Law and ethics in conflict over confidentiality?

Ethical principles that require the preservation of patients' confidential information are reinforced by principles found in several areas of law, suc h as law on contracts, negligence, defamation and fiduciary duty. However, laws sometimes compel disclosures of medical confidences, and more often ma y justify or excuse disclosures. Legally contentious issues concern patient s' confidences regarding possible unlawful conduct, such as pregnancy termi nation, and the risk of spread of HIV and other infections. This article re views the various legal bases of the duty of confidentiality, and legal cha llenges to the ethical obligation of:nondisclosure. It addresses the justif ications and limits of exchange of patients' health information among healt hcare professionals and trainees, and considers legally recognized limits o f confidential duties, and the scope of legitimate disclosure. An underlyin g theme is how to determine whether physicians are ethically justified in e mploying the discretion the law sometimes affords them to breach patients' expectations of confidentiality. (C) 2000 International Federation of Gynec ology and Obstetrics.