RESPONSIBILITY TO PATIENT SHOULD BE FIRST PRIORITY

Q I am a physician in a trauma center that does not check accident victims
for alcohol and drugs. If a driver is intoxicated, insurance will not cover
medical costs. However, not knowing blood-alcohol levels may have adverse
medical consequences. Should we check even if it means added financial
burdens, suboptimal care or exposure to criminal charges?

Anonymous New York

A doctor is pledged to do what is in the patient's best interest medically.
So check blood-alcohol levels, but do not disclose this information --
neither to cops nor to insurance companies -- without the patient's consent.

The American Medical Association's confidentiality policy is meant to
protect individual patients, not to promote public health, aid law
enforcement or reduce insurance rates. Of course, varying state statutes
can create conflicts between what is legal and what is ethical, putting the
doctor in an awkward position.

Fortunately, even aggressive disclosure laws often allow some discretion.
Some doctors, for example, regard a medical chart as a guideline for
continued care: Anything not directly pertinent need not be recorded. From
this perspective, a knowledge of blood-alcohol level that is vital for
immediate treatment may not be germane to future care and can be omitted.

You should discuss these issues with your colleagues when reviewing
emergency-room policy rather than leave them to the ad hoc decision of an
individual doctor under pressure. And do this not when the patient is on
the table but at the end of the working day.

That is also the time to contact your representatives and rally your
colleagues against laws that hinder patient care; this, too, is a doctor's
ethical obligation.

(snip)

Do you have ethical questions that you need answered? Send them to
ethicist@nytimes.com, or Everyday Ethics, New York Times Syndicate, 122
East 42nd St., 14th floor, New York, N.Y. 10168.