Nurses' duty of confidentiality towards patients

Those scholars among you will immediately attribute this intriguing aphorism to Sir Francis Bacon, philosopher and the first Queen's Counsel in the time of Elizabeth I:

‘He who hath a secret to keep, must keep it a secret that he hath a secret to keep’.

Those of you who are, like me, devotees of Yes, Prime Minister will of course attribute it to Sir Humphrey Appleby in the episode entitled ‘A Question of Loyalty’.

I begin with a point about the accurate use of the English language. One does not keep confidentiality, one keeps a confidence. In the same way that you consider breaking a confidence when there appears to be a case for doing so. The moral principle in which such decisions are made is called ‘confidentiality’.

The word ‘principle’ is chosen deliberately. The value of confidentiality in healthcare practice does not consist of a rule-book telling you what, and what not, to divulge. Rules tend to apply in an all-or-nothing way, while principles have a dimension of weight and relative importance. Some readers might be surprised to learn that there is actually very little by way of legal rules in the realm of confidentiality. There is no litmus test showing you how to do it. What could, perhaps, be cause for concern in modern healthcare practice is that there is very little guidance from the law. On reflection, that this is the case should be cause for relief and not disappointment. There is no ‘legal way’ of doing anything. That applies to professional healthcare practice, as well as driving a car and making a rhubarb crumble.