Q: I am a physician. A 30-year-old woman, a student, came for an initial visit. Her condition was unremarkable. A few weeks later the administrator of her school, a long-standing patient, mentioned how impressive it is that this woman continues to study despite having terminal cancer. The school even held a fundraiser to help with her medical bills. I said nothing, but must I let the school know that she does not have cancer? — Name Withheld
A: Your silence was golden: Medical ethics forbids you to disclose even that a patient is healthy, paradoxical as that seems. This strict concern for patient privacy is meant to ensure that nobody will be discouraged from seeking care for fear of what may be revealed to others.
The law takes a similar stance. A legal authority I consulted said that in this circumstance “the doctor cannot acknowledge that this individual is a patient.”
This need not consign you to silence, to feeling implicated in your patient’s deceit. Discuss the situation with the woman and urge her to come clean. You can say that you heard about the fundraiser, without referring to the administrator, and ask why people are raising money to help her pay for treatments for a disease she does not have.
It is conceivable that your patient’s behavior requires not moral reform but psychiatric treatment. Either way, you would do well to remind her of the pitfalls — legal, ethical, emotional — of engaging in fraud and of your unwillingness to be involved in it even indirectly. If she persists in this conduct, you may ultimately decline to continue seeing her as a patient.
Q: My son and daughter-in-law belong to a church with different beliefs from mine, and thus my new grandchildren were not going to be baptized. My 1950s Catholic background would not let me sleep, so I snuck them off to the laundry and performed private rites. Do I get eternal reward or damnation? — Name Withheld
A: By convening in the laundry you may have taken too literally the idea of baptism as the washing away of sin.
You will receive neither eternal reward nor eternal damnation but might face eternal resentment if your son and daughter-in- law discover what you’ve been up to. They may well consider the religious guidance of their children to be a parental prerogative. For anyone to intervene, even a well-intentioned family member, might confuse the kids (if they are old enough to recall your idiosyncratic ritual) and undermine their relationship with their parents. One ethical guideline: A description of conduct that begins with “I snuck” is apt to raise doubts.
Send questions and comments for Randy Cohen to Universal Press Syndicate, 4520 Main St., Kansas City, MO 64111, or ethicist@nytimes.com.
