Doctors should have revealed confession
We all love a moral dilemma, and they don’t get more intriguing than one arising from a deathbed confession.
The man was at death’s door in Auckland City Hospital and in great pain from the cancer devastating his body. He called over a junior doctor and told him he needed to unburden himself of a terrible secret. In the 60s he had been a gang hitman and killed several people for money.
The murders had disappeared into the realm of cold cases and had haunted him throughout his life. After the confession, his condition improved markedly. The pain decreased and the hospital was able to transfer him to a nursing home before he died this year.
The junior doctor advised a supervisor about the confession and a decision was made not to tell the police. We got to know about the story this week because researchers at Auckland City Hospital and academics at Auckland University’s medical and law schools prepared a paper discussing the legal and ethical implications of the decision.
The first thing that struck me about the dramatic confession was that it was probably fictional. It would be sad and embarrassing if a whole lot of academics, doctors and lawyers had agonised about the morality of the decision if the dying man had just spun a load of bull or was delusional.
It didn’t ring true to me. I’d want all the details before I took that sort of story seriously. When, how, what happened to the bodies, that sort of thing. The man went on to tell the doctors he had been to prison, joined the merchant navy and killed again when he fought off pirates. He then made a lot of money that he had given away and took in lost souls in an attempt to turn their lives around. A life like a movie plot.
Even if I believed the hitman scenario, the alarm bells would have started ringing with the claims about pirates and large amounts of money.
All these things would have been easy to check, yet in a bizarre suspension of healthy scepticism, the doctors appeared to take the confession at face value.
The miraculous improvement also looks odd to me. We can all understand the relief of talking about a long-held and terrible secret, but the man’s sudden semirecovery looks suspicious.
Argument about the ethical dilemma doesn’t really depend on the story being true, however, although the doctors are going to look silly if police find the man made it all up.
‘‘A priest grants absolution for sins but he also sets penance, which in this case could be reporting everything to the police.’’
Anyway, let’s treat the story as true and consider what the doctors should have done. The central issue is how far the confidentiality relationship between a doctor and patient goes. I’m not sure it’s as sacrosanct as the confidentiality of the Catholic confessional, but it’s certainly up there.
No duty or expectation of confidentiality can be absolute. It’s easy to imagine scenarios where information imparted in a confidential relationship must be shared more widely. A patient or penitent who reveals him or herself to be an imminent threat or danger to others’ safety needs to be stopped.
What say a patient tells her doctor about a major fraud on her employer that was jeopardising the business and other people’s jobs. I don’t think anyone would blame the doctor for tipping off the company.
Even some medical conditions could require disclosure against a patient’s wishes. A bus driver, diagnosed as being at risk of a major heart attack at any time, and who kept driving, does not deserve confidentiality.
This wasn’t the case with our hitman, who was in no condition to hurt anyone. However, the confession did have the potential to have a profound effect on other people’s lives. Some of the victims’ families would not have to die wondering about their nearest and dearest if the man had simply told police what had happened to the people he executed.
Another factor that detracts from the man’s right to confidentiality is the nature of the confession itself. He was obviously seeking relief by unburdening himself. True remorse entails a wish to repair the situation as much as possible. In this case, that meant providing the authorities with chapter and verse on the killings. The man was going to write a letter to the police. It appears he did not.
The ex-Catholic in me senses that, if the man was genuine, he wanted forgiveness by telling someone. A priest grants absolution for sins but he also sets penance, which in this case could be reporting everything to the police. Remorse is all very well, but it needs to be tested.
In this scenario the doctor was entitled to make an exception to the confidentiality rule. He or she could in good conscience have told the man that if he didn’t tell the police, the doctor would. After all the man was dying. Full disclosure was not a big thing to ask.
In the end, these cases always come down to their particular facts. There are principles but no absolutes.