Medical Ethics: “When a Dying Patient Confesses to Murder”

By Neuroskeptic | November 18, 2018 2:51 pm

What should a doctor do if a dying patient confesses to killing people decades ago? This is the question posed by a fascinating case report in the Journal of Clinical Ethics, from New Zealand-based authors Laura Tincknell and colleagues.
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The facts of the case are fairly straightforward. A 70-year old man with advanced cancer was expected to die imminently and was admitted to a hospital pallative care ward in severe pain. While being assessed by a junior doctor, the man expressed a wish to talk about “his life and some of the choices he had made”.

After being assured that what he said would be kept confidential, patient reported that he had been involved with gangs in his youth, and that he had murdered ‘several people’ in contract killings. According to Tincknell et al., “he thought the bodies of some these people may not have been found.” The patient expressed guilt over what he had done, and said that he had spent the last 40 years of his life trying to atone for his crimes.

The confession seemed to be a great relief to the patient, whose condition and pain levels improved significantly. Although he declined consent for the doctors to share what he had told them, the patient did promise to write down a letter with the information, “to be given to the police after his death.” He died six weeks later in another facility; whether the letter was ever written is unknown.

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This case clearly raises questions over medical ethics, confidentiality, and justice. The consensus of the authors, who include a medical ethicist and a lawyer as well as a pallative-care specialist, is that it would have been both unethical and illegal to breach the patient’s confidentiality during his life.

The accepted norms of medical confidentiality are that information can only be disclosed without consent if this is necessary to prevent harm to the patient or others. In this case, the patient’s crimes took place decades ago, and in his condition he was hardly likely to repeat them. Therefore, breaching confidentiality and sharing the information e.g. with the police, could not prevent harm.

Tincknell et al. go on to discuss whether it would still be wrong to share the information once the patient had died. The bioethicist states that postmortem disclosure would be “ethically permissible.” The lawyer gives a mixed verdict: she says that a court would “probably” conclude that the original legal obligation of confidentality remained even after death, but that the disclosure could be justifiable on grounds of the public interest (e.g. by assisting the investigation of cold cases).

It seems that the doctors did, in the end, tell the police about the patient’s confession, after his death – at least I assume this is what the lawyer means by “The team was permitted, but not obliged, to disclose. The discretion was exercised.”

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In my view this is a truly compelling case. One aspect that Tincknell et al. don’t consider is the possibility of a false confession. Their discussion is based on the assumption that the patient really was a murderer. However, sometimes people confess to crimes that they did not commit. While the psychology of the phenomenon is unclear, spontaneous false confessions are known to occur, even in murder cases.

I’m not saying that I find it likely that this patient’s confession was false. However, the possibility exists, and I think it’s relevant to the ethical questions in the case. Consider the view that since the patient is a murderer (and one who escaped justice), he has forfeited any right to confidentiality. This view might be appealing to many people, but if the patient might not in fact be a murderer, I think the case for respecting his confidentiality is strengthened.

P.S. Many thanks to @Dragons_trainer and @ENHolly for sending me the PDF of this paper!

CATEGORIZED UNDER: ethics, law, papers, select, Top Posts
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  • John C

    I hope you confess being a scam troll on your death bed some day.

  • Chlicook

    I can’t speak to NZ law and I can’t speak specifically to medical ethics; nonetheless I am a probate attorney and post-death client confidentiality does come up from time to time, i.e, whether i can disclose a confidential communication from a client to myself; the general answer is that client confidentiality continues after death; with a couple of exceptions; the relevant exception here would be if disclosure were “in the client’s interest”; whether something is in the interest of the client is pretty broad and includes such things as helping the family to understand why the client did what the client did. So, at least from my perspective, IF the client was disturbed by the crimes and wished to make some sort of partial amends, such as assisting in recovery of the bodies or maybe resolving a mystery as to what happened, then it might by in the interest of the client to disclose this information after death.

  • partyboss

    I think the greater question is why someone feels the need to confess a crime after so many years, particularly on their deathbed.

  • Kamran Rowshandel

    Since the demands of Hammurabi’s family were met, the reason law is practiced has been changed—FROM using the effort of criminals to serve victims in order that they may overcome the result of the crime TO removing criminals from the labor force so that the 99% can take each others’ eyes out until only the 1% still see.

    The rest of the things Hammurabi’s family has done throughout history: never said anything kind, conquered everyone through being unimaginably evil and treats us like we are still being born simply to worship them, proclaimed an overt genetic superiority and has a psychologically sick god complex–their fascist literature being the most common books in circulation still today, caused such a degree of harm to each nation conquered by them that none of them have ever been and to economically recover, systematically targeted 30 million island-dwellers and exterminated them via radiation, started a series of proxy wars so that everyone not related to them could die in them, is forcing us to work because we can suffer but robots and genetic algorithms can’t, and told everyone they’re the biggest victims in the world when they’re the biggest criminals obviously.

  • Erik Bosma

    I would feel no need to tell authorities about past murders confessed to me until after the patient’s death. However, if the patient gave me information about an upcoming murder or other serious crime, I would have no problem sharing this information with the authorities.

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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