SESSION # 1 GENERAL INTRODUCTION
Past President Rotarian Dr. Moshe Kelman has organized an Ethics Seminar for Rotarians and their spouses in Jerusalem. The first session was held Sunday, October 13, 2002 with 10 participants in attendance. They met in comfortable setting of the YMCA library at 6:00 PM.
DEFINING ETHICS
Moshe started out by providing us with definitions of ethics.
- The Science of morals
- Human character of conduct
- Rules of Behavior
- Duty
He pointed out that the norms of each society are different. For example : of the treatment of officers toward female soldiers in WWII would be considered sexual harassment today.
There are no right answers in ethics - just a lot of questions. The art of ethics is asking the right questions.
There is no mathematical correctness to ethics.
Who is right or wrong depends on where you are standing.
Ethics is based on dignity for the person and his or her human rights. Human rights are above any kind of law. Laws are determined by a limited number of legislators and can be unfair, unjust and completely self-destroying
.
BASIC HUMAN RIGHTS:
1. RIGHT TO THINK WHAT YOU WANT and
2. RIGHT TO SAY WHAT YOU LIKE
3. RIGHT TO SPEAK AND BE HEARD
People have a right to persuade other people that their ideas are correct.
4. EXERCISE OF AUTONOMY - the right of a person to control his/her own destiny
These rights have limitations: They cannot do harm to anyone else.
The right to live IS NOT an absolute right. This is relative to religious beliefs and societal norms and economics. Examples deal with limited resources for medical treatment such as dialysis machines and organ transplants allocations.
Rights are not allocated by age or sex.
One Test of Ethics: That it is acceptable for a long time - thus establishing a "universal practice."
ETHICS ARE VARIABLE
The group struggled with the idea that ethics are not universal BUT variable. Standards and norms vary by geography, age of the person and time in history.
ETHICS ARE FUNCTIONAL
The accepted code of conduct enables people to live together in relative harmony based on a system or morals. The test of an ethical system is in how the people "behave." Are they living in harmony? Are they doing the right things?
The first session ended at 7:30 PM
The next session will be held at 6:00 PM Sunday November 10th.
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Dr. Kelman's Notes:
1. ETHICS DEFINITIONS (CHAMBERS TWENTIETH CENTURY DICTIONARY)
2. THE SCIENCE OF MORALS
3. THAT BRANCH OF PHILOSOPHY WHICH IS CONCERNED WITH HUMAN CHARACTER AND CONDUCT
4. A SYSTEM OF MORALS
5. RULES OF BEHAVIOUR
6. THE SCIENCE OF DUTY - DEONTOLOGY - DUTY
INTRODUCTION:
ETHICS IS NOT MATHEMATICS
SOMETIMES THERE ARE NO ANSWERS AT ALL
SOMETIMES THERE ARE A NUMBER OF DIFFERENT ANSWERS WHICH ARE ALL CORRECT
SEVERAL PEOPLE CAN HAVE CONTRADICTING VIEWS, ALL OF THEM MAY BE RIGHT OR ALL OF THEM MAY BE WRONG
ETHICS DEFINITIONS:
Code of behaviour that enables people to live side by side in harmony.
Ethics is based on respect for the dignity of a person, HUMAN RIGHTS and the AUTONOMY of the individual.
AUTONOMY
may be expressed as the right of a person to control his own destiny. There is an implied limitation to autonomy. The right is conditional on respect for the autonomy of others.
ETHICS considers ways in which people can relate to each other in the community so that the greatest possible benefit accrues with the least possible harm.
This is not an easy thing to do and many great philosophers have spent many hours discussing how it might be done.
I do not pretend to have all the answers and do not expect everyone to agree with all that I will suggest.
Some current ethical thought does not conform to religious norms. There may be many different answers suitable for different people. Everyone involved should consider carefully what is best (or least worst) for his situation
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SESSION # 2 Sunday November 10, 2002
SITUATIONAL ETHICS
RIGHT TO EXPRESSION
You may not agree with what someone says or does. He or she has a right to expression as long as it does not harm someone else.
RELATIVE or SITUATIONAL ETHICS
There are both legal and ethical standards. Truth is an absolute but ethics are relative to time and place. Almost no conduct is "good" or "bad" in itself.
Immanuel Kant spoke of SITUATIONAL ETHICS. One must appreciate the consequences of your action. You can logically determine ethical behavior by assessing what would happen to the offended
CAVEAT EMPTER Let the Buyer beware.
