Your patient has just recently been diagnosed with familial adenomatous polyposis (PAP). This disorder is chronic, progressive, and fatal. There is a genetic test that can tell whether children of parents with the disease will develop it. The test is very accurate. The patient has become divorced and refuses to give you his consent to inform his ex-wife who now has custody of their three children. He threatens to sue you if you reveal elements of his medical care to his ex-wife. What should you do?
a. Respect the patient’s right to confidentiality.
b. Transfer the patient’s care to another physician as long as the patient agrees.
c. Ask the health department to inform the patient’s ex-wife about the disease risk.
d. Seek a court order to inform the patient’s ex-wife.
e. Inform the patient’s ex-wife of the risk to the children.
f. Inform the ex-wife’s doctor.
Explanation:
E - Inform the patient’s ex-wife of the risk to the children.
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The patient’s right to confidentiality ends where it comes into conflict with the safety of
other people. The right to confidentiality is extremely strong, but it is not universal and
absolute. In this case, the children of the patient have a right to know whether their lives will
be cut short by the disease of familial adenomatous polyposis (FAP) and colon cancer. The
most important element is that screening for polyps should begin at the age of 12 with
screening sigmoidoscopy every year. Colectomy needs to be done if polyps are found.
Hence, in FAP there is a very specific intervention that can prevent colon cancer and a very
specific screening that can be done. In addition, the mother has a right to know whether her
children will become ill and how to plan for that. If a child falls and breaks his leg, one
parent cannot claim confidentiality as a reason to withhold this critical health information
from the other parent. As a part of divorce, the stipulation that each parent must inform the
other parent of health-care issues for the children as they arise is a standard part of the
agreement. Although, in this case, the health-care issue involves the private health of one
parent, the issue is still pertinent to the other parent as the caregiver of the children.
The right to one person’s to privacy is not as important as the right of another person to
safety. This is established standard and does not require a court order. You will have more
liability from the mother of the children if she is NOT informed than from violating the
confidentiality of the patient to inform. She can successfully pursue a legal action stating
you, the physician, did not inform her that her children were at risk of the “injury” of the
genetic disease.
The health department does not do notification for genetic diseases. The health
department notifies partners and the population at risk of transmissible diseases such as
tuberculosis, HIV, STDs, and food- or water-borne diseases.