Is it permissible for a physician to divulge a patient’s secret if they fear harm to others?

The principle is that a physician is prohibited from disclosing any confidential information acquired in the capacity of a medical professional, especially when there exists no necessity to require this. However, in the presence of gross harm that may extend to others, then in such an instant, it is incumbent upon the physician to alert the competent authorities, and in doing so, it would not be considered violation of doctor-patient confidentiality provided the physician limits the disclosure strictly to those authorities.

 

Safeguarding private information is one of the trusts that must be upheld

Among the most noble values of Islamic law is the principle of trust, through which the rights of Allah and those of His creation are protected. The Prophet (peace and blessings be upon him) was known among his people before his prophetic mission as al-sadiq al-ameen (the truthful and honest). Allah Almighty praises the believers for their protection of trusts, saying, “Those who faithfully observe their trusts and their covenants” (Quran, 23:8), and prohibits the breach of trusts, saying, “O you who have believed, do not betray Allah and the Messenger or betray your trusts while you know” (Quran, 8:27). The concept of trust encompasses everything that is required to be safeguarded and fulfilled. It therefore includes safeguarding entrusted property, fulfilling professional duties, and maintaining confidentiality, the last being the most emphasized. Defining trust, imam Abu al-Baqa` al-Kafawi, the Hanafi scholar, noted in Al-Kulliyyat (p. 197), “Everything that has been made obligatory upon the servants [of Allah] is a trust, such as prayer, zakat, fasting, and the settlement of debts. Among these trusts, safeguarding entrusted deposits holds particular importance, while the highest form of deposits is the keeping of secrets.”  

 

Secrets

A secret is that which is concealed from others and withheld from disclosure; Allah Almighty says, “And if you speak aloud - then indeed, He knows the secret and what is [even] more hidden” (Quran, 20:7). Safeguarding another person’s secret is a sacred trust whose reward is equivalent to that of concealing the faults of others. Abdullah Ibn Umar (may Allah be pleased with them both) narrated that the Messenger of Allah (peace and blessings be upon him) said, “A Muslim is the brother of another Muslim. He does not wrong him, nor give him up … Whosoever conceals the faults of a Muslim, Allah will conceal his faults on the Day of Resurrection” (Bukhari and Muslim).

Additionally, divulging the secrets of others is considered a breach of trust, which is one of the traits of hypocrites. Abdullah Ibn Amr (may Allah be pleased with him) narrated that the Prophet (peace and blessings be upon him) said, “There are four traits that together define a true hypocrite. Whoever possesses even one of them, possesses a mark of hypocrisy until he abandons it: when he is entrusted, he betrays the trust; when he speaks, he lies; when he makes a promise, he breaks it; and when he quarrels, he behaves unjustly” (Bukhari and Muslim). While the texts clearly stress the crucial importance of preserving trusts, including safeguarding the confidences of others, this emphasis takes on an added dimension for those who, by virtue of their profession, are exposed to confidential matters. In such cases, as with physicians, the preservation of confidences is an obligation, given that their profession requires them to be informed of their patients’ condition and circumstances during examination and diagnosis.

 

Breach of doctor-patient confidentiality

It is incumbent upon a physician to uphold the confidentiality of their patients as it is strictly forbidden to divulge any of their private information, as doing so constitutes engaging in ghayba, i.e., mentioning something about a person in their absence that they would dislike, which is prohibited. This is premised on the words of Allah Almighty, “And do not spy or backbite each other. Would one of you like to eat the flesh of his brother when dead? You would detest it. And fear Allah; indeed, Allah is Accepting of repentance and Merciful” (Quran, 49:12). Imam al-Qurtubi noted in Al-Jami’ li Ahkam Al-Quran (16:337), “There is no contention that ghayba is a major sin, and that whoever engages in it must repent to Allah Almighty.” The implication derived from the text is that divulging a patient’s confidences is a form of ghayba, as it involves mentioning something about the patient that they would dislike. Allah Almighty also says, “O you who have believed, do not betray Allah and the Messenger or betray your trusts while you know” (Quran, 8:27). Imam al-Fakhr al-Razi stated in Mafatih Al-Ghayb (10: 109), “Know that a person’s actions are directed at their Lord, other people, or themselves. It is incumbent to safeguard trusts in all of the three areas. Safeguarding trusts in reference to Allah means doing everything that Allah has commanded and refraining from everything He prohibited … As for safeguarding trusts in reference to others includes returning deposits, refraining from cheating and shortchanging in both measuring and weighing, and also involves refraining from exposing the faults of others.”

