Do physicians have to disclose personal health information to patients?
Updated October 6, 2021
Do patients have the right to know if their doctors are vaccinated against COVID-19? Patients can certainly benefit from knowing their doctor’s immunization status, and especially in the midst of the COVID-19 pandemic, many may feel they need this information to help them decide whether or not to get it. health care. But does a patient’s interest in knowing imply an ethical obligation on the part of his doctor to disclose?
As simple as the proposal may seem, there are nevertheless reasons to believe that physicians do not have such an obligation.
WADA Code of medical ethics is clear that patients should be able to trust that physicians will put the interests of patients first (Principle VIII, AMA Principles of medical ethics), treat patients with compassion and respect (Principle I, Opinion 1.1.3), protect the confidentiality of patient personal health information (Opinion 3.2.1) and provide “safe, effective, patient-centered, timely, efficient and fair â(Opinion 1.1.3). In addition, the Coded recognizes that patients should receive, and urges physicians to provide, the information individuals need to make informed decisions about their care (Opinions 2.1.1, 5.1). So also the Coded recognizes that patients are generally free to choose from whom they will receive care (Opinions 2.1.6, 9.2.1, 9.2.2).
However, physicians themselves have the right to enforce the confidentiality of their personal health information, including information about conditions for which they have or have not been vaccinated. If, in the context of a highly communicable disease that carries a risk of serious disease, the only way to protect the interests of patients were for physicians to disclose their immunization status, it would be easier to argue for a duty to disclosure than it actually is.
That physicians have an obligation to disclose personal health information when it may be relevant to patient care is not new. At the start of the AIDS epidemic, the question took the form of whether doctors with HIV had a duty to disclose their HIV status to patients. At the time (1988), the Council for Ethical and Judicial Affairs (CEJA) recognized first, that âthe rights to privacy and confidentiality of the AIDS victim. . . are absolute until they substantially endanger the safety of one or more other persons.
CEJA argued that the challenge was not whether to disclose, but whether the doctor could safely practice:
If there is a risk of transmission of an infectious disease from a physician to a patient, disclosure of that risk to patients is not sufficient; patients have a right to expect that their doctor will not increase, even minimally, their exposure to the risk of contracting an infectious disease. If there is no risk, disclosing the doctor’s state of health to his patients will have no rational purpose. If a risk exists, however, the physician should not engage in the activity.
In the case of COVID-19, the increasing incidence of infections among fully vaccinated individuals underlines that having been vaccinated is not in itself an assurance that the individual will not be subsequently infected and will not infect others. A vaccinated but infected doctor who has asymptomatic illness or has not yet developed symptoms is always at risk. So patients cannot find the comfort they are looking for just knowing that the doctor has been vaccinated.
The significance of a physician’s risk of experiencing a breakthrough infection for his patients depends greatly on the nature of the physician’s practice, for example, whether his patients are immunocompromised or unable to be vaccinated. The magnitude of the risk also depends on other protective measures in place, such as the universal use of personal protective equipment by physicians and staff, frequent testing for COVID-19, and the requirement for patients to wear masks when in the office or clinic. In some circumstances, the most ethically appropriate course may be for the physician to avoid contact with patients (Advisory 8.7).
Physicians can, of course, voluntarily choose to disclose their immunization status. Indeed, it may be ethically admirable for them to do so and could be a way of encouraging patients to get vaccinated. Patients have the right to ask, and if they do, doctors must answer honestly. Physicians would be well advised to proactively educate patients about the steps their practice is taking to keep everyone safe.
Additional ethical advice in the event of a pandemic
WADA provides an overview of fundamental guidance on medical ethics for healthcare professionals and institutions responding to the COVID-19 pandemic.