Fidelity of the physician-patient relationship requires respect for confidentiality. When patients enter into a relationship with a medical professional, an implied promise of confidentiality is made. The physician has an obligation to live up to the patient's expectations of privacy and to earn the patient's trust. While each of these arguments make a strong case for maintaining confidentiality, there are cases where confidentiality may be broken, and in fact there are circumstances where a physician has an obligation to break confidentiality. There are laws in the United States which require physicians to report certain infectious diseases to public health authorities, in order to protect the health of the community.
Similar laws hold true when physicians suspect child abuse in a minor patient.
The landmark case that explores the obligation of physicians to break confidentiality is Tarasoff v. Regents of the University of California. In Tarasoff, a psychologist failed to warn a woman or her family when his patient threatened to murder the woman. The court in Tarasoff found that in spite of the need to protect confidentiality, especially in therapeutic settings, that the therapist had an obligation to warn the potential victim of violence. One standard set forth in Tarasoff is that physicians have a duty to breach confidentiality in cases where harm to the patient or harm to the community may result from maintaining confidentiality. Tarasoff may be helpful in looking at the circumstances of nurse Hathaway and her patient.