Marital secrets

The scene

The man already had children from a previous marriage; the woman had no children but very much wanted a child with her new spouse. She visited her GP, asking if she could be referred for fertility investigations. Tests were not necessary for her partner, she said, as he had already successfully fathered two children.

Her request put the GP in a delicate situation. The patient's husband was also a registered patient and the GP knew he had had a vasectomy in the past, which had not been reversed. In an attempt to buy some time, he suggested to the wife that she ask her husband to make an appointment to see him to discuss the infertility investigations, adding that this was necessary before referral could be made.

The patient agreed to do so, and asked if she should accompany her husband to the appointment. The GP suggested she should discuss this with her husband.

Unsure what more to do, the GP phoned the MDU advisory helpline for assistance.

MDU advice

The MDU advised that in the first instance, it would be preferable to try and persuade the man to tell his wife about the vasectomy. He could perhaps consider a reversal if he had changed his mind about wanting more children. The GP might volunteer to be present to support both patients during the conversation. Alternatively, he might suggest that the couple engaged in discussion about what was preventing them from conceiving, with a view to encouraging the husband to volunteer the information to his wife.

However, if the GP could not persuade the husband to speak frankly to his partner, the doctor would be faced with a different dilemma – the balance between his duty of confidentiality to the man and whether he could justify telling the woman about the vasectomy without consent against whether he should comply with the woman's request to go through invasive tests that might put her at risk, for example, a laparoscopy and dye test.

If the GP had determined that it was necessary for the woman to be told about the sterilisation, he should seek the husband's consent to inform his wife about the sterilisation. Occasionally patients cannot initially bring themselves to share information, but when faced with the possibility that a doctor might consider it necessary, they may decide it is best for them to do so, or they may consent to the GP divulging the information.
 
Without the man's consent, the GP would have to consider whether disclosure of the fact of the vasectomy is a justifiable breach of the husband's right to confidentiality. However, it seems possible that this may be difficult to justify under these circumstances.

GMC guidance, Confidentiality (2009), states in paragraph 37 that 'personal information may be disclosed without patients' consent, and in exceptional cases where patients have withheld consent, if the benefits to an individual or to society outweigh both the public and the patient's interests in keeping the information confidential'.

If the GP chose to approach the man with a view to disclosing the vasectomy to his wife, he must 'weigh the harms' that are likely to arise from non-disclosure against the harm to the patient and the doctor-patient relationship of releasing the information.
 
After carefully considering the options, the GP invited the couple to the surgery to discuss their situation together with him. He explained to them both the invasive nature of the tests the wife would have to undergo to establish her fertility. He stressed the importance of open communication and not agreeing to investigations unless they were quite sure this was what they wanted. The couple agreed to go home and talk about their situation.

Some weeks later, the woman visited the GP to say that her husband had told her about the vasectomy and that they had decided to find out more about the possibility of a reversal procedure.

This page was correct at publication on 17/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.