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Contesting Medical Confidentiality

Origins of the Debate in the United States, Britain, and Germany

Medical confidentiality is an essential cornerstone of effective public health systems, and for centuries societies have struggled to maintain the illusion of absolute privacy. In this age of health databases and increasing connectedness, however, the confidentiality of patient information is rapidly becoming a concern at the forefront of worldwide ethical and political debate.
In Contesting Medical Confidentiality, Andreas-Holger Maehle travels back to the origins of this increasingly relevant issue. He offers the first comparative analysis of professional and public debates on medical confidentiality in the United States, Britain, and Germany during the late nineteenth and early twentieth centuries, when traditional medical secrecy first came under pressure from demands of disclosure in the name of public health. Maehle structures his study around three representative questions of the time that remain salient today: Do physicians have a privilege to refuse court orders to reveal confidential patient details? Is there a medical duty to report illegal procedures to the authorities? Should doctors breach confidentiality in order to prevent the spread of disease? Considering these debates through a unique historical perspective, Contesting Medical Confidentiality illuminates the ethical issues and potentially grave consequences that continue to stir up public debate.

168 pages | 6 x 9 | © 2016

History: History of Ideas

History of Science

Law and Legal Studies: Legal History


Philosophy: Ethics


"A detailed history of the quarrels to flexibilize medical confidentiality in the late 19th to early 20th century should be quite tedious. Not in this case, though: Maehle manages to come up with an exhaustively documented and yet highly readable volume. The book recounts the parallel journeys of medical confidentiality in Germany, the US, and Britain. To that end, the author astutely uses three fields where the clash between medical confidentiality and the public interest of those times was more intense: giving judicial testimony against patients, reporting patients with sexually transmitted diseases, and taking to the authorities patients suspected of illegal abortion. The author's strategy proves fruitful in both delivering the contents and capturing the reader's attention. The result is an erudite and interesting short volume. Highly recommended."


“Maehle provides readers an elegantly written comparative history of what gets classified as medically confidential and why in the US, Britain, and Germany, during the late 1800s to the early 1900s. The period is critical to understanding the social interests that created and sustain modern concepts of confidentiality. Since these modern concepts might be about to give way to something quite different in response to  new information demands in health care, Contesting Medical Confidentiality is particularly timely and vital.”

Pamela Sankar, University of Pennsylvania

“Maehle achieves the complex task of dealing with the subject of confidentiality as understood from three perspectives—that of the medical profession, the public, and the law—in three different countries. Despite its vast importance, currently only a handful of books deal in detail with the history of medical confidentiality. Contesting Medical Confidentiality is the first to offer an in-depth comparative study of the subject, and Maehle is uniquely qualified to make this significant scholarly contribution to the fields of bioethics, law, and medicine—not to mention the relevance his work has for the general public.”

Robert Baker, Union College

“This well researched book deftly demonstrates that both the official policies and the professional practices related to the controversial concept of medical confidentiality have long been contested. Maehle shows how the United States, England, and Germany have tried in different ways over the last three centuries to wrestle with some of the key questions raised by the concept. His long term perspectives will surely help contemporary policy makers, as technological advances further complicate this inherently sensitive and historically disputed issue.”

James C. Mohr, University of Oregon

Contesting Medical Confidentiality is a fascinating, detailed, and dispassionate account of how physicians and societies have negotiated the borders of medical secrecy over infectious diseases, criminalized abortion, and testimony in court. Readers will find enlightening and challenging comparisons between Britain, Germany, and the United States on issues such as the evolution of the physician-patient privilege and the duty to warn others of risks of contagion.”

Leslie P. Francis, University of Utah

"[Contesting Medical Confidentiality] is a valuable opportunity for those interested in the history of medical ethics, documenting how medical confidentiality is not a monolithic concept, but rather historically shaped and a crossing point of diverse scenarios and practices. It is also a perfect example of a good historian work: combining careful archival research and a great ability to catch the sense of the past."

Historical Studies in the Natural Sciences

Table of Contents

Chapter 1 Medical Privilege in Court: Protecting Patient Confidence or Obstructing the Course to Justice?
Chapter 2 Venereal Diseases: The Issue of Private versus Public Interest
Chapter 3 Abortion: Reporting a Crime or Preserving Confidentiality?
General Conclusions

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