When Principles Collide

When Principles Collide

Ever since the Hippocratic oath was first devised around 400 BC, doctors have been bound by the bulk of its principles: to treat the sick to the best of their ability, to teach the secrets of medicine to the next generation, to protect the privacy of patients.

“The Australian Medical Association Code of Ethics articulates and promotes a body of ethical principles to guide doctors’ conduct in their relationships with patients, colleagues and society. This Code has grown out of other similar ethical codes stretching back into history including the Hippocratic oath,” says the preamble to the Australian Medical Association’s 2004 code of ethics, and medical bodies around the globe share these principles.

True, not many of the precepts of the fourth century BC Pythagorean sect now credited with devising that oath hold much sway today — in its original form the Hippocratic oath forbade doctors from performing abortions, euthanasia or even surgery — but the bit about keeping secret any information divulged to them is still considered part of a doctor’s sacred trust. And for good reason. For doctors to do their jobs effectively patients must feel free to confide in them fully — and any sense that what they disclose to their doctor might end up being blabbed to a wider audience is just about guaranteed to stifle that free flow of information.

If patients are to seek treatment for socially embarrassing illnesses, for instance, their autonomy and the privacy of identifiable personal information must be paramount.

So in an ever-shrinking world, where what happens in the US today is mirrored most everywhere else tomorrow, it is deeply disturbing to see a New York judge cave in to the single-minded bullying of that anti-abortion zealot and coverer of statues’ breasts Attorney-General John Ashcroft.

Ashcroft has for some time been waging a bitter war against doctors who perform abortions in New York. In an unprecedented foray into an area usually protected by medical privacy laws, the US federal government’s top lawyer — whose “partial-birth” abortion law demands doctors let pregnant women die if a late-term foetus threatens her life — had been demanding women’s confidential medical records from doctors at two local hospital centres. Hospitals and doctors had successfully resisted that pressure.

Judges in San Francisco and Chicago had also ruled that the release of abortion records would violate women’s privacy without providing much useful information to the government.

Enter Judge Richard Conway Casey of the Federal District Court in Manhattan, who in late March obligingly ordered New York-Presbyterian Hospital to turn over to the Justice Department records on abortions performed there. His ruling conflicts with those interpretations from other jurisdictions and creates further uncertainty about the limits of patients’ medical privacy.

Sun Microsystems CEO Scott McNealy, who famously said: “Privacy is dead. Get over it”, has argued since September 11 that those attacks justify an erosion of personal privacy in the interests of public safety. In a climate of fear, it is a beguiling proposition.

But there is little doubt that the Ashcroft assault on patient privacy, with Judge Casey’s apparent endorsement, like McNealy’s position, leaves a major consideration out of the equation. For many doctors, patients and medical privacy advocates, Ashcroft’s skirmishing over such records is raising anxiety and eroding trust in government.

For many American patriots, the so-called Patriot Act is having a similar effect. Like those patients who might fail to disclose critical information to their doctors for fear of it being broadcast to the world, citizens who know — or even think they might know — information that could help authorities thwart a terror attack might be most reluctant to come forth if they fear their governments cannot be trusted to keep their cooperation private.

Trust is one commodity governments cannot afford to bargain away. Respecting citizens’ privacy to the greatest extent possible is one way to maintain that trust.

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