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XLII.

CONFIDENTIAL COMMUNICATIONS.

T

HERE has been considerable attention recently given to the question of the responsibilities of physicians in the communication of medical facts of a confidential nature. The trial of a practitioner in France, guilty of betraying such a trust, and the verdict of the court against him, has added much interest to the discussion. A physician of great respectability recently has been subjected to persecution by a person who suspected the former had given an opinion unfavorable to his character. In a second instance a physician was importuned by the employers of his patient to divulge the nature of the disease; and on evading the inquiries, was informed that they had examined his prescriptions in the hands of the druggist, and found them of such a nature as to cast suspicion on his patient. A writer regards the question of the duties of practitioners, under these circumstances, as so unsettled that it is advisable for the local associations to "vote as a body that they will not, under any circumstances, impart information when applied to in private, concerning any patient, in answer to an inquiry

which implies suspicion of the moral character of such patient." The obligations of physician to patient in matters of a confidential nature have been recognized and defined both by our profession and by writers on legal medicine. In this country the profession has been especially careful to establish the rule of conduct in such cases, and we can not believe that any well educated physician has any doubt as to the nature of his duties. Every graduate is required to subscribe, either in language or form, to the famous code of professional morals embodied in the oath of Hippocrates, which contains the following: "Whatever, in connection with my professional practice, or not in connection with it, I see or hear, I will not divulge, as reckoning that all such should be kept secret." This pledge has been incorporated into the text of every system of medical ethics from the days of its author to the present. We are not, however, left to this ancient inaugural oath for guidance; but the American Medical Association has defined explicitly and at length the relations of physician to patient. No American physician certainly needs to have his duties in confidential cases more clearly set forth. In Art. II., sec. 2, of the Code of Medical Ethics, is the following:

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Secrecy and delicacy, when required by peculiar circumstances, should be strictly observed; and the familiar and confidential intercourse to which physicians are admitted in their professional visits, should be used with

discretion and with the most scrupulous regard to fidelity and honor. The obligation of secrecy extends beyond the period of professional services; none of the privacies of personal and domestic life, no infirmity of disposition or flaw of character observed during professional attendance, should ever be divulged by him except when he is imperatively required to do so. The force and necessity of this obligation are indeed so great that professional men have, under certain circumstances, been protected in their observance of secrecy by courts of justice."

But when we examine as to the medico-legal aspects of this subject, we find the duties of the physician are changed. If it is necessary to answer the demands of justice, the medical witness is required by the common law to divulge in court information of a confidential nature acquired in the practice of his profession. Fonblanque says: "When the ends of justice absolutely require the disclosure, there is no doubt that the medical witness is not only bound but compellable to give evidence, ever bearing in mind that the examination should not be carried further than may be relevant to the point in question." In a celebrated English trial it was decided "that, in a court of justice, medical men are bound to divulge these secrets when required to do so." But on that occasion the presiding judge made the following pertinent acknowledgment of the moral obligations of the physician : "If a medical man was voluntarily to reveal these secrets, to be sure he would be guilty of a breach of honor and of great indiscretion; but

to give that information which by the law of the land he is bound to do, will never be imputed to him as any indiscretion whatever." It has been contended, indeed, by able writers that, even in a court of law, where the testimony of the physician is important to meet the ends of justice, he ought not to be obliged to divulge confidential communications. Belloc, an eminent French authority, says: "The tribunals neither ought, nor have the power, to exact from a physician the revelation of a secret confided to him in consideration of his office; at all events, he may and ought to refuse." The late Prof. Lee, in his notes to Guy's Forsenic Medicine, takes the same ground. He says: "We believe it to be the moral right and the duty of medical men to refuse to disclose in a court of justice secrets intrusted to them in professional confidence, and we have always acted on such belief. If physicians become the repository of secrets, under the full conviction, on the part of society, of our moral and professional obligations to hold them sacred-secrets which otherwise never would have been revealed-who can believe that there is any earthly power which ought to wring them from us, or which can, if we rightfully understand our privileges and duty? If private confidence is thus to be broken upon every imaginary necessity, where is the end to the mischievous consequences that would arise-especially at this day, where every trial is published to the world

through the medium of the public prints ?" Such reasoning has had its influence upon legislative bodies; and in some States the statutes have been so framed as to prohibit the physician from disclosing confidential communications. The following is the substance of this rule in New York, Missouri, Wisconsin, Iowa, Indiana, and Michigan:

"No person duly authorized to practice physic or surgery shall be allowed to disclose any information which he may have acquired in attending any patient in a professional character, and which information was necessary to enable him to prescribe for such patient as a physician, or to do any act for him as a surgeon."

In whatever light we view this subject, the fact is constantly prominent, that the moral obligation of the physician to retain inviolate all communications of a confidential nature is undisputed. By the Hippocratic oath he is not to divulge what he sees or hears, whether in connection with his professional practice or not. The code of ethics of the great governing body of this country pledges him never to divulge the privacies of personal and domestic life, nor the infirmities of disposition, nor flaws of character observed during professional attendance, except when imperatively required to do so. It is only in courts of justice that the seal of secrecy can be broken, and even here the peculiar moral obligations of the physician are acknowledged and respected.

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