I’m (obviously) not a doctor, and I assume some doctors will vehemently disagree with what I’m about to write. But I feel that the first thing we need to recognize is that the Hippocratic oath represents the ideals of a person who died in the historical vicinity of 370 B.C. Now, this doesn’t make it valueless or inherently flawed. It’s a good oath. But we’re dealing with a modern problem, so I would separate the conditions of that concept from this discussion. And even if you refuse to do that — even if you feel your commitment to this symbolic oath supersedes all other things — keep in mind that one of its cornerstones is to “do no harm.†Are you latently doing harm by allowing someone to be penalized for a crime he did not commit? This is not exactly a medical issue, but your relationship to the problem is still an extension of your position as a physician.
Here is the root of the problem: You promised a man that you would keep his secret in confidence, only to have him tell you something you now view as too important to remain unspoken. The stakes are pretty high; the possibility of someone’s being convicted of a crime that he did not commit is awful. But you’ve painted yourself into a corner. You should not tell someone “Whatever you tell me will never leave this room†if that promise only applies to anecdotes you deem as tolerable. It doesn’t matter if you’re a physician or anyone else. The deeper question, of course, is whether breaking this commitment is ethically worse than allowing someone to go to jail for no valid reason. On balance, I have to say it is not.
I would advise the following: Call the patient back into your office. Urge him to confess what happened to the authorities and tell him you will assist him in any way possible (helping him find a lawyer before going to the police, etc.). If he balks, you will have to go a step further; you will have to tell him that you were wrong to promise him confidentiality and that your desire for social justice is greater than your personal integrity as a professional confidant. There is, certainly, danger in doing this. I don’t know what the real impact will be (considering the circumstances, it seems as if it would be easy for him to claim his confession came under mental distress and that you coerced or misinterpreted his admission — but the information still might help the innocent man’s case).
This is a situation in which I’m personally uncomfortable with my own advice. If I told someone “Whatever you tell me will never leave this room,†it would be almost impossible for me to contradict that guarantee, regardless of whatever insane thing the person proceeded to tell me. That is my own human weakness. But given the advantage of detached objectivity, it’s very difficult to argue that the significance of your promise to a guilty stranger is greater than an innocent stranger’s freedom from wrongful prosecution. You should not have made the original promise, and you should not allow that bad promise to stand. But keep in mind I’m only looking at this from a civilian perspective. The conditions of doctor-patient privilege might make this untenable. I’m merely weighing the two evils and deeming one to be greater, at least in this specific case.
SOCIAL MENACE
I work as an assistant doing typical office-related tasks. There is another assistant who works with our program’s social-media presence. She requested that I share a link to the program’s Facebook page on my own account. A few days later, she asked me to send private messages to specific people I thought might be interested in the program. When I said I prefer not to use my account in this way, she told me I was being unreasonable and questioned whether I should be working with a program I wasn’t willing to promote. Am I obligated to fulfill her request by using my personal account (which is not associated with my position at the program) and increasing traffic for the program’s social media? MELISSA GOLDIN, ROCHESTER
You are not required to exploit your personal relationship with social media to promote a program you happen to work for. The only reason I’m even answering this question is to draw attention to the fact that this kind of request has become incredibly common and is almost always wrong. There is no ethical obligation to promote your place of employment within the sphere of your private life; just because a technological mechanism makes this easy to do does not mean it’s remotely mandatory. My advice to you would be to cut and paste this response into an e-mail and send it to your co-worker about 300 times over the next 30 days. She needs to realize how unlikable she expects other people to be.
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