Examkin

Question

Difficulty: HardConfidentiality and Privacy

A 48-year-old woman comes to the clinic for a follow-up appointment. One month ago, she was diagnosed with Huntington disease after presenting with a 2-year history of progressive choreiform movements, irritability, and cognitive decline. Genetic testing confirmed a CAG trinucleotide repeat expansion. She is accompanied by her husband, who is aware of the diagnosis. The patient has a 26-year-old son from a previous marriage. Her son and his wife are currently expecting their first child. During the visit, the physician strongly encourages the patient to discuss her diagnosis with her son given the 50% risk of inheritance. The patient becomes visibly upset and states, "He is already under so much stress with the baby coming. Knowing about this disease will ruin his life right now. I forbid you from telling him or anyone else." The patient's examination shows clear capacity to understand her diagnosis and make medical decisions. Which of the following is the most appropriate next step by the physician?

  1. Maintain the patient's confidentiality and document her refusal to disclose the informationAnswer
  2. B
    Warn the son directly to fulfill the duty to protect third parties from harm
  3. C
    Notify the son's primary care physician to facilitate future genetic counseling
  4. D
    Ask the husband to authorize the disclosure of the diagnosis to the son
  5. E
    Report the diagnosis to the state health department for mandatory family contact tracing

Answer

Maintain the patient's confidentiality and document her refusal to disclose the information.
The correct action is to maintain the patient's confidentiality. A core tenet of medical ethics is respecting the autonomy and privacy of a competent adult. While the physician acted appropriately by strongly encouraging the patient to share this crucial genetic information with her son, the patient has explicitly refused. Breaking confidentiality against a patient's wishes is only permissible in narrow circumstances, such as imminent violent threat to a specific individual (Tarasoff), suspected child or elder abuse, or mandatory reporting of certain communicable diseases. For genetic conditions, professional guidelines state that confidentiality should not be breached, particularly for diseases like Huntington disease where there are no early preventative measures, lifestyle changes, or cures that could alter the son's medical outcome.

Step-by-Step Solution

1
Assess the patient's decision-making capacity and right to privacy.
The patient is competent and explicitly refuses to allow disclosure of her protected health information (PHI).
Competent adults have the right to control who receives their medical information under HIPAA and ethical guidelines.
2
Evaluate if the scenario meets the criteria for overriding confidentiality (exceptions).
The situation involves a genetic disease risk, not an imminent threat of physical violence, child/elder abuse, or a mandatory reportable communicable disease.
Confidentiality can only be breached without consent in highly specific, legally mandated scenarios.
3
Determine if the 'duty to warn' applies to this specific genetic condition.
The duty to warn does not apply because Huntington disease is neither preventable nor curable.
While physicians should strongly encourage patients to share genetic risks with family, they cannot force disclosure or breach confidentiality unless the harm is highly likely, severe, imminent, and preventable.

Key Concept

Physicians must maintain confidentiality regarding a competent patient's genetic test results; the duty to warn third parties does not apply because the disease lacks preventative or curative interventions.
Rate this question

Topics

Confidentiality and Privacy

More questions from this topic