The question of whether healthcare providers (HCPs) in the United Kingdom should embrace the concept of coexisting duties when it comes to considering the interests of genetic relatives without fears of liability for negligence or breach of confidence is explored in an article published in the Journal of Medical Ethics.
Authors considered the ethicolegal dilemma concerning whether to communicate familial genetic risk beyond the confines of the single patient-doctor relationship. The issue becomes more pertinent with the integration of genetics and genomics research into routine health care. Cases in which the HCP breaches confidence may be justified when the aversion of harm by the disclosure substantially outweighs the claim to confidentiality. Where physicians conclude that these interests deserve priority, the law recognizes only a legal duty to protect the patient’s confidence and not a duty to consider the interests of third parties.
The General Medical Council (GMC) recognizes that disclosure of information to others without the patient’s consent is justified “if failure to do so may expose others to a risk of death or serious harm.”
In other words, current GMC confidentiality guidelines state that disclosure might be justified in the context of genetic information if a patient refuses to consent to the disclosure of information. Phrasing in the GMC confidentiality guidelines is vague, such that resolution on the matter is merely discretionary. Despite the statement that protection of private interests is also a matter of public interest, grounds for public interest do not seem to provide an adequate legal basis for modifying the obligation of confidence to the patient.
The authors concluded that “what initially [looks] like conflicting duties can be reconciled when we see them as each focused on the same objective: allowing the implementation of a robust professional assessment of the value of preserving patient confidence and respecting relatives’ interests in disclosure, in the context of striving for an outcome that will provide the best clinical genetics service for that family to be implemented, without the fear of legal action.”
One author acknowledges conflicts of interest. Please see reference for a full list of disclosures.
Dove ES, Chico V, Fay M, Laurie G, Lucassen AM, Postan E. Familial genetic risks: how can we better navigate patient confidentiality and appropriate risk disclosure to relatives? [published online May 23, 2019]. J Med Ethics. doi:10.1136/medethics-2018-105229