6 - Revisiting the Fiduciary Relationship

Summary

Is it ethical when doctors breach their pregnant patients’ confidentiality? Is it legal? What about HIPAA (properly known as the Health Insurance Portability and Accountability Act of 1996)? Are there different rules for pregnant women than for men? These are some of the questions women ask me after I give a talk. I understand this bewilderment and, for many, fear. At the heart of their questions resides this chilling thought: Could this happen to me or my daughter? Depending on where they live, the answer may be yes. And, increasingly, wealth will not save them. As this Chapter explains, physicians owe their patients care, confidentiality, loyalty, and trust, and the principle that undergirds all of this – the fiduciary relationship – is not contingent on the sex of the patient. However, with increased pressure from state legislatures and prosecutors, some doctors and nurses have abrogated their responsibilities to their patients. Among them, some are genuinely fearful that unless they adhere to whatever law enforcement demands of them, they may lose their licenses to practice medicine. Some of these doctors are genuinely ambivalent about their duties. These doctors tell me they feel powerless.