Chapter 2: Confidentiality and Privacy

Sharing Information with Family Case Description: A 35-year-old woman with breast cancer asks her oncologist not to tell her husband about her diagnosis, fearing his reaction. During a joint visit, the husband asks directly about her condition. Ethical Question: What should the oncologist do?

A. Tell the husband the truth to support family communication.
B. Respect the patient’s request and withhold the diagnosis.
C. Suggest the patient discuss it with her husband herself.
D. Disclose only general information without specifics.

Minor Seeking Confidential Care Case Description: A 15-year-old boy visits a clinic for STI testing and requests confidentiality from his parents. The physician discovers a positive result and wonders about informing them. Ethical Question: How should the physician proceed?

A. Maintain confidentiality, as he requested.
B. Inform the parents, as he’s a minor.
C. Encourage him to tell his parents, but inform them if he refuses.
D. Report the case to public health without parental notification.

Breaching Confidentiality for Public Safety Case Description: A 40-year-old truck driver with epilepsy discloses frequent seizures but begs the neurologist not to report it, fearing job loss. His condition poses a driving risk. Ethical Question: What should the neurologist do?

A. Respect his confidentiality and not report it.
B. Report the condition to the DMV despite his request.
C. Warn him of the risks but take no further action.
D. Consult the ethics committee before deciding.

Confidentiality in Mental Health Case Description: A 28-year-old man tells his psychiatrist he’s planning to harm his ex-partner but demands confidentiality. The psychiatrist believes the threat is credible. Ethical Question: How should the psychiatrist respond?

A. Maintain confidentiality, as it’s a therapeutic trust.
B. Warn the ex-partner and notify authorities.
C. Encourage him to reconsider but keep it confidential.
D. Document the threat but take no action.

Sharing Information in a Team Setting Case Description: A 50-year-old man with HIV asks his doctor not to tell other healthcare team members unless necessary. During a surgery consult, the surgeon asks about his status. Ethical Question: What should the doctor do?

A. Disclose the HIV status, as the surgeon needs to know.
B. Respect the patient’s request and withhold it unless critical.
C. Ask the patient’s permission to share with the surgeon.
D. Tell the surgeon it’s irrelevant to the procedure.

Confidentiality and Social Media Case Description: A nurse posts a photo of a patient’s unique tattoo on social media, not showing the face but mentioning the hospital. The patient identifies himself and complains. Ethical Question: Was confidentiality breached?

A. Yes, because identifiable details were shared.
B. No, because the face wasn’t shown.
C. Yes, but only if the patient sues.
D. No, because it’s public domain now.

Mandatory Reporting of Abuse Case Description: A 30-year-old woman with bruises tells her doctor her husband hit her but begs him not to report it, fearing retaliation. The doctor knows reporting is mandatory. Ethical Question: What should the doctor do?

A. Respect her request and not report it.
B. Report the abuse to authorities as required.
C. Warn her husband instead of reporting.
D. Delay reporting and seek her consent later.

Confidentiality in Genetic Testing Case Description: A 45-year-old woman tests positive for a hereditary cancer gene and asks her doctor not to tell her sister, who may also be at risk. The sister is also a patient. Ethical Question: What should the doctor do?

A. Respect her confidentiality and not inform the sister.
B. Tell the sister to protect her health.
C. Encourage the patient to tell her sister herself.
D. Share anonymized information with the sister.

Breach in Electronic Records Case Description: A hospital employee accidentally emails a patient’s psychiatric records to the wrong recipient. The patient demands the hospital not disclose the error to anyone. Ethical Question: How should the hospital respond?

A. Honor the patient’s request and keep it quiet.
B. Notify the recipient and request deletion, informing the patient.
C. Report the breach to authorities despite the patient’s wishes.
D. Ignore the error unless the recipient complains.

Confidentiality in Adolescents Case Description: A 17-year-old girl seeks an abortion and asks her doctor not to tell her parents. State law allows confidentiality for minors in reproductive care. Ethical Question: What should the doctor do?

A. Maintain confidentiality, as legally permitted.
B. Inform the parents, as she’s a minor.
C. Refuse the abortion unless parents consent.
D. Consult the ethics committee first.

Sharing Information with Insurance Case Description: A 60-year-old man with alcoholism asks his doctor not to report his condition to his insurance company, fearing higher premiums. The insurer requests his full history. Ethical Question: What should the doctor do?

A. Respect his request and omit the alcoholism.
B. Disclose it, as the insurer needs accurate data.
C. Ask his permission to disclose it first.
D. Provide a vague report without specifics.

Confidentiality in Public Health Case Description: A 25-year-old man with a reportable STI refuses partner notification, fearing stigma. Public health regulations require contact tracing. Ethical Question: How should the clinician proceed?

A. Respect his confidentiality and not notify partners.
B. Notify partners anonymously, as required.
C. Warn him but delay notification.
D. Seek his consent for notification.

Breach by a Colleague Case Description: A doctor overhears a colleague discussing a patient’s abortion in the cafeteria, loud enough for others to hear. The patient had requested confidentiality. Ethical Question: What should the doctor do?