A standard of ethics at one time was that the buyer was responsible for any errors or omissions in a purchase, it is his job to check out what he is buying. The Buyer, not the Seller, is responsible for the ethics of the transaction.
THE TEST OF LAW
This test is where some person's legal rights are being violated.
PATERNALISM
This is the belief that "Someone else knows better" (English ruling class, parents, the Church.) Authority may be derived using a religious text (e.g. Torah, Koran), expert knowledge (e.g. The doctor knows best..)
AUTOMONY (as opposed to PATERNALISM)
A person has the inborn right to determine his/her future. The individual has the right to control what he can do.
HIPPOCRATES (Father of Medical Ethics)
He founded a medical school and developed an Oath of Medical Ethics for physicians to follow. The Hippocratic Oath has formed the basis of more recent medical oaths taken by students as they begin the practice of medicine. The chief tenents of this Oath are:
honor instructors in the medical arts
pass on the Art only to those bound by the Oath
practice for the benefit of patients; "do no harm"
give no deadly medicine or substance to produce abortion
when you enter homes for the benefit of the sick you must abstain from mischief and corruption particularly of a sexual nature.
doctor-patient confidentiality
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SESSION # 3 - Sunday December 8, 2002
EUTHANASIA
This session deals with end of life issues euthanasia (Greek for 'easy death'), the right to life sanctity of life, and quality of life potential for human contentment.
One definition of "life" is "That state where a person can be benefited by and can benefit others." (Professor Abraham Steinberg- Rabbi and author of the 6 volume Jewish Medical Ethics and Halakhah.)
The initial questions from the 16 Rotarians and guests in attendance centered around the meaning of "life" and when you "should" put a person on and a take a person off life support and who has the right to make the decision.
Moshe (Kelman) pointed out the difference between the concepts of eugenics, the deliberate sorting out of people, and; euthanasia, merciful expiration. Often euthenasia focuses on futile or burdensome treatments of terminally ill patients. In a sense both concepts have the commonality of "putting people out of their misery.
THE SLIPPERY SLOPE
A SLIPPERY slope argument is a kind of argument that warns you if you take a first step, you will find yourself involved in a sticky sequence of consequences from which you will be unable to extricate yourself, and eventually you will wind up speeding faster and faster towards some disastrous outcome.
An example is the German government policy of killing "degenerates" in the early thirties which rapidly turned into the Holocaust. The Germans permitted active euthanasia for mentally ill, cripples, gypsies, homosexuals, degenerates and eventually Jews. - Slippery slope (supported by The German Medical Assn.).
DOCTOR ASSISTED DEATHS
On the matter of doctor assisted deaths, it was pointed out that the children of the person involved do not have the automatic right to make the decision to take a parent/patient off life support. Modern technology enables extension of life of agony beyond natural expectancy.
Some ethical issues:1) Hippocratic Oath forbids mercy killing, 2) Ban on active euthanasia - permissible to refrain from treatment if the patient is dying, suffering, or does not wish to delay death. This includes non-attachment to life-support machine. Must provide palliation and advance directives
Only a legal guardian has the legal right to decide. The Ethical Dilemma typically occurs with a dying patient in the last two weeks (more or less) terminally ill.
LIVING WILL
The Living Will involves a surrogate decision - maker. This can be a friend who is not an inheritor. A person is identified who knows the patient sufficiently well to understand what the person in question would want.
LIFE SUPPORT
There are two kinds of life support machine the pacemaker and artificial respiration. One solution to the life support dilemma is the TIME CLOCK The physician can set the machine to go off at a specific time. When the time is up the machine automatically goes off.
This raises the question of when the time clock is set to turn off.
Moshe tells the story of a doctor who tells his patient he has 6 months to live. The patient replies that his investments do not come due until October. The doctor says, "Ok, I'll give you 9 month."
End of life issues deal with concerns of degree of suffering, whether the condition is incurable and how soon the patient is expected to die.
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SESSION # 4 Sunday January 12th 2003
LIFE EXTENDING TECHNOLOGY
- A Short Review - Ethical Relativism
We are reminded that ethical standards changes with the norms of a given society at a particular time. Thus both life extending technologies and ethical standards are constantly undergoing change.
In addition to the current acceptable moral and ethical standards within a society, decisions will depend largely on the timing, mood, economic deprivation or affluence at the time of their initiation. As these factors change, ethical standards are subject to modification. (See the Slippery Slope concept in session #3.)
