Communicable Diseases: Confidentiality and the Duty to Warn

Imposition of Legal Duty to Warn

R v Dica [2004]

Tarasoff v Regents of the University of California (1976)

Reisner v Regents of the University of California (1995)

Myers v Queensberry (1983)

Di Marco v Lynch Homes-Chester County (1990)

Thomson v County of Alameda (1980)

Gammil v United States (1984)

Osman v UK [1999]

Possible Implementation into UK Law

Pittmann Estate v Bain (1994)

Caparo Industries plc v Dickman [1990]

Goodwill v B.P.A.S. [1996]

Smith v Littlewoods Organization Ltd [1987]

White v Jones [1995]

Henderson v Merrett Syndicates Ltd [1994]

Autonomy

General

JS Mill, "On Liberty"

Harm principle

G Dworkin, "The Theory and Practice of Autonomy"

Many definitions of autonomy

Five criteria for a workable definition of autonomy

Applied in the abstract to communicable diseases

Autonomy of the patient vs. autonomy of the third party

Harm principle

Can limit autonomy to protect others

Contrast with consent

Consequences

General

Confidentiality is crucial to controlling the HIV/AIDS epidemic

Patients may not seek treatment if no guarantee of confidentiality

Stigma of a diagnosis of AIDS

Historical examples

Plague, SARS, Quarantine in Canada

Applied in the abstract to communicable diseases

Utilitarianism

Breaching confidentiality leads to less people seeking treatment - more harmful

Consequences for third party

Debiliting, terminal illness

Morally wrong?

Trust

General

GMC Guidance on genetics

Crucial to a successful doctor-patient relationship

Applied in the abstract to communicable diseases

Bassford, HIV and Confidentiality

Patients literally and metaphorically in their doctor's hands

Common Law

X v Y [1988] 2 All ER 649

R v Department of Health ex parte Source Informatics Ltd [2001] QB 424 (CA)

Campbell v MGN [2004] UKHL 22

H (A Healthcare Worker) v Associated Newspapers Ltd and N (A Health Authority) [2002] LLMLR 210

W v Edgell [1990] 1 All ER 835

Tarasoff v. The Regents of the University of California (1976) 17 Cal (3d) 358

Ashworth Security Hospital v. MGN Ltd [2000] 1 WLR 515

R v. Dica [2004] EWCA Crim 1231

Statutes

Data Protection Act 1998

NHS (Venereal Diseases) Regulations 1974

NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000

Public Health (Control of Diseases) Act 1984

AIDS (Control) Act 1987

Health and Social Care Act 2001

Professional Guidance

Hippocratic Oath

General Medical Council

Protecting and Providing Information

Department of Health

Confidentiality: NHS Code of Practice

British Medical Association

Medical Ethics Today

European Convention on Human Rights

Article 2

Article 3

Article 8

Z v. Finland (1998) 25 EHRR 371

European Convention on Human Rights and Biomedicine

Article 10

Physical Harm

United Kingdom

W v Edgell [1989] 1 All ER 1089

United States

Tarasoff v Regents of the University of California (1976)

Molien v Kaiser Foundation Hospital (1980)

Communicable Diseases

United States

Di Marco v Lynch Homes - Chester County Inc. (1989)

Reisner v Regents of the University of California (1995)

Santa Rosa Healthcare Corporation v. Garcia (1998)

C.W. v. Cooper Health System (2006)

Partner Notification, e.g. New York

United Kingdom

R v Dica [2005] EWCA Crim 2304

HM Advocate v Kelly (unreported)