By Murali Vallipuranathan –

Dr. Murali Vallipuranathan

“When Herod realized that he had been outwitted by the Magi, he was furious, and he gave orders to kill all the boys in Bethlehem and its vicinity who were two years old and under, in accordance with the time he had learned from the Magi” ~ Matthew 2:16

Reports have emerged that the Terrorism Investigation Department (TID) had sought information on all babies born from May 25th to May 30th 2018 in the Kilinochchi district from doctors and public health officials (1) (2). Consequently doctors and public health officials in the Kilinochchi District are compelled to provide the information about the mothers who delivered babies between May 25^th and May 30^th. This news has caused ripples among the medical personnel and public health officials as such disclosure of information will constitute violation of confidentiality of patients’ information. Ethics of confidentiality is not only applied to the medical practitioner but also to other health care professionals such as nurses, midwives and institutions involved in providing health care (3).  

General Medical Council stipulates that a medical practitioner must not disclose personal information of patients to third parties such as lawyers, police officers or officers of a court without the patient’s explicit consent, unless it is required by law, or ordered by a court, or can be justified in the public interest (4). Applying the same standards of ethical practice in Sri Lanka a medical practitioner should not disclose information to TID officers without them fulfilling the above criteria and if they disclose the information that would result in TID officials treating all the mothers delivered between these days as suspects or aiding terrorists, visiting them and subjecting them to the well-known interrogation methods used by police in extracting information. The only justification in disclosing information in the GMC recommendation would be in an instance where others remain at risk. In this example if the mother is directly involved in terrorist activity then probably information about that person may be disclosed. But here it appears the TID officials has taken an unusual method of finding a terrorist suspect by tracing the delivery date of his wife. Even if somebody argues that the details of the wife of a terrorist suspect could be disclosed there is no justification to reveal the details of the delivery dates of other innocent mothers because they were not involved in any criminal activity or not putting others into any risk. 

If the confidentiality is not maintained the patients will lose confidence in the health care provider and will not share any sensitive information (5). In this instance if mothers find that the information revealed to government health service could be revealed to the security services and they are at the risk of being subjected to unpleasant interrogation they will in future not turn up to the government service clinics and even resent public health midwife and other health care providers visiting their households and collecting information. This would be a major setback to the public health achievements Sri Lanka had achieved so far such as low maternal and infant mortalities and high level of immunization rates in par with developed countries. We were able to reach these targets because of the fullest cooperation extended by the public to the health care providers and the confidence of the people placed on the public health system in Sri Lanka. As a responsible public health official with knowledge in medical ethics I appeal to the authorities, medical associations and human rights organizations to support my call to allow the confidentiality of the patients to be maintained and without jeopardizing the confidence of the mothers have on the health service providers and the public health system. TID officials should use improved techniques to find out suspects rather than harassing all the mothers by using the data on the date of deliveries. This improvised method only remind me the biblical account of Massacre of Innocents where all suspected children born on a particular period near Bethelehem were killed. 

*Dr. Murali Vallipuranathan, MBBS, PGD (Population Studies), MSc, MD (Community Medicine), FCCP (SL), FRSPH (UK), Board Certified Specialist Community Physician, Visiting Lecturer in Ethics – University of Colombo

References:

1. https://www.tamilguardian.com/content/tid-seeks-information-about-babies-born-kilinochchi-may 

2. https://www.jvpnews.com/srilanka/04/179615 

3. http://media.axon.es/pdf/91523.pdf 

4. https://www.gmc-uk.org/-/media/documents/Confidentiality_good_practice_in_handling_patient_information___English_0417.pdf_70080105.pdf

5. https://depts.washington.edu/bioethx/topics/confiden.html