NationStates Jolt Archive

In the papers today there was a highly publicised case of a mental patient telling his doctor of a plot to kill Prime Minister Fredrik Reinfeldt's wife Filippa. The plans were detailed and he had by his own admission set aside money to buy a weapon to do it with.

The doctors chose to break confidentiality (as Swedish law permits in cases where patients tell their doctors of credible plans to commit crimes which hold a punitive value of at least two years of imprisonment - and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family) and contacted the Swedish security police, which investigated the man and has instructed the mental care facility to contact them if he should try to leave the forced care he's been put under.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.

The doctor-patient confidentiality should only be breached when there are safety concerns about the public. However, not everything should be released, just that which is completely relevant. There should be a level of confidentiality and privacy maintained for the aspects that are not related to the concern. That which is released should be relevant and purely factual, leaving no room for media spin because the media can't be trusted.

The doctors did the right thing, the media however, did not.
Confidentiality should be broken when someone's life is at risk.
My privacy, for example, is not as important as someone else's life. Especially if my privacy would lead to their death, by my own design.

In the papers today there was a highly publicised case of a mental patient telling his doctor of a plot to kill Prime Minister Fredrik Reinfeldt's wife Filippa. The plans were detailed and he had by his own admission set aside money to buy a weapon to do it with.

The doctors chose to break confidentiality (as Swedish law permits in cases where patients tell their doctors of credible plans to commit crimes which hold a punitive value of at least two years of imprisonment - and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family) and contacted the Swedish security police, which investigated the man and has instructed the mental care facility to contact them if he should try to leave the forced care he's been put under. correct and applauded.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.wrong. There is NO REASON to give a person's medical Charts or/and records to the media. I hope the Doctor wasn't the one who told the media.

In the papers today there was a highly publicised case of a mental patient telling his doctor of a plot to kill Prime Minister Fredrik Reinfeldt's wife Filippa. The plans were detailed and he had by his own admission set aside money to buy a weapon to do it with.

The doctors chose to break confidentiality (as Swedish law permits in cases where patients tell their doctors of credible plans to commit crimes which hold a punitive value of at least two years of imprisonment - and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family) and contacted the Swedish security police, which investigated the man and has instructed the mental care facility to contact them if he should try to leave the forced care he's been put under.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.
Fass, I remember you stating, and I'm paraphrasing, that one should follow one's conscience in these matters. Oaths, contracts, promises -- nothing should stand in the way of one's free will to choose the right way.

So I'm surprised to see that you even need to ask the question. Clearly, the consequence is irrelevant to the ability of choosing.

The doctors did the right thing, the media however, did not.
Confidentiality should be broken when someone's life is at risk.
My privacy, for example, is not as important as someone else's life. Especially if my privacy would lead to their death, by my own design.

But in this case the man had himself approached the hospital and had already been placed under forced psychiatric care. It was during that that he talked about his plans.

Fass, I remember you stating, and I'm paraphrasing, that one should follow one's conscience in these matters.

I don't recall having spoken about the Swedish professional ethics and laws of patient-doctor confidentiality with anyone on this board, least of all you, so I am surprised that you seem to have a recollection of such having taken place.

Oaths, contracts, promises -- nothing should stand in the way of one's free will to choose the right way.

Nothing like that is relevant to this situation - there is no oath, no contract, no promises.

So I'm surprised to see that you even need to ask the question. Clearly, the consequence is irrelevant to the ability of choosing.

The consequence here is not for the doctor but for the patient. He is the one that has suffered this intrusion. Is it justified?

wrong. There is NO REASON to give a person's medical Charts or/and records to the media. I hope the Doctor wasn't the one who told the media.

That would have been illegal - only the pertinent authority may be contacted, not the media. The Security Police (SÄPO) are refusing any comment and are citing - funnily enough - confidentiality and have classified their records on this. Yet, there is a leak...

Tricky one. I say yes for normal medical doctors, but I lean towards no for psychiatrists. There is the obvious argument that lives will be saved, but what about the long term? The consequence of having a therapist who you can't necessarily trust with full confidentiality may be dire, potential killers would be too scared to see a shrink in the first place if there is a threat of them getting reported and therapy might be one of the few available ways of preventing the killer. So is it better in the long term to keep absolute confidentiality? Sure, allowing them to breach confidentiality will prevent a few deaths initially, but there is seemingly a risk of more killings and mentally deranged people without the potential help they could receive. However there is still a lot of ambiguity concerning the actual extent of what the damage will be in the long term, so I really can't make a judgement.

