Patients within family; sharing confidential information

Ethics Forum. May 6, 2002.

Scenario: Is it ethical to have members of the same family as patients?

In some communities and some medical practice settings, it is not uncommon for a physician to treat several members of the same family, or physicians from the same group to treat members of a family. What ethical issues should physicians be mindful of when they care for members of the same family? Should physicians discuss these matters with patients at the outset?

Reply:

Primary care physicians in particular often care for more than one family member or loved one (from here on, family is understood in a broad sense). Sometimes patient care can even be delivered at the same time and in the same room. In fact, such care is part of the description of being a family physician, and can be viewed as essential in rendering sound care according to the bio-psychosocial model.

Yet caring for multiple persons also runs counter to the imaginary notion of a physician-patient dyad, a notion that makes abstraction of the patient's family relationships.

In a dyad, there are times when a physician's concerns of benefiting the "one" can conflict with concerns for "others." Yet beyond the dyad, information divulged by family members can be of great relevance to the care of the patient (for example, a relative conveying concerns about the patient's heretofore unknown substance abuse difficulties).

In a dyadic model, therefore, a physician may face conflicting obligations to one family member's autonomy claims and another's beneficence claims. Can this or should this be resolved by a call to "just care for the patient in front of me?" The answer depends on the patient, the family and the doctor. [...]