
Most
intimate
Choose
to withhold
personal
information
Me
When to Override
Confidentiality?
High risk of serious harm to
identifiable person
No alternative way to avoid harm
One takes steps available to minimize
harm to patient from disclosure
Overriding Confidentiality
To prevent harm to a third party
(see previous justifications)
To prevent harm to the patient
(same criteria as justifying
paternalism)
Reporting Law: A Special
Case
Law is publicly known
We have obligations to know what the law
is
Therefore can argue that patient has
implicitly given consent if now seeking
medical care under those circumstances
How valid a justification?
Approaches to Ethical
Reasoning
Principles
Cases
Either-or or both-and?
Abstract principles
Concrete specific judgments
PRINCIPLES
CASES
Principles
Ethical wisdom lies in a small number of
concise, abstract principles
From principles can deduce what to do in
a given case
Case “anecdotes” are merely illustrative of
the correct application of principles
Cases (Casuistry)
Ethical wisdom consists of detailed,
nuanced, concrete judgments about
specific cases
Often uses maxims or rules but these are
general organizing concepts, not infallible
sources of ethical insight
Often a rule or maxim creates a line of
cases
The “Truth” Line of Cases
Maxim: Don’t lie
Paradigm case: George W. and the cherry
tree
“Line of cases”: Each new case differs
just a little more from the paradigm
case; as one gets farther away a wider
variety of other ethical considerations
compete with the maxim
Difficult Cases
Kant: Do you tell the truth to the
homicidal lunatic who asks which way
your friend went?
At intersection of two lines of cases-“Don’t lie” and “Protect lives” maxims
Reasoning About Cases
Differences: how two cases which at
first glance seem identical actually have
features requiring different ethical
analyses or actions
Analogy: how two cases which at first
seem quite different actually have
common features which may point to an
ethical resolution
Abstract principles
REFLECTIVE
EQUILIBRIUM
Concrete specific judgments
Reflective Equilibrium
Look for best overall “fit”
Reason both from cases to principles and
from principles to cases
Sometimes a specific case judgment will
seem better “grounded,” other times a
principle will
Be willing to revise ethical judgments
based on new ideas and insights