A. Confront the colleague privately.
B. Ignore it, as it’s not his patient.
C. Report it to hospital administration.
D. Tell the patient about the breach.

Confidentiality in Research Case Description: A researcher publishes a study with anonymized patient data, but a rare condition makes one participant identifiable. The patient had consented but not to identifiable disclosure. Ethical Question: Was confidentiality maintained?

A. Yes, as data was anonymized.
B. No, because the patient could be identified.
C. Yes, because consent was given.
D. No, but it’s acceptable in research.

Sharing with Law Enforcement Case Description: Police demand a 20-year-old gunshot victim’s records to investigate a crime. He’s unconscious, and no warrant is provided. The hospital staff hesitate. Ethical Question: What should the staff do?

A. Release the records to assist the investigation.
B. Refuse without a warrant, protecting confidentiality.
C. Provide limited information without details.
D. Consult legal counsel before deciding.

Confidentiality in Substance Abuse Case Description: A 30-year-old woman in rehab asks her counselor not to tell her employer about her cocaine use, fearing job loss. The employer calls asking about her progress. Ethical Question: What should the counselor do?

A. Respect her request and withhold details.
B. Tell the employer she’s in treatment without specifics.
C. Disclose her cocaine use for her safety.
D. Ask her permission to share limited updates.

Breach in a Small Community Case Description: In a rural clinic, a nurse recognizes a patient’s STD results and tells her friend, assuming it’s harmless gossip. The patient learns of the breach. Ethical Question: Was confidentiality violated?

A. Yes, because private information was shared.
B. No, because it wasn’t intentional harm.
C. Yes, but only if the patient complains.
D. No, because it stayed within the community.

Confidentiality and Minors’ Parents Case Description: A 16-year-old girl with depression tells her therapist about self-harm but begs her not to tell her parents. The therapist fears for her safety. Ethical Question: What should the therapist do?

A. Maintain confidentiality, respecting her wishes.
B. Inform the parents due to safety concerns.
C. Encourage her to tell her parents herself.
D. Document it but take no action.

Sharing with a Spouse Case Description: A 50-year-old man with terminal cancer asks his doctor not to tell his wife about his prognosis. She calls later, asking about his condition. Ethical Question: What should the doctor say?

A. Tell her he’s seriously ill but stable.
B. Respect his request and withhold the prognosis.
C. Suggest she ask her husband directly.
D. Disclose the full prognosis for her benefit.

Confidentiality in Telemedicine Case Description: A patient discusses a sensitive mental health issue via telemedicine. The doctor’s teenage son overhears from the next room due to poor soundproofing. Ethical Question: Was confidentiality breached?

A. Yes, because a third party overheard.
B. No, because it was unintentional.
C. Yes, but only if the son shares it.
D. No, because it’s the patient’s responsibility.

Reporting Infectious Diseases Case Description: A 35-year-old woman with tuberculosis asks her doctor not to report it to public health, fearing discrimination. Reporting is legally required. Ethical Question: What should the doctor do?

A. Respect her request and not report it.
B. Report it, as required by law.
C. Delay reporting and seek her consent.
D. Warn her contacts without reporting.

Confidentiality in Group Therapy Case Description: In group therapy, a 40-year-old man shares his HIV status, asking others to keep it confidential. Another member later tells a friend outside the group. Ethical Question: Was confidentiality breached?

A. Yes, because it was shared outside the group.
B. No, because group confidentiality isn’t binding.
C. Yes, but only if the patient complains.
D. No, because it’s hearsay.

Sharing with Colleagues Case Description: A doctor discusses a patient’s rare condition with a colleague in a public hallway, not using names but describing unique symptoms. A bystander overhears. Ethical Question: Was this a breach of confidentiality?

A. Yes, because identifiable details were shared publicly.
B. No, because no name was used.
C. Yes, but only if the patient finds out.
D. No, because it was for professional discussion.

Confidentiality in Court Case Description: A psychiatrist is subpoenaed to testify about a patient’s mental health in a custody case. The patient begs her not to disclose anything. Ethical Question: What should the psychiatrist do?

A. Respect the patient’s request and refuse to testify.
B. Testify as required by the subpoena.
C. Seek to limit testimony to non-sensitive details.
D. Consult the ethics committee before testifying.

Breach by Family Access Case Description: A 60-year-old man’s daughter finds his medication list on the kitchen table and asks his pharmacist about his condition. The pharmacist confirms his diabetes. Ethical Question: Was confidentiality breached?

A. Yes, because the pharmacist disclosed it.
B. No, because the daughter already knew.
C. Yes, but only if the patient didn’t consent.
D. No, because it’s common knowledge.

Confidentiality in Emergency Case Description: An unconscious 25-year-old woman is brought to the ER after a drug overdose. Her friend asks about her condition, claiming to be family. Ethical Question: What should the staff do?

A. Share her condition, assuming the friend is family.
B. Refuse until family status is verified.
C. Provide vague updates without specifics.
D. Consult the ethics committee first.

