Denying a patient's final will: public safety vs. medical confidentiality and patient autonomy.

Especially when caring for patients approaching the end of life, physicians and nursing staff feel committed to fulfilling as many patient desires as possible. However, sometimes a patient's "final will" may threaten public safety. This can lead to severe conflicts, outweighing the physician's obligation and dedication to care for the patient and to respect his autonomy. Yet, public safety can be threatened if confidentiality is not broken. This article provides a concise summary of the medicolegal and ethical fundamentals concerning this difficult situation. If the patient's and others' health and safety are at risk, physicians may (and in some countries must) break medical confidentiality and disclose confidential patient information to the police and other authorities. Physicians should be able to professionally deal with such a conflict in all patients, not only in patients with advanced illness.

[1]  Desmond O'Neill,et al.  Driving assessment for maintaining mobility and safety in drivers with dementia. , 2013, The Cochrane database of systematic reviews.

[2]  C. Regehr,et al.  Confidentiality in Crisis: Part I—The Duty to Inform , 1998, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[3]  D. Carr,et al.  The older adult driver with cognitive impairment: "It's a very frustrating life". , 2010, JAMA.

[4]  J. Dumbrell.  A Special Relationship , 2006 .

[5]  N. Kass.  Public Health Ethics: From Foundations and Frameworks to Justice and Global Public Health , 2004, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[6]  M. Rizzo,et al.  Practice Parameter update: Evaluation and management of driving risk in dementia , 2010, Neurology.

[7]  Pellegrino and Medicine: A Critical Revision , 2006, The American journal of bioethics : AJOB.

[8]  T. L. Bennett,et al.  Identifying At-Risk Older Adult Community-Dwelling Drivers Through Neuropsychological Evaluation , 2009, Applied neuropsychology.

[9]  B. Lo,et al.  Clinical Decision Making during Public Health Emergencies: Ethical Considerations , 2005, Annals of Internal Medicine.

[10]  Lynnette G. Kay,et al.  Predicting fitness to drive in people with cognitive impairments by using DriveSafe and DriveAware. , 2009, Archives of physical medicine and rehabilitation.

[11]  Rare But Routine: The Physician's Obligation to Protect Third Parties , 2006, The American journal of bioethics : AJOB.

[12]  Ross Upshur,et al.  Dual loyalty of physicians in the military and in civilian life. , 2008, American journal of public health.

[13]  L. Radbruch,et al.  Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients , 2007, Anesthesia and analgesia.

[14]  E. Pellegrino.  Toward a Reconstruction of Medical Morality , 2006, The American journal of bioethics : AJOB.

[15]  T. Beauchamp,et al.  Principles of biomedical ethics , 1991 .

[16]  K. Kipnis.  A Defense of Unqualified Medical Confidentiality , 2006, The American journal of bioethics : AJOB.

[17]  J. Gaertner,et al.  Assessing cognition and psychomotor function under long‐term treatment with controlled release oxycodone in non‐cancer pain patients , 2006, Acta anaesthesiologica Scandinavica.

[18]  T. Hughes,et al.  “Can I drive, doctor?” LEAN thinking may help us answer the question , 2009, Practical Neurology.

[19]  Birgit Kraft,et al.  Opioid medication and driving ability , 2005, European journal of pain.

[20]  M. Byas-Smith,et al.  The Effect of Opioids on Driving and Psychomotor Performance in Patients With Chronic Pain , 2005, The Clinical journal of pain.

[21]  L. Gostin,et al.  Public Health Ethics: Mapping the Terrain , 2002, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.