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By LISA EISENHAUER
June 1, 2020

Veatch

When it comes to whether people have a right to know the name of someone who might have exposed them to the virus that causes COVID-19, Catholic ethicists can politely disagree. Dr. Daniel P. Sulmasy and Robert Veatch demonstrated that as they shared their views on a case study that was the focus of a webinar May 28.

Sulmasy, professor of biomedical ethics and acting director of the Kennedy Institute of Ethics at Georgetown University, said that based on the facts of the case, revealing the name of the person who might have infected others with the novel coronavirus would be an unnecessary breach of the person's right to confidentiality.

Sulmasy

"We can't abandon all of our medical ethical principles in order to pursue the common good of protecting people from the spread of this virus," he said. "Confidentiality is one of those other principles and I think it's a significant one that we should not at all think about dismissing lightly."

Veatch, who once also led the Kennedy Institute of Ethics and is now a professor emeritus of medical ethics and senior research scholar at Georgetown, saw releasing the name of the infected person as a necessary step to alert others to the potential risk. In his view, "if the circumstances dictate, and the risk is severe enough, then disclosure is morally required."

Facts of the case
"Should COVID-19 Positive Individuals Be Named Publicly to Alert Potential Contacts?" is part of a webinar series on Catholic ethics and the challenges of the pandemic. The series is co-sponsored by CHA and Georgetown University in cooperation with the university's Pellegrino Center for Clinical Bioethics.

Moderator David G. Miller, associate director for academic programs and administrator for the Pellegrino Center, gave panelists Sulmasy and Veatch a set of facts from an actual case to debate.

In the case, a private university alerted the entire university community by email that a staff member had tested positive for the virus. The email said that those who were potentially exposed would be personally notified. The staff member wasn't named. Subsequently, a faculty member asked ethicists at the university's medical school whether the staff member should be named to, in Miller's narrative, "maximize public health benefits and slow the spread of the virus."

To trace or to tell?
Sulmasy said no to revealing the person's identity. "I certainly recognize that people have justifiable fears about COVID-19," he said. "It's a new virus. It's novel. It's not fully understood. It is quite contagious, and it is potentially lethal. But I think our responses to this, like any other public health problem, have to be measured."

The appropriate response, he said, would be contact tracing. He said that tactic of finding out who the infected person might have exposed and alerting them to take precautions against the virus's spread has proven effective for decades with other transmittable illness, including tuberculosis and sexually transmitted diseases.

"It's imperfect, but I think that it strikes the right balance of not sacrificing confidentiality at the altar of public health," Sulmasy said.

Veatch, however, said contact tracing would have shortcomings in a situation like the case being discussed. He said the sweep of the exposure from the infected person couldn't be definitively known and the confidentiality of the person would have to be breached at least to the small circle of contact tracers.

"Releasing the identity of the individual is a much more thorough way of alerting people so that they can determine whether they're at risk," Veatch said.

Open to interpretation
Veatch and Sulmasy weren't completely at odds on the appropriate response to dealing with people who are potentially transmitting the COVID-19 virus. They agreed, for example, that if someone is spreading any disease intentionally and with malice, confidentiality could and should be set aside for the common good.

But they weren't in agreement on their interpretations of how Catholic social teaching was best applied to the case at hand. Sulmasy said the belief that physicians should keep information about their patients confidential is a principle that goes back to Hippocrates. The right to patient privacy and confidentiality is a directive in the Ethical and Religious Directives for Catholic Health Care Services.

Veatch said Jewish and Christian ethics support a much more social view of the role of physicians. Those teachings say doctors should safeguard not only the best interest of patients but of the wider community, he said. His conclusion was "if there's a grave enough risk, then there's not only a right but a duty to warn."

The webinar series will resume June 11 with a discussion on "COVID-19 and the Elderly: Ethical Issues and the Pandemic." Watch for registration information on CHA's website.

Prior coverage of this webinar series

Reasoned action is needed to restart clinical training for medical and nursing students, ethicists say

Surveillance tools offer great promise, perils amid pandemic, ethicist says

Watch the webinar recording