- Aging, Euthanasia, Ethical Standards
All societites face dilemmas of what to do with their elderly populations.
One point of view has been to "put the poor buggers out of their misery." Another perspective is that ANYONE who NEEDS or WANTS to die and IS SUFFERING - is in constant agony -has the right to have the wish to die fulfilled.
Today only the state of Oregon (USA), Belgium and the Netherlands recognize and give legal permission, under(at least on paper) strict guidelines, for Euthanasia - to fulfill the "absolute right" of a person to have his or her life terminated.
WHEN TO USE A LIFE SUPPORT MACHINE
Nobody has a problem with hooking up a patient to a life support machine. However, the dilemma is when you can take a patient off this support.
One solution is the use of the Time Clock where a machine automatically shuts off at a give time (see Session #3.)
Three important criteria for use of life support machines deal with whether the condition is FUTILE, if there are
WORTHWHILE TREATMENTS and the RELIEF OF PAIN AND SUFFERING.
- Cost of Treatment and Available Resources
The cost of treatment and available resources also are factors that determine the use of life support machines. The classic case is the use of the dialysis machine. There is invariably a shortage of machines and criteria need to be made to determine who will be put on the machine. In one county in England the criterion was age - no one over the age of 62 would be given the treatment.
DNR ORDERS (Do Not Resuscitate)
The issues around the placement of DNR Orders are only one part of a much larger discussion about the role of the state in preventing harm to the weak and the vulnerable. But even such a phrase as "the weak and the vulnerable" carries with it a tone of paternalism that is loathsome to those who want to be active in determining their own destiny as full citizens in a democratic society.
The DNR Orders related to Advanced Directives (See living will in Session #3.) In Israel today the Living Will is not recognized as legal. However, there is proposed legislation to recognize this.
THE STEINBERG COMMITTEE
The Ministry of Health (State of Israel) convened a the Steinberg Committee chaired by the renowned medical ethicist, Professor Avraham Steinberg. The committee included clergy from Islam, Christianity and Judaism, sociologists, lawyers, medical ethicists and others.
There was consensus on a proposed bill concerning life support issues.
The proposed new law (Steinberg committee 2002) suggests incorporating many of the above ideas into the standard procedures including the "living will", palliative and hospice care and provision of food and drink.
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UPCOMING MEETINGS
The dates of forthcoming meetings (as long as we continue!)
Feb.9, Topic: TOLERANCE
March 9,
April 13,
May 11,
June 6
The order of topics was determined by club members back in September. Some feel that after four meetingas we might want to review this list and adjust the order or even introduce new topics.
TOP CHOICES
SUBJECT
Votes
Euthanasia 27
Tolerance 23
Morality 20
Confidentiality 18
Just allocation
of Resources 16
Human RIghts 15
Freedom of Speech 14
Patriotism 13
4-Way Test 12
SESSION # 5 Sunday, February 9, 2003 - TOLERANCE
TOLERANCE The liberty given to allow a minority to hold and express their own political or religious opinion
Baroness Mary Warnock – The virtue of refraining from exercising one’s power with regard to others’ opinion or action although that deviates from one’s own over something important and although one morally disapproves of it.
Tolerance of things, which are, or are thought to be, immoral- or distasteful –or disliked –
Limitations - intolerable –unbearable - disruptive to order in society,
Voltaire –We are all frail, fallible and prone to error. Let us mutually pardon each other
Prudence, Rationality, Morality
Non-judgementalism
Refusal to tolerate – intellectual arrogance
Non toleration of the non-tolerant
Pluralism in Society
Freedom of Speech
Recognition that we might be wrong
Freedom of the Press
Freedom of Thought
March 9th
Societal Boundaries
SESSION # 6 - Sunday March 9, 2003 - TOLErance (Continued)
Moshe started out by saying that EVERYONE claims they want to be tolerant. BUT we have our boundaries of tolerance.
As an example we can explore the issue of cruelty to animals.
Fox hunting: "Foxes are meant to be hunted."
Bull fighting: "That was a brave bull. That is what it is for. It is bred for the bull ring."
We tend to be more tolerant to WILD animals. Even many vegetarians tolerate the killing of animals to eat.
Our tolerances are like GOAL POSTS you can MOVE. Each person has his/her tolerance BOUNDARIES.