The divine command to safeguard trusts encompasses everything a person is entrusted with. Accordingly, a physician is entrusted with all the confidences of their patients. It is prohibited to divulge them without a necessity, and doing so constitutes betrayal of trust. Islamic texts enjoin Muslims to protect the privacy and faults of their fellow Muslims. The texts enjoin upon Muslims the duty to protect the privacy and faults of their fellow believers; the Prophet (peace and blessings be upon him) said, “If Allah conceals the faults of a servant in this world, He will conceal them on the Day of Judgment” (Muslim). Commenting on the hadith, Qadi Iyyad in Ikmal Al-Mu’alim bi Fawa`id Muslim explains that it means that Allah will conceal a Muslim’s faults and sins on the Day of Judgment by not exposing them before the assembly of all humanity gathered for the final judgement. He also suggests that it may mean that Allah will withhold judgment on those sins and not mention them before the individual.

Ibn al-Haj, the Maliki scholar, stated in Al-Madkhal (4:135), “A physician must be trustworthy with their patient’s confidences. They should not disclose anything the patient has shared, as they do not have the patient’s consent; and even if they do, they still must refrain from doing so.” 

The renowned physician Ibn Abu Usaybi’ah, in ‘Uyun Al-Anba` fi Tabaqat Al-Atibba (p. 45), records from the Hippocratic oath, “Whatever I witness while treating patients, or hear at other times concerning the affairs of others that is meant to remain private, I will not divulge. I hold that such matters should never be spoken of.” In the same book, Abu Usaybi’ah quotes from the Egyptian physician Ali Ibn Ridwan (pp. 564-5) saying, “This is taken from his own words, copied from his handwriting: According to Hippocrates, a true physician is one who possesses seven qualities … the third being that he must be discreet with his patients’ private information, never divulging anything about their illnesses.”

 

Breach of doctor-patient confidentiality when there is concern for the well-being of others

The principle is that it is impermissible for a physician, or someone in a similar role, to disclose a patient’s private information, as doing so constitutes a breach of trust, which is prohibited. However, there are certain circumstances in which exceptions may apply, allowing a physician to share a patient’s private information without violating the duty of confidentiality.  One such case is when doing so serves a greater benefit or prevents harm. This includes situations where there is concern for the well-being of others, among which is fear for the welfare of others, which is the subject of the inquirer’s question. Examples include a patient infected with an epidemic disease that raises serious concern for public health, or a patient who has sustained an injury in the course of a crime and seeks medical help from a physician, and so forth. In such cases, the physician must inform the competent authorities to take the necessary measures to reduce the likelihood of harm to others. This is not considered a violation of patient confidentiality or a breach of trust based on the principle that states: private harm may be tolerated to prevent public harm.

It is essential to recognize that a physician’s duty to report such matters plays a key role in preserving the well-being and stability of society, since breaching a patient’s confidentiality in such cases constitutes a private harm which carries less weight than the public risk. Accordingly, it should not take precedence, as a lesser harm may be borne to avert a greater harm to the public. Similarly, informing the competent authorities of the patient’s condition serves as an Islamic legal interest as it pertains to the public good and helps prevent harm. Jurists have permitted the disclosure of the faults of others when doing so serves to prevent significant harm and promote a great benefit; this does not constitute backbiting which is prohibited. Imam al-Nawawi observed in his commentary on Sahih Muslim (2:113), “All of this is considered gossip if it lacks legitimate religious purpose; however, if necessity calls for it, then there is no prohibition against it. This applies, for instance, when a person informs another that someone intends to cause harm to them, to their family, or to their property, or reports to the imam or to a person in a position of authority that someone is engaged in certain actions that are likely to cause harm, and it is then the duty of those in authority to investigate and act to prevent the harm. Situations like these and others of a similar nature, are not considered prohibited; some of them may be considered obligatory and others recommended, depending on the circumstances. And Allah knows best.”

Article (5) of Egyptian Ethics Charter for Human Medicine for 2003 CE states, “A doctor must inform the competent health authorities when an epidemic disease is suspected, so that preventive measures are taken to protect the society,” while article (30) of the same charter states, “A doctor may not disclose his patient’s confidential information which he learnt by virtue of his profession, unless this is based on a judicial decision, in the event of the possibility of serious and certain harm affecting others, or in other cases specified by law.” Additionally, article (33) states, “A doctor must inform the competent authorities of injuries and accidents suggestive of criminal activity, such as gunshot wounds, stab or cut wounds, or others, and write a detailed medical report on the case at the time it is presented to him. The doctor can invite a fellow practitioner to assist in evaluating the case and drafting the report.”

It is important to note that any such disclosure, where permitted, should be confined to the competent authorities. This is because divulging a patient’s confidential information in such cases is treated as a necessity; the Islamic legal maxims states that a need is accorded the same weight as a necessity and that a necessity is measured by its extent. Therefore, if a physician divulges a patient’s confidential information to other than the competent authorities, they are considered to have betrayed the trust placed in them, failed in their professional duty to maintain patient confidentiality, and to have exposed themselves to legal liability.

And Allah Almighty knows best.