“I’m going to die – don’t tell anyone.”

Daniel James' GP maintained confidentiality in the patient's best interests.

When should a doctor maintain patient confidentiality, and when is it ethical to breach it? Police are asking for clearer guidelines for doctors as it emerged that Daniel James, the paralysed rugby player, had told his doctor he intended to end his life at the Dignitas assisted suicide clinic and the doctor failed to inform the authorities.

There are times when a doctor is justified in breaching confidentiality – for instance, if she knows or suspects that the patient might harm others or is acting illegally. A doctor can also be justified in breaching confidentiality if she believes the patient might harm himself – but there was no legal requirement for Daniel’s doctor to inform anyone. Daniel’s GP did, however, refer him to a psychiatrist. The psychiatrist assessed Daniel as capable of making decisions for himself.

Careful examination of the story shows the case to be very different to one where an emotionally disturbed person is a danger to him or herself. The British Medical Association is already concerned about confidentiality in a the government’s proposed Health and Social Care Bill, and fears that patients might withhold important information because of confidentiality issues. Dr Vivienne Nathanson, head of science and ethics at the BMA, accused the government of placing its desire for access to information over the need to respect patient confidentiality.

But Detective Inspector Andrew Todd of of West Mercia Police told the Commission on Assisted Dying that he believed that the issue of patient confidentiality was “a massive barrier” to the GP making contact with police at the time. He called for “clarification” for medical staff and others involved in assisted suicide cases to ensure that professionals knew “what they should and shouldn’t be doing”.

Read more:
Family doctor knew rugby player wanted to die (Telegraph)
GP knew paralysed rugby player intended to die (Mail Online)
BMA expresses concerns over patient confidentiality (BBC)
What is Confidentiality? (online resource with further links and info)
Commission on Assisted Dying (Lord Falconer)

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