# Could medical info be kept secret in this situation? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [December 27, 2013, 9:39pm UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315 "2013-12-27T21:39:34Z")\ **Posts on this page:** 14\ **Page:** 1
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 27, 2013, 9:39pm UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/1 "2013-12-27T21:39:34Z")
Hey all, Well, it’s time for another question for a fictional scenario in my book! And everyone here is SO smart… I just KNOW that somebody will know the answer. 🙂 Here’s the situation: The main character’s rich, eccentric uncle (Julius) is told that he has an aggressively growing brain tumor and is terminal. He doesn’t want his nephew (Nate, the MC) told about it. Nate lives about a thousand miles away and has no other living relatives. He’s also a minor. In this case, does Nate have any right to know that outweighs patient privacy? I’m FAIRLY conversant with HIPPA, but I really don’t know what the answer would be here. ---
**Author:** ![Shagnasty](https://avatars.discourse-cdn.com/v4/letter/s/9dc877/32.png) [@Shagnasty](https://boards.straightdope.com/u/Shagnasty)\ **Post date:** [December 27, 2013, 9:53pm UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/2 "2013-12-27T21:53:16Z")
No, Nate doesn’t have a right to know if his uncle does not want him too. No hypothetical family members would either including a spouse, children or parents if Julius had them. HIPAA rules are very clear on that and that is exactly the type of privacy it is meant to protect. No medical professionals would be allowed to give Nate any information without his uncle’s express consent. ---
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 27, 2013, 11:05pm UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/3 "2013-12-27T23:05:36Z")
Poor kid. ☹ Well, as it turns out, Julius makes a deal with Satan and doesn’t really die anyway; he just hovers in an undead kind of status. So there’s that. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [December 28, 2013, 12:10am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/4 "2013-12-28T00:10:05Z")
Just out of curiosity, why would you think that the kid might find out. I can’t think of an IRL situation where that might happen. You have to sign something to even let them release that information to your spouse. If you want Nate to find out, you can have Julius sign a form when he first registers at that office saying that they can discus Julius’ medical information with Nate. You have, no doubt, signed that same paper at every doctor’s office you’ve ever been at. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [December 28, 2013, 12:22am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/5 "2013-12-28T00:22:59Z")
Something like [this](https://www.google.com/search?safe=off&biw=1290&bih=740&tbm=isch&sa=1&q=patient+privacy+form+sample&oq=patient+pri&gs_l=img.3.2.0l7j0i5l3.100995.102401.0.104983.11.10.0.1.1.0.123.923.7j3.10.0....0...1c.1.32.img..0.11.930.QRFcVQl8H2s#facrc=_&imgdii=_&imgrc=ISADGol13j10cM%3A%3BjpxdnxM5lmxXVM%3Bhttp%253A%252F%252Fimg.docstoccdn.com%252Fthumb%252Forig%252F38917793.png%3Bhttp%253A%252F%252Fwww.docstoc.com%252Fdocs%252F38917793%252FPATIENT-CONSENT-AND-AUTHORIZATION-FORM%3B1275%3B1650) (Sorry, I can’t link directly to it). If you can write in a way for Julius to write in Nate’s name on this then you can possibly write in a way for Nate to find out, legally. Maybe he misses some appointments and they call Nate out of concern? Maybe Nate does some snooping (calls neighbors) somehow and finds out that he goes to that doctor and they tell him what’s going on? I dunno, but if his name is on that form, they can talk to him without breaking any HIIPA laws, I think. ---
**Author:** ![picunurse](https://avatars.discourse-cdn.com/v4/letter/p/7bcc69/32.png) [@picunurse](https://boards.straightdope.com/u/picunurse)\ **Post date:** [December 28, 2013, 12:38am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/6 "2013-12-28T00:38:37Z")
Is Nate his closest living relative? If so, when Julius becomes incapacitated from his disease, and if Nate is present in the hospital, he will be given updates on his prognosis and treatment. If he is not present, or he is not the closest living relative, then no, he will not know unless another family men=mber tells him. ---
