Communicable Diseases: Confidentiality and the Duty to Warn
The Duty to Warn
Communicable Diseases
HM Advocate v Kelly (unreported)
R v Dica [2005] EWCA Crim 2304
Partner Notification, e.g. New York
C.W. v. Cooper Health System (2006)
Santa Rosa Healthcare Corporation v. Garcia (1998)
Di Marco v Lynch Homes - Chester County Inc. (1989)
Physical Harm
United States
Molien v Kaiser Foundation Hospital (1980)
United Kingdom
W v Edgell [1989] 1 All ER 1089
The Law of Confidentiality
European Convention on Human Rights and Biomedicine
Article 10
European Convention on Human Rights
Z v. Finland (1998) 25 EHRR 371
Article 8
Article 3
Article 2
Professional Guidance
British Medical Association
Medical Ethics Today
Department of Health
Confidentiality: NHS Code of Practice
General Medical Council
Protecting and Providing Information
Hippocratic Oath
Statutes
Health and Social Care Act 2001
AIDS (Control) Act 1987
Public Health (Control of Diseases) Act 1984
NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000
NHS (Venereal Diseases) Regulations 1974
Data Protection Act 1998
Common Law
R v. Dica [2004] EWCA Crim 1231
Ashworth Security Hospital v. MGN Ltd [2000] 1 WLR 515
Tarasoff v. The Regents of the University of California (1976) 17 Cal (3d) 358
W v Edgell [1990] 1 All ER 835
H (A Healthcare Worker) v Associated Newspapers Ltd and N (A Health Authority) [2002] LLMLR 210
Campbell v MGN [2004] UKHL 22
R v Department of Health ex parte Source Informatics Ltd [2001] QB 424 (CA)
X v Y [1988] 2 All ER 649
Normative Aspects of Confidentiality
Trust
Bassford, HIV and Confidentiality
Patients literally and metaphorically in their doctor's hands
GMC Guidance on genetics
Crucial to a successful doctor-patient relationship
Consequences
Consequences for third party
Debiliting, terminal illness
Morally wrong?
Utilitarianism
Breaching confidentiality leads to less people seeking treatment - more harmful
Confidentiality is crucial to controlling the HIV/AIDS epidemic
Stigma of a diagnosis of AIDS
Plague, SARS, Quarantine in Canada
Historical examples
Patients may not seek treatment if no guarantee of confidentiality
Autonomy
Applied in the abstract to communicable diseases
Contrast with consent
Can limit autonomy to protect others
Autonomy of the patient vs. autonomy of the third party
General
G Dworkin, "The Theory and Practice of Autonomy"
Five criteria for a workable definition of autonomy
Many definitions of autonomy
JS Mill, "On Liberty"
Harm principle
Recommendations
Possible Implementation into UK Law
Henderson v Merrett Syndicates Ltd [1994]
White v Jones [1995]
Smith v Littlewoods Organization Ltd [1987]
Goodwill v B.P.A.S. [1996]
Caparo Industries plc v Dickman [1990]
Pittmann Estate v Bain (1994)
Imposition of Legal Duty to Warn
Osman v UK [1999]
Gammil v United States (1984)
Thomson v County of Alameda (1980)
Di Marco v Lynch Homes-Chester County (1990)
Myers v Queensberry (1983)
Reisner v Regents of the University of California (1995)
Tarasoff v Regents of the University of California (1976)
R v Dica [2004]
