Pressure to breach confidentiality

A GP became worried about one of his patients, an 83-year-old woman suffering from severe osteoarthritis, when he was informed in a letter from her stepdaughter that she intended to take her own life.

The GP met the patient on several occasions to discuss the matter but she made it clear that she did not intend to change her mind and requested that he did not attempt to dissuade her. Furthermore, she informed the GP of the date she would take her life, saying that she intended to take an overdose of paracetamol.

The GP telephoned the coroner's office for advice on whether a post mortem and inquest would be inevitable after a suicide, believing that if this were so, it may help him persuade the woman not to carry out her intentions. The coroner's office confirmed that a post mortem and inquest would inevitably follow. The GP asked the coroner's secretary what the consequences would be for him, given that he was aware that the patient intended to commit suicide. He was asked for the patient's name but refused to disclose it, having promised his patient not to tell anybody what she intended to do. The coroner expressed astonishment at the doctor's lack of co-operation.

Later the same day a senior police officer telephoned the GP, having been informed of the problem by the coroner's office, and asked him for the name of the patient. Again the GP refused to disclose it. He was warned that it was a criminal offence to aid and abet a suicide, punishable by 13 years' imprisonment, and that his duty of confidentiality did not entitle him to refuse to disclose the patient's identity.

The GP telephoned the MDU for advice. He was advised to maintain confidentiality. It was agreed that he would seek a second opinion from a partner or a psychiatrist to ensure that no opportunity for any appropriate treatment under the Mental Health Act 1983 was being missed. He was also advised to keep careful notes and to ring the MDU if there were further developments which gave rise to concern.

A psychiatrist found that the woman was a meticulous, self-confident person who could no longer tolerate her progressive physical deterioration. She had had a long term plan to take her own life if ever she became disabled and when she found walking more difficult, she believed that her quality of life had become unacceptable. She had put all her financial affairs in order and would not be dissuaded from her decision. She was anxious to avoid any distress and trouble for the GP and the psychiatrist.

The psychiatrist was satisfied that there was no evidence of depression or psychiatric disorder. There were no grounds upon which the patient could be admitted compulsorily to hospital under the Act.

During the course of the next four days the GP visited the patient daily. She remained determined to carry out her intentions. She showed the GP a note she had written requesting that should her attempt prove initially unsuccessful, no medical treatment was to be administered. The note also said that the GP had attempted to dissuade her from taking her own life.

On the fourth day the GP arrived at the patient's house to find that she had taken an overdose of paracetamol and had left a note indicating that this had been her intention. She was unconscious, vomiting and convulsing. She was taken to hospital some distance away. She regained consciousness briefly but died two days later. The post mortem revealed that death was due to broncho-pneumonia due to drug overdose.

The GP was visited by the police who warned him that he would be interviewed under caution. The MDU instructed a solicitor to be present during the interview. No criminal charges were pressed.

The patient had died outside the jurisdiction of the coroner to whom the GP had initially spoken. A neighbouring coroner therefore presided at the public inquest. His attitude was very different. The GP gave evidence and the coroner concluded that he did not think that "any crime had been committed by the GP and that it would have been a breach of his professional duty to disclose the patient's intentions to any third party". There was no evidence that he had provided any assistance to the deceased but it was recognised that the GP had done everything possible to try to dissuade the patient from her actions and it was to his credit that he had been open and honest with his partners and a psychiatrist about the case.

The coroner recorded a verdict of suicide.

This page was correct at publication on 01/10/2002. 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.