That would have been illegal - only the pertinent authority may be contacted, not the media. The Security Police (SÄPO) are refusing any comment and are citing - funnily enough - confidentiality and have classified their records on this. Yet, there is a leak...

yep. If it was the doctor... or any healthcare worker...there would be hell to pay in the US.

However, where did the media get the medical charts. there would be NO reason to give those to the police either. so the charts (and this is going by how the hospital I work at does things) would have to have come from the medical facility.

and what was he in there for since he was already under forced care?

i concur with that guy up there

But in this case the man had himself approached the hospital and had already been placed under forced psychiatric care. It was during that that he talked about his plans.

Ah. I didn't get that from the OP. I was under the impression that he had 'admitted' his plans to the doctors, which reported him to the authorities, whom then placed him under forced care.

But it is actually irrelevant. He admitted to being involved in a conspiracy to end someone's life. So someone should be alerted, whether or not it breaks his right to privacy.

It is my opinion, that during a crime, the perpetrator is no longer under certain protections that law provides. Depending on the severity of the crime of course.

However, where did the media get the medical charts. there would be NO reason to give those to the police either. so the charts (and this is going by how the hospital I work at does things) would have to have come from the medical facility.

According to "Lagen om yrkesverksamhet på hälso- och sjukvårdens område" which together with "sekretesslagen" (and several other laws) governs matters of confidentiality:

"Utöver vad som annars följer av lag eller förordning är hälso- och sjukvårdspersonalen skyldig att lämna ut sådana uppgifter
[...]
2. som behövs i verksamhet för personskydd för riksdagens ledamöter, statschefen och övriga medlemmar av kungahuset, statsråd, statssekreterare och kabinettssekreterare, om uppgifterna i ett särskilt fall begärs av Säkerhetspolisen,"

"Apart from what otherwise follows by law or statute healthcare personnel are obliged to share such information
[...]
2. that is needed in the execution of personal protection for the members of the Riksdag, head of state and other members of the royal family, ministers, secretaries of state and secretaries of the cabinet, if the information in a specific case is demanded by the Security Police"

I guess the Security Police demanded the charts after they were contacted.

and what was he in there for since he was already under forced care?

According to the published sections of the chart he had been suffering from psychiatric illness for a while (personality disorder, empathic disorder and lack of impulse control) and had seen a deterioration of his state that led him to contact the hospital.

According to "Lagen om yrkesverksamhet på hälso- och sjukvårdens område" which together with "sekretesslagen" (and several other laws) governs matters of confidentiality:

"Utöver vad som annars följer av lag eller förordning är hälso- och sjukvårdspersonalen skyldig att lämna ut sådana uppgifter
[...]
2. som behövs i verksamhet för personskydd för riksdagens ledamöter, statschefen och övriga medlemmar av kungahuset, statsråd, statssekreterare och kabinettssekreterare, om uppgifterna i ett särskilt fall begärs av Säkerhetspolisen,"

"Apart from what otherwise follows by law or statute healthcare personnel are obliged to share such information
[...]
2. that is needed in the execution of personal protection for the members of the Riksdag, head of state and other members of the royal family, ministers, secretaries of state and secretaries of the cabinet, if the information in a specific case is demanded by the Security Police"

I guess the Security Police demanded the charts after they were contacted.



According to the published sections of the chart he had been suffering from psychiatric illness for a while (personality disorder, empathic disorder and lack of impulse control) and had seen a deterioration of his state that led him to contact the hospital.

thanks.

so "Medical Charts" could just be the diagnosis... I thought it was his full charts which would include meds given, treatment plans, etc...

if it was just the Diagnosis and offical statement of his mental status, then I can see the hospital giving that to the police for their records.

still... gotta wonder on these 'leaks'.

the doctor should of done what the law told him and then campaigned like hell to have the law changed so that when a patient admits such things he should be placed under constant watch and care because of being a threat to himself and others

I hope I sounded cleverer than that reads

thanks.

so "Medical Charts" could just be the diagnosis... I thought it was his full charts which would include meds given, treatment plans, etc...

Actually the Swedish word for the chart is "journal" (yeah, we borrowed it from the French) and does encompass the treatment given, personal information and so on. It is not a light breach of confidentiality that the law permits, but quite a serious one indeed and which would not have taken place had SÄPO not been contacted. So, the doctors' actions have led to SÄPO being able to get the chart. Somehow the media have gotten hold of it. I should expect an investigation into the matter, but the thing is that the Swedish constitution gives journalists the right not to disclose their sources and in several cases prohibits government officials from even trying to ascertain the identity of a source. This is of course to guarantee a free press.

