A Psychiatrist's Duty of Confidentiality
Lancet. 1988 Dec 24/31; 2(8626/8627): 1503-1504.
A British barrister reflects on a recent High Court ruling that psychiatrists owe a less extensive duty of confidentiality to patients detained under the Mental Health Act 1983 than they do to other patients and that in some circumstances they have a duty to disclose their findings to the authorities. In the case at hand (W v. Egdell and others), a patient diagnosed as suffering from paranoid schizophrenia after killing five people requested transferral to a medium security unit with a view to eventual release. The patient sought to suppress, on the grounds of confidentiality, a report sent to the hospital and to the Home Office, recommending against transfer, made by an independent, consultant psychiatrist. The High Court's decision accorded with common sense, but, Brahams concludes, raises questions of doctor liability and threatens to reduce the physician's duty of confidence whenever a patient appears to be a serious threat to his family or to the public at large. (KIE abstract)