When training to be a psychiatrist, one of the most disturbing situations I faced involved a mother who came to the emergency room for treatment for depression and told me confidentially, in passing, that she often beat her seven-year-old son. When she grew frustrated with him, she said, she would slap him hard with the end of an electrical cord. As she told me, my neck bristled.
As a trainee, I wasn’t sure what to do. Medical school emphasized how our primary responsibility was to our patients and their privacy. But what about the harm to her son? I was uncertain whether I should report her to Child Protective Services and, if so, whether they would take her son away from her, whether she, therefore, would become more distraught and depressed — and whether any of that mattered. She was young and hadn’t finished high school; how well would she understand these issues?
I told her to wait in the curtain-partitioned cubicle and I wandered out to find a supervisor, who told me that the child’s right to be safe trumped her right to confidentiality. I told the mother that I would need to report the case.
Dr. Sean Conley, Trump’s White House physician, has refused to disclose key information about President TrumpDonald TrumpJan. 6 panel plans to subpoena Trump lawyer who advised on how to overturn election Texans chairman apologizes for 'China virus' remark Biden invokes Trump in bid to boost McAuliffe ahead of Election Day MORE’s medical condition. When asked particular questions, he responded, “I’m not going to answer that.” He cited the Health Insurance Portability and Accountability Act (HIPAA) as a reason. But HIPAA rules do not apply if a patient chooses to release his or her information to others. Hence, Trump could easily agree to disclose more information about his condition, eliminating HIPAA as a barrier.
Medical privacy dates back to the Hippocratic Oath, written around 550 BC, which states: "What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about."
Medicine has advanced enormously since then and so, too, have an appreciation of the complexities of bioethics. The Hippocratic Oath also opposed abortion — which was, undoubtedly, dangerous in the era before sterile techniques were developed — and states that medical school should be free for a professor's children.
Today, a patient’s right to privacy is an important ethical principle but must be weighed against other ethical principles as well, such as beneficence, justice and avoiding harm to others.
Many examples exist when a patient’s privacy takes a backseat. When a patient develops a sexually transmitted disease such as syphilis, public health departments have long conducted contact-tracing. They ask the patient to provide the names and contact information for all sexual partners to find these individuals since the disease is treatable but highly contagious and can initially cause only mild symptoms that patients ignore for weeks while further spreading the disease.
Similarly, in the so-called Tarasoff Decision, a graduate student at the University of California, Berkeley, became depressed in 1969 when a fellow student he dated, Tatiana Tarasoff, broke up with him. He consulted a campus psychologist and confided that he wanted to kill Tarasoff. The psychologist asked the campus police to detain him; the police did so but then released the student, who was later accused of killing Tarasoff. Tarasoff’s parents sued the university, which defended the therapist, arguing that the patient’s privacy was paramount. The California Supreme Court disagreed, decreeing that physicians have duties not only to the patient but also to threatened individuals. Further court cases have upheld this principle in many instances.
Crucial limitations on a patient’s confidentiality thus exist — when there is potential serious harm to others.
With Trump, fitness to carry out his office's duties — to protect our nation and advance its interests — is now in question. COVID-19 causes significant neurological, cognitive and psychiatric problems, with 36 percent of hospitalized COVID patients in an early study, and 82 percent in a more recent study developing neurological symptoms. With SARS, resulting from a very similar coronavirus, 59 percent of patients developed psychiatric disorders and 33 percent still had symptoms 30 months later.
Moreover, for COVID-19, 47 percent over 50 tested positive report not having returned to their prior state of health after two to three weeks. Across all ages, 20 percent reported still suffering from confusion.
Trump’s symptoms thus pose immense potential risks to our nation and the world. These cannot be ignored and can outweigh the single principle of privacy alone.
In the ER, when I told the mother I would need to tell the authorities, she started to cry but then nodded and softly said, "Thank you." She had felt overwhelmed and appreciated that we were now helping. She recognized that her son’s well-being outweighed her own privacy — that another’s benefit should, at times, prevail over a patient’s confidentiality.
Trump needs to recognize this fact as well and allow his records to be released. The health of our globe is at stake.
Dr. Robert Klitzman is a psychiatry professor, director of the Masters of Bioethics Program and a co-founder and former co-director of the Center for Bioethics in the Vagelos College of Physicians & Surgeons and the Mailman School of Public Health at Columbia University. He is the author of nine books, including “When Doctors Become Patients” (2007), “Am I My Genes? Confronting Fate and Family Secrets in the Age of Genetic Testing” (2012) and “Designing Babies: How Technology is Changing the Ways We Create Children” (2020).