Whatever discretion a court may have in not compelling disclosure of confidential information, it will not be exercised where withholding evidence may protect a criminal or endanger public health. Although Dr Mann advised his patients to go to the police, he did not seek their consent to identify them to the authorities. The Australian Medical Association's revised Code of Ethics recognises that in some circumstances medical confidentiality may be ignored, although it would have been more helpful if the guidelines had been more specific. Suppose a patient confesses to his psychiatrist that he intends to kill his girlfriend. The different States and Territories have various reporting laws, dealing with matters such as child abuse, fitness to hold a driving licence, and notifiable diseases, which require medical practitioners to provide certain information to relevant authorities.
Child abuse is notifiable in all States and Territories except South Australia and Queensland.
South Australia imposes a duty on doctors, opticians and physiotherapists to inform the relevant traffic authorities if they have reasonable cause to believe that a person whom they have examined suffers from a disability such that, if driving a motor vehicle, he or she would be likely to endanger the public. In the absence of mandatory reporting requirements, I suggest that a doctor is nonetheless under a positive duty to inform the relevant authorities where he or she reasonably suspects that a patient suffers from a psychiatric or other medical disorder which may pose a threat to that person or to the lives or safety of others. Where practical or meaningful, the patient's permission to disclose the information should be sought, and, if permission is refused, the patient should be warned that the information will be passed on to the relevant authority. But taking such a course of action may result in legal action. In 1983, a general practitioner in New Zealand had been treating a bus driver who had had a coronary bypass and whose heart condition was unstable.