The general medical council is the professional body for UK doctors. In its guidelines it says. 'Disclosure of personal information without consent may be justified where failure to do so may expose the patient or others to risk of death or serious harm… You should generally inform the patient before disclosing the information’

What are the fundamental reasons why remaining medical confidentiality is important:

-Respect for the right to privacy

This principle emphasises the patients right to have autonomy over their life, this then implies that a person should have a right to dictate who knows what information about themselves (doctors should not pass information on that the patient has told them, without the patients consent) 

-Implied promise

-The relationship that a doctor and a patient has implies a form of contact, an element of this contact is that a doctor should not breach a patients confidentiality, therefore when a patient has a consultation with a doctor there is an understanding that whatever the patient says will be kept confidential and if this didn’t happen a 'promise' would be broken.

Best Consequences

This argument says that keeping the patients confidentiality has the best consequences, this supports the major moral philosophy that the right action is the one that will have the best consequences. Maintaining confidentiality has the best consequences because if the doctor keeps the patients confidentiality then the patient will trust them, this is vital as people will only seek the help they need if they can fully trust the person helping them.

Issues that arise from the foundations of Confidentiality:

The foundation of respect for the right of privacy can be problematic in real life scenarios this is because it all depends on whose autonomy we focus on when the case involves more than one person. Using the example that if a heterosexual couple went through genetic testing to see what the chances of their child having a severe  genetic disorder and during this testing they found out that the male in the couple was not the biological father, it can be debated on whose autonomy you focus on, the man's autonomy is respected by telling him the information however the woman's autonomy is respected by giving her the control of telling her partner.

The implied promise theory can also be similarly problematic when applied to real life situations. The woman should expect that the doctor keeps all of her information confidential (that is the implied promise), however it can be argued that this piece of information is also the husbands information as it is equally relevant to him. Therefore if it is information that is equally relevant to both parties, both of them should be aware of it

The best consequences theory may also cause issues with this same example as it is difficult to judge which action will have the best outcome. Is it better for the family if it is kept a secret and the male is not aware or would there be a better outcome if the male was told this ? No one would be able to answer this for sure.

When discussing consent and whether someone is able to give consent in a medical sense it is important to also discuss and consider patient autonomy and competence. For example, one consideration for deciding if someone can give consent is age. For this there is something called Gillick competence, this is where the doctor has the right to decide whether a patient under the age 16 has the competence to make a medical decision for themselves. This decision is completely situational and something that only a doctor can decide.

Another factor to consider in the discussion of consent is capacity, especially when talking about patients who may be older or have a condition or disease that effects their capacity to make decisions for themselves such as dementia. The way that medical professionals resolve this is by performing a series of assessments to decide whether a patient has adequate capacity. These assessments may include getting a patient to draw a certain time on a clock or getting them to memorise an address and assessing if they can remember this after a certain amount of time. Finally the patient is also required to repeat back to the doctor who they are and the decision they are making. If a patient is successful in these assessments they are deemed to have capacity and they can then give consent and make their own decisions.

If a patient is unable to complete these tasks then the doctor will have to make the decision themselves using their best judgment and following the GMC guidelines ( This stands for the general medical council and this is the body that sets out the way in which medical professionals should conduct themselves)

However, some patients have what is called a power of attorney this is where a patient decides when they have capacity that someone else who they decide can make medical decisions for them when they no longer have capacity to do so, in this case the doctor must follow what the appointed power of attorney decides.

These are the rules for consent and the evaluation of capacity and competence across all of healthcare and medicine however this includes how doctors and other medical professional should conduct themselves when making decisions on cases involving genetics.

Case study one:

Helen is a carrier for a severe genetic disorder and passed this disorder on to her son. Helen has a sister, Helen and this sister do not speak however she knows her sister is pregnant, the sister goes to see the geneticist because she knows her nephew (Helens son) has a speech delay but she does not know the genetic disorder that Helen carries.  Helen wants her information about the genetic disorder she carries to be kept a secret from her sister because she know that if her sister finds out the severity of the genetic disorder she may also carry then she knows that the sister may terminate her pregnancy. Helen is morally against abortion and therefore wont share the information, Is this fair on the sister?

( you cannot just test the sister of the condition because lots of conditions cause speech delay, she would have to be tested for the disorder her sister carries but her sister won't disclose this)

The personal account model

Helens genetic state belongs to Helen and Helen alone and therefore she has autonomy on who knows this and therefore has no obligation to tell her sister

The joint account model

Genetic information should be seen in a completely different way to most medical information, genetic information should be free information to all those closely related as this could affect them and is therefore their information too. It would be unfair to hide the sisters genetic make-up from her.

Case study two:

For example, a couple who had a child with a severe genetic disorder and were told that by genetic testing a prenatal diagnosis could be given for any future pregnancy's that the couple may have, during this testing they find out that the male in the couple was not actually the father of the child with the severe genetic disorder- is it ethical to tell the couple this when this is not what they were testing for?

-'The influential committee on assessing genetics risks at the institute of medicine in the US  recommends that in cases like these  only the woman should be told'

-You could argue this because the institute believes that genetic testing should not be used in a  way to disrupt families.

-Another argument for only telling the mother is that a cross-cultural comparison argues that 'Protection of the mothers confidentiality overrides disclosure of true paternity'

-The doctor should tell the mother and it is up to her what she does.