Should I Protect a Patient at the Expense of an Innocent Stranger?

Obligation is a powerful moral compass. Often times, we find ourselves relying on our
ingrained creed to guide all of our actions without question. But life isn’t that simple. We cannot
base all of our decisions on the words of someone we happen to agree with. Each situation we
encounter is unique and has to be approached with nuance and discretion, not with a broad
strokes mentality. As I said though, life isn’t that simple and as a physician. You have a
professional obligation as well a personal obligation.

Patient confidentiality is a guiding principle in your line of work that must be upheld but
the Hippocratic Oath also states to do no harm. From what you wrote, it’s clear that someone is
being harmed; just not your patient. The innocent prisoner is losing precious time from his or her
personal life and their mental health is in jeopardy. You’re patient on the other hand isn’t being
harmed by confessing to his crimes, in fact, he is being treated by his confessional. You stated
that his headaches subsided after he told the truth and if he were to confess and free an innocent
person, his conscious and head would be clear.

To be crystal clear, I am not advocating for breaking patient confidentiality. Nor am I

advocating for you to do nothing. I believe there is a middle ground for you to consider. Two
middle grounds specifically. You should attempt to convince your patient to confess to his
crimes. You might argue that by convincing his patient to confess to his crimes, that he is
harming his patient. Tell him that further confession would improve his mental health and in turn
resolve his headaches. I believe that this is the best option as it doesn’t violate patient
confidentiality and still fulfills your personal obligation to do what is right. If he refuses, you still
have another path at your disposal.

You can call the local authorities, anonymously, and explain that the convicted person is
actually innocent and to revisit the case. Obviously, this doesn’t ensure that the innocent person
is freed from prison, but it isn’t exactly doing nothing. As I said, life isn’t simple and somethings
are out of our control, including the justice system. But at least you can sleep well knowing you
did your best to uphold both your professional and personal obligations.

If you were to consider violating patient confidentiality and instead uphold your own
personal obligation, then I would argue you are being ethical despite your unethical action. You
promised your patient that nothing he said would leave the room, so you have another personal
obligation to your patient not to disclose your conversation.

Revisiting the topic of obligation, I feel that I have an obligation to disclose to you that I
am not a doctor and that most of my advice should be taken with a grain of salt. However, the
clearest advice I can give you is that you need to set a hierarchy. Which comes first, professional
or personal obligation? I cannot answer that question for you, but I firmly believe that each
situation merits its own hierarchy. In this case, I believe that personal obligation should take
precedence over professional as someone else’s life is impacted.