Colonial powers e.g. Germany, France, England, Belguim, Spain, Holland, Portugal when out to civilize "pagans" to believe in the "one true faith."
Boundaries of tolerance
In the 1800 century in Britain pornographic literature was LOCKED in the PRIVAT BOOK CASE in the British LIbrary and only made available to academics (Oxford Dons and Clergymen. These books where not deemed suitable for women or the general public.
In biblical times there where different Boundaries of tolerance. There was lots of violence.
The class began a discussion of how we should deal with intolerance. One person share a personal intolerance she felt when her daughter (of European decent) began to date and become serious with a boy from a Middle Eastern family.
It was generally agreed.that each person sets their own boundaries – their own “no go” area.
Coercion sets a boundary. It is not acceptable.
Both Locke and Hume felt that freedom of thought and belief is acceptable. However, moving to action is where the problems come in.
George Bernard Shaw: "Parents have the right to feed, clothe and bath their children and after that they should mind their own business.
Colonialization of ‘primitive’ societies
Conversion of ‘pagans’ and ‘idol worshippers’ to the TRUE FAITH (whatever that is)
Conflict based on religious imperative to ‘save the heathen’
Crusades
Jihad
Who says that your God is better than my God?
All religions seem to be somewhat intolerant at first glance
Many religious groups have abandoned missionary activities
– because they are no longer ‘politically correct’ or
– because the paramount importance of tolerance has now become accepted by religious leaders
The group discussedthe SOURCCES of INTOLERANCE. There was general agreement that "FEAR OF THE STRANGER" fear of the unknown ...we tend to DEMONIZE the "OTHER."
The class ended with a discussion of the remedies to intolerance. There was a strong expressed feeling that EDUCATION is a way to combat intolerance. Other felt LEGISLATION is the remedy and still others suggested RELIGION.
However, paradoxically they also believe that education, legislaton and religion can be the root causes of intolerance.
SESSION # 7 - Sunday April 13, 2003 TOLEERANCE (Continued)
We started off with a review of the past two sessions on tolerance looking at its various definitions. An example: "Liberty given to a minority to hold its believes";
"The freedom to express one's ideas without fear of reprisal."
It is a mistake to believe that it relates to thinking with which we agree.
"The virtue of refraining to use power over something you morally disagree of."
Limitations on Tolerance:
We cannot tolerate something completely creating DISORDER. Intellectual arrogence is intolerable.
Flagrant violations of human rights and dignity and the creation of disruptions or intolerable.
Respect for another human being is another form of tolerance.
We looked at the persective of Karl Popper – that the devotion to toleration can potentially destroy liberty. Examples would be to tolerate the actions of dictators like
Lenin, Mussolini, Hitler, Stalin, Mao, Castro, Saddam Hussein.
And it really doesn’t matter who you put upon the list…
………
We don’t have to tolerate EVERYTHING.
Karl Popper: There cannot be an absolute commitment to nonviolence. When circumstances become intolerable it may be necessary to remove the caused (people and institutions ) that cause that intolerance. "Devotion to tolerance can destroy liberty.
Where do we draw the line?: When ACTION replaces theory
Who decides between what is:
Incompetence or sabotage;
Manslaughter or Murder
Socrates – I know that I do not know, and hardly that.
There cannot be an ABSOLUTE commitment to NON-VIOLENCE.
We discussed the classic example of colonial intolerance where the colonists disrespected, humiliated and generallly maltreated the "natives" they ruled.
We discussed our personal observations of intolerance and expored our responsibilities when we saw acts of intolerance.
We came to the understanding that our own political and religious agendas influences our limits on tolerance.
Lord Scarman – Toleration and the Law
Toleration Act UK 1689- Religious toleration
Roman Catholic Relief Act UK 1829
Her Majesty’s subjects professing the Jewish religion UK 1849
Sex Discrimination Act UK 1975
Race Relations Act UK 19
Public order Act UK 1936
One way to become more tolerant is to avoid labelling people.
LABEL JARS...NOT PEOPLE
Identification of the objects of intolerance –colour, features, size and shape, dresss, behaviour, language, accent, dietary code.
Terminology Of the Intolerant:
– yid, wog, spic, frog, hun, kraut, dago, nigger, kurdi, tamani, homo, les, junkie, commie, leftie, haredi, reformi, hiloni, etiopi, morrocai, yekke, anglo-saxi,
SESSION # 8
May 11th 2003
Morality - from the latin –mos, moris, manner, custom
- The quality of being moral.