Actually the Swedish word for the chart is "journal" (yeah, we borrowed it from the French) and does encompass the treatment given, personal information and so on. It is not a light breach of confidentiality that the law permits, but quite a serious one indeed and which would not have taken place had SÄPO not been contacted. So, the doctors' actions have led to SÄPO being able to get the chart. Somehow the media have gotten hold of it. I should expect an investigation into the matter, but the thing is that the Swedish constitution gives journalists the right not to disclose their sources and in several cases prohibits government officials from even trying to ascertain the identity of a source. This is of course to guarantee a free press.
I see... here in the US, releasing the totallty of the patients records is wrong. even to the police. usually a warrant is needed/required.

but the problem isn't the medical facility/doctor giving the police what was required by law. it's whomever who gave those charts to the media.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.

I believe the doctors were correct in contacting the authorities with their concerns in this case, given the nature of the conversation, that they found the plan credible, and that the law forces them to do so in this particular set of circumstances.

However, whomever contacted the media and gave his personal information out, and whomever made crap up just to make the story more interesting, whether at the hospital, in the media, or at the police agency, should be strung up by whatever they'd LEAST want to be strung up.

Absolutely they were right.

In the papers today there was a highly publicised case of a mental patient telling his doctor of a plot to kill Prime Minister Fredrik Reinfeldt's wife Filippa. The plans were detailed and he had by his own admission set aside money to buy a weapon to do it with.

The doctors chose to break confidentiality (as Swedish law permits in cases where patients tell their doctors of credible plans to commit crimes which hold a punitive value of at least two years of imprisonment - and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family) and contacted the Swedish security police, which investigated the man and has instructed the mental care facility to contact them if he should try to leave the forced care he's been put under.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.

I think the media should evolve to where their brains aren't located in their ass. *nods*

Most people in Canada don't know this...but the only privilege that is absolute is between lawyer and client. All other forms of 'confidential' relationships can be breached, or compelled.

Just FYI canukis.

In the papers today there was a highly publicised case of a mental patient telling his doctor of a plot to kill Prime Minister Fredrik Reinfeldt's wife Filippa. The plans were detailed and he had by his own admission set aside money to buy a weapon to do it with.

The doctors chose to break confidentiality (as Swedish law permits in cases where patients tell their doctors of credible plans to commit crimes which hold a punitive value of at least two years of imprisonment - and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family) and contacted the Swedish security police, which investigated the man and has instructed the mental care facility to contact them if he should try to leave the forced care he's been put under.

This story broke to the media today and they have splashed the man's medical chart for all to read, and have made several false claims about the man (that he had been arrested, that a prosecutorial investigation had been started and so on). With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.


I think the doctors were right, but the media is as usual disgusting about it. Still, I don't see anything else he should have done. Legally he had to. And while I'm a big fan of doctor-patient confidentiality, that's not more important than a human life.

What I'm curious about is how the media got the story and the guy's medical charts (etc) if the doctor only went to the security police.

I'm fine with the doctor/patient confidentiality being breached as required by law when the patient is a danger to himself or herself or someone else.

If the patient is a danger to himself or others, then it's time to let people know.

If the doctor believes there is a genuine threat to public safety, then s/he should be obliged to inform the relevant authorities. If not, then doctor-patient confidentiality should be kept. The publishing of the patient's medical records by the media was totally wrong, and almost certainly illegal.

Generally, confidentiality should not be breached. If, however, there is a real chance that it will prevent a violent crime, the police should be notified, but the details should not be publicized. Certainly medical and psychiatric records should not be plastered all over the media - the public's right to know does not legitimately extend that far.

I think that under the circumstances, it was right to notify the authorities.

However... I disapprove of the way it has apparently been splashed all over the media. I think it should have been done as discretely as possible.

As you stated here:

...and as is stipulated they must when the victim of the plan is a member of the Riksdag, Government or the Royal Family...

It seems they really didn't have a choice under law but to report it.

With this media frenzy in mind, do you think the doctors were right in breaking confidentiality? Do you feel that confidentiality should be absolute? If yes, why? If no, when should it be broken? Poll coming.

The unlawful leaking to the media of confidential information should not have played a part in their decision making. Unless the doctors themselves leaked the info, they probably did not forsee this circumstance.

I would hope that whoever leaked the info is caught and severely punished. A doctor should not have to factor in information leaks by a third party when deciding difficult legal/privacy issues. The Doctor should be able to make the decision based on the assumption that information will only be revealed on a strictly legal need-to-know basis.

As for confidentiality being absolute.... I can think of no right that should be absolute when it comes into direct conflict with other rights or legitimate concerns. When two directly opposing principals meet, one must give way to another based on the special circumstances that apply in that instance.