Professional confidentiality is a long-standing right (and expectation) accorded to relations between doctors, lawyers and the clergy and their clients. The mutual understanding of personal confidentiality is now extended to other professions where a relationship of intimacy and trust is necessary, such as to accountants and therapists. Professional confidence protects the privacy of the individual and so may permit disclosure of otherwise illegal, incriminating, embarrassing or shameful matters. The problem arises when a sharing of confidences becomes, in effect, a collusion of deception which has the potential to harm others, or threatens to make the professional a party to illegality, or some similar serious consequence. The cloak of confidentiality can expand to include what professionals hide from patients, clients, and the public at large. This prevents outsiders from finding out about negligence, overcharging, unnecessary surgery, or institutionalization. Confidentiality is also used to protect incompetent colleagues, companies, or entire industries.
Hypothetical examples are: a lawyer to whom her client has confessed murder and whose defence convicts an innocent party; a family doctor who fails to reveal to one spouse that the other has AIDS; a financial adviser who knowing certifies the accounts of a business indulging in tax evasion; and a priest who repeatedly absolves in confession a multiple child-molester. A recent twist on the latter scenario is the Italian journalists who confessed very serious, but fictitious, offences to priests and were consistently absolved of sin and often counselled, in the case of criminal offences, not to tell the police.
The medical profession should safeguard the public and itself against physicians deficient in moral character or professional competence. Physicians should observe all laws, uphold the dignity and honour or the profession, and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession (American Medical Association's Principles of Medical Ethics). In practice such exposure is extremely rare.
Surely a train driver's drug addiction is more than his private affair, just as the guilt of the client on whose behalf the lawyer cooperated in perjury is not a matter of privacy alone.