**Author:** ![samclem](https://avatars.discourse-cdn.com/v4/letter/s/a9a28c/32.png) [@samclem](https://boards.straightdope.com/u/samclem)\ **Post date:** [December 28, 2013, 12:47am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/7 "2013-12-28T00:47:42Z")
Theoretical questions about fictional things-----IMHO. Moved from General Questions. **samclem** , mnoderator ---
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 28, 2013, 1:02am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/8 "2013-12-28T01:02:15Z")
Well, here’s one thing that I did think of. The uncle has a glioblastoma, which actually does have a strong genetic basis. [Here’s something about that.](http://www.webmd.com/cancer/brain-cancer/news/20101222/genetic-defect-at-work-deadly-brain-tumors) In the fictional scenario, scientists found out within the last year that these kinds of tumors are 100% genetic. Genetic diseases DO have to be revealed to close relatives. SO… what kind of scenario could happen from that? All ideas welcome. 🙂 ---
**Author:** ![buddha\_david](https://avatars.discourse-cdn.com/v4/letter/b/ee7513/32.png) [@buddha\_david](https://boards.straightdope.com/u/buddha_david)\ **Post date:** [December 28, 2013, 1:28am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/9 "2013-12-28T01:28:52Z")
> [@Shagnasty](#): > > No, Nate doesn’t have a right to know if his uncle does not want him too. No hypothetical family members would either including a spouse, children or parents if Julius had them. HIPAA rules are very clear on that and that is exactly the type of privacy it is meant to protect. No medical professionals would be allowed to give Nate any information without his uncle’s express consent. To clarify, HIPAA rules apply _only_ to medical doctors and related professionals. I believe this law covers a wide umbrella, so if Dr. Smith (Uncle Julius’s doctor) is discussing the case which is overheard by Dr. Jones (the hospital shrink) then Dr. Jones would be forbidden from telling anyone even if he doesn’t treat Uncle Julius. Non-medical personnel, such as family members, are not affected by HIPAA. Nate’s older brother may know about Uncle Julius’ cancer and there is no law preventing him from telling anyone – in fact, Nate’s brother may decide to tell Nate anyway, against Uncle Julius’ wishes, if he feels there is a moral imperative to tell Nate the truth. Since this appears to be a fantasy novel, Nate could learn the truth from a tarot card reading, or hearing angelic voices, or maybe even by bribing Satan himself. (I’m pretty sure Satan isn’t bound by HIPAA.) ---
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 28, 2013, 2:16am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/10 "2013-12-28T02:16:00Z")
> [@buddha\_david](#): > > (snippety snip) > > Since this appears to be a fantasy novel, Nate could learn the truth from a tarot card reading, or hearing angelic voices, or maybe even by bribing Satan himself. (I’m pretty sure Satan isn’t bound by HIPAA.) HA! I’m sure he isn’t. 😉 The thing is, though, that I really want to avoid the entire magical realism genre, including any aspect that drifts into it. Picture something much more like a Stephen King-type narrative voice, where there’s a HUGE divide between the real and the unreal, and characters spend a lot of time and energy trying to deny the supernatural things they’re witnessing. So… overall, it would be most useful, I think, to try to figure out if the genetic link thing would work. I’m looking for truthiness. 🙂 ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [December 28, 2013, 3:01am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/11 "2013-12-28T03:01:09Z")
> [@Anise](#): > > Genetic diseases DO have to be revealed to close relatives. Is that something you made up for the book or is that real, I’ve never heard of it? Either way, it seems like you have your answer. ---
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 28, 2013, 3:05am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/12 "2013-12-28T03:05:51Z")