- That which renders an action right or wrong.
- the practice of moral du
– Virtue especially in matters of sex
– The duties of life
Moral philosophy is more or less equivalent to ethics
Difference - maybe morality is more ecclesiastical “do-gooding”, however “moral’ is not religious, at least it does not have to be.
ethics more philosophical, scientific, clearer guidelines but this is not clear-cut.
Ethics is the theory of right and wrong conduct
Morals is its practice.
In daily usage we mix these up we talk about moral principles and ethical conduct. It should be the other way round.
We talk correctly about medical ethics and a doctor’s morals
Morality is more than merely a code of sexual behaviour
Immorality – amorality
Immorality is knowingly not doing the right thing
We can not avoid making moral decisions – other people are, however remotely involved in these decisions
Lying,
Stealing
Smoking
Drug taking
Drug trafficking
No definitive conclusion on moral questions
“fairness” treating people equally, or at least treating equal people equally
SESSION # 9 Morality (Continued)
June 1st 2003
Where does Moral Sense come from? Why Be Moral?
Promoting the greatest good for the greatest number (Utilitarianism)
How do you measure competing claims: -
Jews or Palestinians
Secular or Ultra-orthodox - who decides who is ‘ultra’?
Obeying your conscience
Keeping God’s law
Which God?
Which interpretation?
Acting in line with the mores of your society
Because if you don’t you’re in trouble?
And if you can get away with it – why not?
Striving for the victory of the working class
Living a life of sexual self-denial
Diversity in the rules in different societies, even within sub societies
Polygamy OK in some societies
Cohabitation without marriage very acceptable today (even if polygamous) in the west
Homosexuality becoming acceptable (ancient Greece – the norm)
Widows may remarry/must remain on their own/in some societies used to commit suicide
Dare one say? – FORGET BEING MORAL - BE SENSIBLE?
Morality: Manners or customs (from the Latin mas or mores. This once meant “the quality of being moral.”
Morality involves individual choice. It is the quality that renders an action right or wrong. This is not an absolute. At any given time and society there are accepted ethical principles and standards of moral conduct.
Morality is knowingly not doing the right thing – incorrect behavior.
Amorality is the absence of a sense of morality. The individual has now way of knowing whether something is moral or not.
What is immorality? Sects, cults and other groups define what their standards are. Therefore, immorality is the deviation from these standards. In general usage immorality is connected to sexual behavior.
At one time in the Western world a 2-piece bathing suit was considered immoral. Times have changed.
Having more than one wife in Israel is considered immoral but not elsewhere. However, one husband can impregnate many women to secure continuation of the family or race.
Is beating children moral? Standards have changed here also.
Is it moral for a couple to live together before marriage? Is homosexuality moral? These standards are also changing.
There is also “State morality.” The Emperor of Japan after World War II told his people to limit their family to only 1 or 2 children to help the State become economically prosperous. In India Indira Gandi also tried to enforce small families for economic growth. This is still true today in China.
So we judge State behaviors in the same way as we judge individual behaviors.
Killing is morally wrong except when its OK. What about the policeman who kills a kidnapper; the wife of a pain-ridden cancer patient injects her husband and kills him.
Victorian rules of morality obsessed on issues of sex.
Morality is not a religious concept. Are the sacrifice of animals and brit milah moral? What about other self mutilation of the body like body piercing, tattooing, Some of these practices are now accepted because of custom, mores and usage.
In the 20th century it became common to perform appendectomies, and the surgical removal of tonsils.
Is suicide bombing immoral, moral or amoral? Sampson was the first suicide bomber. Is a soldier firing into a crowd to kill snipers immoral? Does it depend on where the individual is standing?
In WW II the Kamikaze pilots of Japan where suicide bombers. Their deeds where considered heroic – they where giving their lives for their country. It was a former of glorification of death. There is only a degree away from the Kamikaze pilot or the suicide bomber. Is this immoral or amoral? Is the immoral person the suicide bomber or the men pushing him. It is the prostitute or the people who her into Israel?
Is war immoral. George Bush and Tony Blair are both religious men. They believed that Saddam Hussein was dangerous to the whole world.
To determine morality we must determine what the individual believed at the time of his/her action.
What is the most immoral behavior? The cigarette manufacturer Philip Morris intentionally produced a very addictive product. Saddam Hussein gave money the families of suicide bombers. WW I French military officers where guilty of shooting deserters in the back.
