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Doctors have a duty to breach patient confidentiality to protect others at risk of HIV infection

BMJ 2013; 346 doi: (Published 06 March 2013) Cite this as: BMJ 2013;346:f1471
  1. Tak Kwong Chan, assistant professor and clinical ethicist, Li Ka Shing Faculty of Medicine, University of Hong Kong
  1. theo{at}

Balancing the competing duties of maintaining privacy in the doctor-patient relationship with minimising potential harm caused by non-disclosure of HIV status is not always easy, says Tak Kwong Chan

The theoretical reasons for breaching patient confidentiality to protect a third party from risk of HIV infection are straightforward. On the other hand, Rose J in X v Y said that confidentiality is vital to securing public health because infected people cannot be treated and counselled unless they come forward.1 To resolve the conflict, the confidentiality guidance of the UK General Medical Council provides that “disclosure of personal information about a patient without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm.”2 As the GMC guidance provides only a guiding principle, the decision to breach confidentiality will continue to present a challenge for physicians.

The legal side is less predictable, given the paucity of UK cases in which a non-patient third party successfully challenged a physician. However, as the European Court has recently held that there should be a legal framework for resolving the conflict between a physician’s duty of confidence and a third party’s right …

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