Chapter 6: Rights, Truth and Consent

Section 4. Readings: Berkich on Siegler

A. Siegler, Mark. "Confidentiality in Medicine: A Decrepit Concept". New England Journal of Medicine, Vol. 307, No. 24 (9 Dec. 1982), pp. 518-521.

Outline by  Don Berkich,  University of Texas, Corpus Christi (by permission)

Siegler presents us with an analog of the Practical Impossibility Argument: If it is a practical impossibility to respect confidentiality, then confidentiality is not a right. It is a practical impossibility to respect confidentiality. Hence confidentiality is not a right.

Of course, Siegler does not describe confidentiality as a right; it is, rather, an outdated, outmoded, or 'decrepit' concept. But the point is the same.

Some time ago, one's only exposure to the medical community would be through two or three medical professionals--physicians, nurses, etc. Confidentiality was a simple matter for the professionals to respect: don't go around telling people about your patient. Today, however, various specialties, sub-specialties, administration, insurance, and even the government all become involved in treatment at one time or another. As Siegler notes, the facts of a given case might be known to up to a hundred people in a hospital setting.

It is also important to realize that this particular article was published in 1982, well before the widespread implementation of electronic data-keeping in the medical profession. The existence of vast digital databases of patient/client information is an enormous complication for any attempt at respect for confidentiality, since records in digital form are quickly and easily transmitted, copied, and 'mined' for data.

Sadly, confidentiality is mostly a right in the mind of the patient only. To be sure, some hospitals have taken steps to respect confidentiality: one sometimes sees "shush" signs in hospital corridors warning medical professionals to avoid discussing cases while in public areas. But the medical professionals themselves well understand the enormous extent to which confidentiality is, to their minds, an unrealizable ideal. It's a good idea, but not one they can be expected to honor.

We should not be too quick to condemn the medical community. After all, the vast majority instances where confidentiality is ignored are cases where it must be ignored for the sake of the patient/client. A generalist must be able to consult with specialists, for example.

At the same time, confidentiality is becoming increasingly important, particularly in a system with employer-provided health insurance. Already individuals have been fired from their jobs for testing positive on genetic-disorder tests.

Siegler offers no solutions whatsoever. Rather, we study the article to learn that there is a significant problem which will only get worse as medical technology and the implementation of digital technology progress.


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Copyright Philip A. Pecorino 2002. All Rights reserved.

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