Professional Confidentiality⤒🔗

Since Hippocratic times medical confidentiality was part of a doctor's code of ethics. Similarly, the "oath according to Hippocrates in so far as a Christian may swear it," includes the oath of medical confidentiality. "Whatsoever in the course of practice I see or hear (or outside my practice in social intercourse) that ought not to be published abroad, I will not divulge, but consider such things to be holy secrets."¹The purpose of the code of confidentiality is to help patients to trust their physician so that disclosed information will not be passed on to others. This bond of trust between patient and physician is important both in the diagnostic process and in the treatment phase. The outcome often turns out to depend not only on surgery and medications, but also on the patient's confidence in the doctor.

In some sense, however, medical confidentiality as patients and doctors have traditionally understood it, no longer exists. There are often quite a few health professionals and hospital personnel who are involved in providing healthcare services, and as such have access to the medical records. In modern hospitals there are often several attending physicians (surgical, intensive-care unit, and "covering" house staff), the nursing personnel (on three shifts), therapists, nutritionists, clinical pharmacists, students, unit secretaries, hospital financial officers, chart reviewers, techni­cal and support services, etc. Therefore, one must distinguish between information about the patient that will be kept confidential regardless of the interest of third parties and information that will be exchanged among members of the health-care team in order to provide care for the patient.

There are many angles to professional confidentiality and many confidentiality dilemmas in professional ethics. Should a physician warn the partner of an HIV-positive patient? Should a psychiatrist keep confidential a patient's threat to kill someone?

Pastoral Confidentiality←⤒🔗

In various new forms for the ordination of elders and deacons, the third question put to the brethren contains the question: "Do you promise … to keep the required secrecy with regard to what is confidentially brought to your attention in the discharge of your office?"²

This goes not only for elders and deacons, but also for pastors. Prof. C. Trimp correctly applies this to family visitation reports and pastoral reports.

To be sure, we are to report on our visiting. The members of the congregation will know that as well. This does not mean, however, that we are to report to council everything raised in family visiting or in a pastoral visit. That which they share with us explicitly in a confidential way is to remain confidential. Even if afterwards we feel the need to talk about it with a fellow office-bearer, of whom we know that he is also under oath of confidentiality, we may not do so, except with permission from the member(s) in question. They must be able to count on confidentiality. If need be, we can discuss with them to what extent they agree that we report to council. We should clearly agree on this with them. They may never feel that we betrayed them.

In reporting on our visits, elders and pastors need to be to the point and keep back confidential information. Our contact with the members of the congregation is to be marked by love and patience, by hoping and hiding and by covering (1 Corinthians 13:7), even if for a lengthy period of time we need to admonish and urgently counsel them. Only in that way there continues to be an open relationship with the members and the Word of God is given free course to bring about healing.

It is different, when the member of the congregation makes the sin to be a public sin, or we as office-bearers have become convinced that they are slowly but surely drawn into a questionable scheme against God and His people.³ Lynn R. Buzzard and Dan Hall quote Ecclesiastes 3:7 in their subtitle: "A time to be silent, and a time to speak."⁴ The purpose of confidentiality is not to undermine, but rather to protect respect for persons. For example, Jeanette Hofstee, Milgrom and Gary R. Schoener tell of a teenager who told her pastor of her father sexually abusing her. She asked him not to tell anyone else. The pastor talked with her for a long time, and finally, when she began to understand that the pastor was not to keep this information confidential, she agreed to contact children's protection services, etc.⁵

Confidentiality by Church Councils←⤒🔗

In practice it turns out to be difficult for members of the church council to keep things confidential. You will know the familiar story that at a council meeting there was a lengthy discussion of a very weighty matter. At the close of the discussion the chairman reminded the brothers of the confidentiality of the discussion. He stated it explicitly: "That is to say, brothers, you are not to speak about this matter with anyone." One of the brothers asked in response: "But chairman, what then can we tell our wives when we get home?" You will understand the point of the story: There are some who have difficulty keeping silent and others who tend to be nosy. As a result we sometimes hear members in the congregation say: "No, I'm not going to tell my district elder, for then his wife finds out as well, and then in no time the whole congregation will know." Sometimes elders hear members in their district say: "No, I'm not going to tell the pastor, for then his wife finds out as well, and then in no time the whole congregation will know."

It is necessary for us to keep confidential things confidential. We may not tell our family members any of it. When we become office-bearers, we need to discuss this matter of confidentiality with our wives, and our wives need to honour this obligation to keep confidential things confidential. Even though our wives are more aware than other members in the congregation of various aspects of our work as office-bearers, by their very attitude they are to convey that their husbands honour confidentiality.

May we not talk at all about our work as office-bearers to our wives? Are there not some aspects of our work as office-bearers that we may tell them? I repeat that we definitely may not talk with our wives about things that are clearly to be kept confidential. But maybe there are some aspects of a family visit that we can share, such as sickness in the family or other needs that our wives may know about. But then that should concern "things" that are clearly public knowledge or should be public knowledge, and the very best will be to ask the family if you may tell your wife.

Prof. W. H. Velema suggests that each office-bearer needs to know whether his wife is able to keep silent or not. If your wife is the type to readily talk with others about all she knows, then you can discuss with her less than someone whose wife is able to keep things silent.⁶

It is also needful to pastors to keep confidential things confidential over against their colleagues. Sometimes we pastors, when involved in "very difficult cases" feel the need to ask for advice from colleagues who have been in the ministry longer. At times we even feel the need to ask our wives for advice. This, however, is to be done only after we have asked for and received permission from those who are involved.

Prof. Trimp reminds us that we are not in council in order to satisfy our curiosity neither simply 'to pass on the latest' news. "Every office-bearer ought to so love the members who have been entrusted to his care that he in his contacts shows forth the form of Christ and for that reason knows how to restrain himself in his talking about these members of the congregation."⁷

The Need to Gain the Confidence of Those with Special Needs←⤒🔗

The matter of confidentiality is a matter of confidence. If there is this confidence and in practice we as office-bearers show that we know how to shepherd those who have special needs, that confidence will be given. It is not simply a matter of secrecy, of having to keep silent. Even if we are given the strictest rules for confidentiality, they as such do not encourage members to come to us and share matters which are to be kept confidential.

The question is: Do we as office-bearers have the wisdom to understand and are we able to lead in love those who are entrusted to our care? If that is missing, the most important things are missing. It is important for us in our labours as office-bearers to be not merely theologians who reason, but rather under-shepherds who love and lead the sheep.