Medical confidentiality

committees representing some 25 countries, most of them in North America and Western Europe. If we examine 15 statements from eight nations, Australia, Canada, Fed- eral Republic of Germany, France, the Netherlands, Spain, the United King- dom, the United States, we find that they unanimously concluded that in vitro fertilisation is in principle accept- able, but some would restrict this to heterosexual married couples with a medical need. Eleven of the 15 com- mittees include couples living together in stable relationships, and only five regard either single women or members of homosexual couples as appropriate candidates for in vitro fertilisation in some circumstances. All the committees accept the potential clinical usefulness of embryo freezing, but they regard the technique as experimental and consider that a time limit should be set for the cryo-preservation of frozen embryos. They disagree on the appropriate length of time. Of the 15 committees, 12 find ovum WORLD HEALTH, April 1989 donation to be acceptable without qualification . A more cautious approach is taken to embryo donation; they agree that donation should be genuine, but some draw distinctions between reimbursement of donor expenses, payment for time and incon- venience. But there is a fear that this may open the door to commercial- isation. The committees also disagree on the question of donor anonymity, and express strong opposition to surrogate motherhood. Eleven com- mittees approved some kinds of research with early embryos remaining from clinical abortion. The problems posed by the new reproduction technologies cannot be left for ever to health professionals, who, after all, represent only part of society. Nations will have to promul- gate laws, but they are right to be cautious, as no legislation can be enacted unless the basic ethical agreement of the population con- cerned is reached. Up to now no consensus could be obtained on some of the main issues, and each country should be prepared to pass legislation according to its own moral values. At the same time, there should not be too many disparities between statutes. In view of the increasing interdependence between countries it is essential that an international dia- logue be initiated. On such intimate matters, legislation invariably lags behind the evolution of mental atti- tudes. These attitudes will have to attune themselves to new concepts that overtake traditional ways of thinking. Science moves forward more quickly than mankind evolves; the laws will follow. • }['~!~~r;ec: ~oe~fc~~i:~a~~f~~~~ of prospectiv~. clients who _seek life insurance~ and . recently they have started asking doctors whether or not tt)eir patient is :at risk from .AIDS . . A general _ prac- tit!oner writ!p9 in the .British Medical Journal commented: "Obviol!sly, if:a patient h~s been testectforHIV '(the AIDS virus) and tqund · positivE:1r that information Is legitimately of. real concern to potential insure~s. E;lut we are .mov!pgJo aJidiculous_ position in .. which patients who have been AIDS tested think that they have to conceal this from.their physici~ns; rE:1gardless of,the result, because doctors may hot be safe holders o~ that information." . The GP ahd his colleagues d.ecided that insurance com- panies ought to rely on their plients to answer quesUons about h~w they live, and should restrict questions addressed to physi~ cians to matters that are strictly medical. He wrqt~: "To put our policy intp pra,ctiqe we have hada r!Jbber stamp made that reads: 'We are not willing . to .(lnswer questions about /ife$tyles ', and we apply it Jreely to insurance questionnaires." '' • .What the doctor bears uin the consulting room is intend~ to be confidential. · 9