> [@Joey\_P](#): > > Is that something you made up for the book or is that real, I’ve never heard of it? Either way, it seems like you have your answer. No, that’s real. > [@](#): > > A person’s decision not to disclose her or his risk of developing a genetic condition to a family member may pose a dilemma for the health care professional, who has to choose between ethical obligations to inform the at-risk party1, 2 and legal requirements to respect and protect the patient’s privacy. > > (examples) > The potential for harm to family members often plays a large role in the decision. In such cases, clinicians should carefully explain the reasons for sharing information with family members, strongly encourage patients to notify at-risk relatives, and offer to help develop a plan for notifying them. When patients choose not to notify family members, clinicians typically respect the decision. There are situations, however, in which the clinician may consider overriding the patient’s preferences because the family member is judged to be in danger of serious or immediate harm or there is a high likelihood that a dangerous condition will occur that can be either prevented or adequately treated with early recognition. Clinicians who believe it is necessary to override a patient’s wish regarding the notification of family members, should consider consulting an ethics committee or legal council.3 [Here is the NIH paper.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677756/) In THIS example, you see, it’s a type of tumor that can kill within weeks, and can occur at any age. (By the time the truth is finally revealed, Nate is about 21.) So I guess another question is-- is that scenario believable to the point where doctors reading this wouldn’t just laugh? ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [December 28, 2013, 3:20am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/13 "2013-12-28T03:20:18Z")
> [@Anise](#): > > No, that’s real. > > [Here is the NIH paper.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677756/) > > In THIS example, you see, it’s a type of tumor that can kill within weeks, and can occur at any age. (By the time the truth is finally revealed, Nate is about 21.) So I guess another question is-- is that scenario believable to the point where doctors reading this wouldn’t just laugh? Glancing at that article (without clicking on all the footnotes) makes it seem like that doesn’t override HIIPA it just sorta makes it seem like if someone does decide to go around the HIIPA laws with the blessing of the ethics committee at the group they work for, they’ll probably be in the clear it the patient decides to sue them. They’ll probably also need the person that they gave the information out to to be on their side on not on the plantiff’s side. Not telling them is HIIPA, that’s law. Telling them is “ICN Code of Ethics”. I assume that’s not law and that HIIPA overrides that. Has Julius ever been close with Nate? Would there ever have been any reason for him to put his name on that Patient Consent form I linked to earlier? If he signed that, maybe even with his GP earlier that year and his GP had all of his medical records (would he have a copy of this) you might be able to make this work? Is there a good reason for the nurse that’s going to inform Nate to know that Nate exists and know how to get a hold of him? I mean, I don’t talk to my doctors about my relatives that live thousands of miles away. ---
**Author:** ![Anise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/anise/32/21721_2.png) [@Anise](https://boards.straightdope.com/u/Anise)\ **Post date:** [December 28, 2013, 4:32am UTC](https://boards.straightdope.com/t/could-medical-info-be-kept-secret-in-this-situation/677315/14 "2013-12-28T04:32:24Z")
Okay, so here’s the exact situation, which it might help to know. Julius (creepy old uncle) was diagnosed with this tumor pretty recently, so he could die at any time. He and Nate are the last of the family. Nate’s father also was diagnosed with the tumor… but he and all the other relatives died in a mysterious bus accident when Nate was seven years old.There is brand new medical information showing that this tumor is actually a lot more likely to strike younger people without any warning. So Nate could pretty much drop dead any day now. I think… (goes back to research what happened… um, I mean, what the FICTIONAL SCENARIO is… 😉 Julius did sign a patient consent form at one point, because he realized that it would have looked too strange to others if he didn’t. He’s been working for several years on a project to cheat death, using mysterious records in the family library hinting at a deal with an unearthly entity that fell through. What he didn’t expect was for the familial death sentence to descend at that time, because he’d already figured out that it had always been a lot more likely to strike younger people. So the upshot of all this is that Dr. Burns (the neurologist) called Nate and asked him to come back home. (The nurse was literally the one who called, but you know what I mean.) Believable, or no? 🙂