Sharing with Employers Case Description: A 45-year-old man with chronic fatigue asks his doctor not to tell his employer about his condition. The employer requests a health report for accommodations. Ethical Question: What should the doctor do?

A. Respect his request and withhold details.
B. Provide a report with his condition disclosed.
C. Ask his permission to share limited information.
D. Refuse to provide any report.

Confidentiality in Schools Case Description: A 14-year-old student tells the school nurse about anxiety but asks her not to tell the principal. The nurse thinks it affects his grades. Ethical Question: What should the nurse do?

A. Maintain confidentiality, as he requested.
B. Inform the principal for his academic benefit.
C. Encourage him to tell his parents instead.
D. Share it with a counselor, not the principal.

Breach via Lost Device Case Description: A doctor loses a laptop with unencrypted patient data. A patient whose information was on it demands confidentiality about the loss. Ethical Question: How should the doctor respond?

A. Honor her request and not report the loss.
B. Report the breach to authorities, informing her.
C. Notify affected patients without reporting.
D. Ignore the loss unless it’s discovered.

Confidentiality and Media Case Description: A celebrity is admitted for a drug overdose, and a reporter calls the hospital asking for confirmation. The patient requests total privacy. Ethical Question: What should the hospital say?

A. Confirm he’s a patient but give no details.
B. Deny knowledge of the patient entirely.
C. Say “no comment” to avoid confirmation.
D. Consult legal counsel before responding.

Sharing with Friends Case Description: A 30-year-old woman with a terminal illness asks her nurse not to tell her best friend, who keeps asking about her health. The friend corners the nurse. Ethical Question: What should the nurse do?

A. Tell the friend she’s seriously ill.
B. Respect the patient’s request and withhold it.
C. Suggest the friend ask the patient directly.
D. Share vague information to ease her concern.

Confidentiality in Divorce Case Description: A 50-year-old man’s ex-wife, a former joint patient, asks his doctor about his recent depression treatment during a custody battle. He had requested confidentiality. Ethical Question: What should the doctor do?

A. Disclose it to help the custody case.
B. Refuse, respecting his confidentiality.
C. Provide a general update without specifics.
D. Consult the patient before responding.

Breach in Overheard Conversation Case Description: A patient overhears two doctors discussing her rare cancer in an elevator, using her name. She had assumed confidentiality. Ethical Question: Was this a breach?

A. Yes, because it was in a public space.
B. No, because it was unintentional.
C. Yes, but only if she complains.
D. No, because it was between doctors.

Confidentiality in Partner Notification Case Description: A 22-year-old man with HIV refuses partner notification, fearing rejection. The clinician knows his partner socially. Ethical Question: What should the clinician do?

A. Respect his refusal and not notify.
B. Notify the partner anonymously.
C. Tell the partner directly, given the connection.
D. Seek legal advice before acting.

Sharing with Child Protective Services Case Description: A 35-year-old mother admits to drug use but asks her pediatrician not to tell CPS, fearing losing her child. The child shows neglect signs. Ethical Question: What should the pediatrician do?

A. Respect her request and not report.
B. Report to CPS due to child safety concerns.
C. Warn her but delay reporting.
D. Consult a social worker first.

Confidentiality in Workplace Injury Case Description: A 40-year-old worker injured on the job asks his doctor not to tell his employer the full extent, fearing discipline. The employer demands a report. Ethical Question: What should the doctor do?

A. Respect his request and omit details.
B. Provide a full report as requested.
C. Ask his permission for limited disclosure.
D. Refuse to provide a report.

Breach via Third Party Case Description: A lab technician shares a patient’s positive cancer result with her sister, a friend, assuming she knows. The patient had requested confidentiality. Ethical Question: Was this a breach?

A. Yes, because it was unauthorized sharing.
B. No, because it was to a family member.
C. Yes, but only if the patient objects.
D. No, because it was an honest mistake.

Confidentiality in Elderly Care Case Description: An 85-year-old man with dementia tells his nurse about past abuse of his wife but asks her not to tell his children, now his caregivers. Ethical Question: What should the nurse do?

A. Respect his request and keep it confidential.
B. Tell the children to protect their mother’s memory.
C. Document it but not disclose it.
D. Consult the ethics committee.

Sharing with Public Figures Case Description: A politician’s aide asks a doctor for his boss’s recent test results, claiming it’s for scheduling. The politician had requested privacy. Ethical Question: What should the doctor do?

A. Share the results with the aide.
B. Refuse, respecting the patient’s request.
C. Ask the politician’s permission first.
D. Provide a vague update only.

Confidentiality in Genetic Counseling Case Description: A 30-year-old man with a genetic disorder asks his counselor not to tell his fiancée, who’s planning pregnancy. She’s not a patient. Ethical Question: What should the counselor do?

A. Respect his confidentiality and not tell her.
B. Inform the fiancée to protect future children.
C. Encourage him to disclose it himself.
D. Share anonymized risks with her.