It was within the rights of a Halifax doctor to disclose confidential patient information about a medical student to police after becoming concerned about possible threats to Dalhousie University faculty and students, a University of Toronto psychiatry professor says.
Dr. David Goldbloom says confidentiality between doctor and patient is "not completely sacrosanct" — that it can be breached when a clear threat to the public exists.
"There are very clear guidelines provided by the Canadian Medical Association," Goldbloom said.
"A physician can encounter circumstances where the duty to protect really trumps the duty to keep information confidential."
Goldbloom spoke with CBC Nova Scotia's Maritime Noon after search warrant documents allege Stephen Gregory Tynes met with a psychiatrist on Aug. 20, and told the doctor he would stab the associate dean of undergraduate medical education and her daughter, who was also his classmate.
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The guidelines, says Goldbloom, have legal precedent and back up the decision made by Tynes's psychiatrist.
"This has been confirmed at the level of Supreme Court of Canada, where they said that, you know, the danger to public safety could form the necessary basis for breaching confidentiality," says Goldbloom. "So it's not like confidentiality is absolute — it's relative."
A doctor's decision to disclose is a mix of ethics and law, Goldbloom says.
"There are laws that allow physicians and, at times, oblige physicians to breach confidentiality. It's also an ethical issue that I would say, even if you're unfamiliar with the ethical or legal requirements, it's ultimately at a personal level, it's a how-you-sleep-at-night question."
Should patients withhold true feelings?
Goldbloom says he's happy a potential tragedy at Dalhousie University was averted by the prompt disclosure to Halifax police of the possible threat.
Having negative thoughts towards others is common, he says, but threatening action is a well-defined line to cross.
"Increasingly, I would say, psychiatrists inform patients at the beginning of an assessment that it's a confidential process, that there are circumstances that may lead that physician to breach confidentiality."
Psychiatrists aren't the only doctors allowed to breach confidentiality, says Goldbloom. Other physicians may disclose private information if:
- A child is at risk.
- A province requires mandatory reporting.
- A patient has a condition that may cause driving impairments.