There is no defense in the law or morality to say, “everyone else is doing it.”
The only person responsible for your behavior is YOU.
“Ethics is Situational” is a DANGEROUS idea. Using excuses like, “the government is at fault” is not acceptable.
Individuals determine their own fate. They make their own choices.
Classic Case: A 19 year old girl got married in 1940. She had a baby. She had no money to support herself and her child. She lived 3 miles from a huge army base. There was a coal dump outside the camp. The woman stole coal to warm her sick child. She was caught by the local village policeman. He took coal into her house, lit a fire and gave her tea then went to make a report. She is brought before the magistrate and is fined 1 Pound. The magistrate gives her 5 Pounds and tells her to pay the fine, go home and not steal any more.
Was the mother doing the right or wrong thing to steal?
Main Point: Ethics and Morals are NOT ABSOLUTE.
START OF RY 2003-04 Seminar
Session # 10 -September 7th 2003
Confidentiality - from the Latin –confidere- completeness of trust
Trust to keep a secret
Fidelity
Keeping promises –expressed promises – implied promises – assumed promises
The importance of confidentiality for relationships of trust.
Confidentiality in human relationships
Husband and wife, partners, parents and children
Schoolteachers and children, telling tales, “sneaking”
Unfair pressure on children
Confidentiality in professional practice
Justification of the professional emphasis on confidentiality.
Confidentiality also means the right of a professional to refuse to divulge professional confidences.
Special Justifications for lying could be protection of confidentiality
Priest and confessional
Accountant and taxes
Doctor and serious disease, competence to drive
Lawyer and guilt of his client
Journalist and source - on and off the record
conflict between the rights of the individual and the interests of the general public.
Stoolpigeon
circumstances in which a breach of confidence is professionally acceptable.
harm caused by breaches of confidentiality: examples from everyday life.
Utilitarianism: the harmful consequences of breaches of confidence for
the individual. Back to trust and distress.
Government
Openness, truth, transparency, secrecy, security, right of the public to know, 30-years rule, 50-years rule,
How extensive is the right to confidentiality when it apparently conflicts with the public interest?
Legal
confidence and defamation.
Basic Law – Human rights Israel
There shall be no violation of the confidentiality of conversation, or of the writings or records of a person
The Prevention of Terrorism Act 1989. A strict obligation the neglect
of which can carry a stiff jail sentence.
The civil offence of breach of confidence. Example: commercial espionage.
Medical
Hippocratic Oath - Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.
the importance of personal and professional relationships of trust and why they are so important for the clinical relationship.
allowing the patient to decide what is and is not secret about information concerning their treatment.
'The doctor/patient relationship is founded on trust and a doctor should not disclose to a third party information about a patient acquired in a professional capacity without the permission of the patient.
To do so may lead to a charge of serious misconduct.
A doctor should also be aware that the duty of confidentiality extends to other members of the team.'
The potential harm to the general public of those suffering from
infectious disease not submitting themselves for treatment for fear of
breaches of confidence.
Notifiable diseases: serious infectious diseases which must be reported to the Department of Public Health.
Dangers posed by unreported infectious diseases as well as other hazards.
Confidentiality, HIV and AIDS: the rights Where the patient cannot give consent for information to be shared and where friends or relatives have information crucial for effective treatment.
What are the rights concerning confidentiality of patients who are
infected with HIV or who have AIDS?
of patients and the rights of and risks to professional caregivers
Might seem that sharing information with other clinicians involved in the patient's care is a breach. Not so. Patients have given their implied consent for information to be revealed in their best clinical interests
But if the doctor suspects a patient has the virus. Should he or she
warn other health professionals? No. Further discussions should occur
with the patient. He should only warn others if they require
information about HIV status in order to treat safely. Patients should be informed of this.
The tension between the interest of the individual and the interest of the public.
'There may be circumstances in which the public interest outweighs a
duty of confidentiality and in which disclosure would be justified.
Situations where confidentiality may but not necessarily must be
breached.
Confidences may be breached in situations where you believe, and have evidence for it, that maintaining confidence will place others at serious risk.
Confidentiality and the Internet
Providing your details to others, commercial agencies
There is an adoption web-site www.adopt.org that is run by the National Adoption Center a nonprofit organization that is trying to find families for children. Next to the photographs of the children is a full medical profile including diagnoses and medications. Do these poor children have to give up their right to confidentiality, without their informed consent so that prospective “parents” can decide whom they want?
