A case on confidentiality in Netherlands

A 48-year-old woman who died of a lung embolism and a heart attack after being discharged from hospital. She had been treated in a hospital since 1993 for myotonic dystrophy which is a kind of hereditary muscular disease. In June 2005 while having a pacemaker fitted she had a pneumothorax. She was discharged but returned the next month for tests, complaining she felt tired. Her husband said that she had her heart and lungs tested, samples of blood and urine taken, and data from her pacemaker read. She and her husband had expected her to be admitted overnight, but instead she was discharged. Four hours later she was readmitted as an emergency but died on the way to hospital. The healthare inspectorate was not asked to investigate, but her husband reported to the police a possible case of "culpable homicide". His wife had not given permission for her files to be read by anyone other than the doctors treating her, so her husband requested her medical files be made available. The hospital refused, arguing that there was no "reasonable suspicion of guilt" that could justify breaking medical confidentiality.

The judge concluded that doctors' rights to professional confidentiality were not absolute. "In very exceptional circumstances the importance of establishing the truth should prevail over the right not to disclose information". The judge accepted that society had an interest in maintaining medical confidentiality so that everyone could seek medical help freely without fear of their medical details becoming public knowledge. But he concluded that in cases of a "serious suspicion of a culpable lack of care, or careless medical treatment, with far reaching or fatal consequences for the patient, then as complete as possible an investigation should be carried out". He judged that exceptional circumstances existed in this case that justified breaking medical confidentiality.

The Dutch Medical Association concerns that the judge had broadened the interpretation of "very exceptional circumstances". Culpable homicide, in which there is no intention to commit a crime, had not been thought sufficient reason to break confidentiality in previous similar judgments. The hospital is considering to appeal against the decision.

# British Medical Journal 2007