Divided Loyalties: Legal and Bioethical Considerations of Physician-Pregnant Patient Confidentiality and Prenatal Drug Abuse

Author:

Plambeck Cheryl M.

Publisher

Informa UK Limited

Subject

Law,General Medicine

Reference33 articles.

1. 10 GREAT BOOKS OF THE WESTERN WORLD xiii (Robert Maynard Hutchins ed., 1952). Hippocrates composed the oath circa 400 B.C.

2. Beneficence is defined as "providing benefits and balancing risks or burdens against those benefits." Linda Farber Post, Mandatory Testing of Pregnant Women and Newboms: HIV, Drug Use and Welfare Policy: Bioethical Consideration of Maternal-Fetal Issues, 24 FORDHAM URB. L.J. 757, 758 (1997). It generally "connotes acts of mercy, kindness and charity" and the principle of beneficence "refers to a moral obligation to act for the benefit of others." TOM L. BEAUCHAMP & JAMES F. CHILDRESS, PRINCIPLES OF BIOMEDICAL ETHICS 421 (4th ed. 1994).

3. Principle IV of the American Medical Association's Code of Medical Ethics is a less absolute statement of the duty of confidentiality than is the Hippocractic Oath. That principle states that a physician "shall safeguard patient confidences within the constraints of the law." AMERICAN MEDICAL ASSOCIATION, COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS, PRINCIPLES OF MEDEAL ETHES, available at http://www.ama-assn.org/ama/pub/category/2512.html. See infra Section II (regarding the physician-patient relationship and the duty of confidentiality).

4. See Charity Scott, Is Too Much Privacy Bad for Your Health? An Introduction to the Law, Ethics and HIPAA Rule on Medical Privacy, 17 GA. ST. U.L. REV. 481, 495-98 (listing losses of a patient's privacy that ate considered tolerable, such as disclosing to family members or public agencies when a patient has a highly contagious, infectious disease, as well as mandatory reporting of gunshot wounds, domestic violence, and child abuse). See also Michelle Oberman, Mothers and Doctors' Orders: Unmasking the Doctor's Fiduciary Role in Maternal-Fetal Conflicts, 94 Nw. U.L. REV. 451, 462 nn.50-51 (2000) (citing statutes requiring physicians to report certain conditions); Tarasoff v. Regents of the Univ. of Cal., 551 P.2d 334 (Cal. 1976) (establishing legal duty of psychiatrists to breach confidentiality and warn third parties if a patient threatens to kill or injure that person); Reisner v. Regents of the Univ. of Cal., 37 Cal. Rptr. 2d 518 (Ct. App. 1995) (extending that duty to warn to a third person with whom there is no special relationship-such as a physician-patient relationship-even an unknown and unidentifiable third party).

5. The effect of maternal substance abuse on babies has captured the public interest. As well as the obvious fixation on the tragedy of suffering babies, concerns also have grown regarding the high financial cost of caring for children born to addicts. See Rachel H. Nicholson, No (Pregnant) Woman Is an Island: The Case for a Carefully Delimited Use of Criminal Sanctions to Enforce Gestational Responsibility, 1 HEALTH MATRIX 101, 104 (1991).

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