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• Confidentiality is a deeply rooted principle of the medical Profession, and an absolute value which is not left to doctors' evaluation, discretion or preference in each case examined.

• This value perfectly conforms to the teachings of Islam; and Islam adds to its strength and deep-rootedness.

• Negligence of this value would undermine the medical profession which is an indispensable practice to mankind. Such negligence, based on unjustifiable transient and individual pretexts, would entail grave distress, and substantial loss in the long run that far outweighs temporary benefit.

• Nevertheless, each rule has some exceptions dictated by a stronger necessity. Neither doctors nor health authorities are to determine such exceptions, for that is the duty of the law-maker. Law has specifically enumerated these exceptions, and no additions or deletions should be made except by virtue of a legal provision. It is our moral obligation to make public, at all times, the law-stipulated cases for secret divulgence so that the public would not assume our actions to be betrayal of the professional secrecy - intentional or unintentional. Legal authorities should not be assigned this task, for it is firmly acknowledged in legal tradition that "Ignorance of the law is no excuse."

Professional confidentiality is a basic brick in the edifice of medical practice, without which the practice is threatened by collapse. Nevertheless, my actual observations show that this value is still shrouded with misty vagueness in the eyes of a significant number of practicing doctors. I think that this serious value has not been rendered due service in medical colleges. More often, it remains a common slogan habitually repeated and generally applied without embracing its precise and detailed dimensions. Many doctors still lack full awareness of the doctor-patient relationship, and pay no heed to this until a blunder befalls, though it may not. On the contrary, in countries where public awareness of rights strikes deep roots, sometimes to an excess, doctors are well aware that they are not immune from litigation, and therefore feel compelled to seek precision and accuracy in their practice to avoid being sued on charges of omission or commission; the issue of "Profession Confidentiality" is included in this sense.

There is evidence that the awareness of doctors as regards profession confidentiality has not yet reached the desired degree. You may for instance come across a doctor at his wit's ends, handling a specific case with overwhelming anxiety as he seeks the intuition of his heart or the counsel of colleagues or even the findings of symposia and conferences, describing the concomitants of a single case in great perplexity as to whether or not he should divulge the secret.

Before commenting on this example, I would like to present an overall review of profession confidentiality:

The sanctity of profession confidentiality in medicine is a deeply rooted legacy. Since the very early stages of this profession, the medical practice has cherished and endeavoured to safeguard this value. The physician, Imhotep of ancient Egypt used to have his students take an oath not to divulge any secrets of their patients. Then came the Greek physician, Hippocrates, whose oath is still widely taken by graduates of most medical schools. This oath implies that all information, medical or non-medical, obtained by the physician through audible, visual or deductive means should be treated as secrets that must not be divulged being protected by professional confidentiality. Then emerged the sun of Islam rising over the entire world, as a belief, a law, a state, a call, then a civilization culminating in the Islamic pan-nation, the best community sent forth unto mankind, with the best civilization that sheltered man. It confirming conventions of the pre-Islamic era when not conflicting with the religion, and even deemed them human virtues attained by Man in the course of history: "Use thou indulgence and enjoin seemliness and turn away from the ignorant." Consequently "Professional Confidentiality" gained firmer stability in medical practice. This is mentioned in "Tabaqat Al-Attiba", "Physicians' Classes", by Ibn-abi Osaibi'a, and ascertained by the chief physician of Egypt. Ali Ibn Radwan, 453 A.H. Muhazzab Al-Deen Ibn Hobal Al-Baghdadi recommended that a confidentiality oath be taken. One of the functions entrusted to "Al-Mohtasib", (nowadays: a Minister of Interior) was having physicians take the Hippocratic oath. Moreover, the oath of confidentiality is enshrined in the Islamic Code of Medical Ethics" of the First International Conference on Islamic Medicine, Kuwait, 1980; and also in the "Physician's Oath" incorporated in this Constitution, both adopted by many Islamic countries, let alone the praise of some non-muslim bodies.

I would like to make clear that Islam has not confined confidentiality to doctors, for it is rather a principle that should be adhered to by all Muslims. Doctors, however, were placed at the top of the hierarchy since their profession directly affects human integrity, and the medical practice would not, therefore, flourish until both doctor and patient are absolutely confident that their shared information is undivulgeable, whether the information is good or evil, repugnant or pleasant, honorable or shameful. Lack of this absolute confidence may strongly shatter the medical practice. The general ethics of Islam include that you should not tell about an absent fellow man what he would not like, even though you may be telling the truth. The Prophet, may the peace of Allah be upon him, enumerated three signs of the hypocrite:

"He lies when he speaks, he breaks his promise and he betrays when confided in".

Even in matters of gravity, attaining information is controlled by certain procedure that should not be overlooked under the false pretexts of fact finding. This is Omar Ibn Al-Khattab climbing a fence to ascertain that a man was drinking alcohol in the garden of his house, but the man reminds him that he had climbed the fence while Allah says,

ENTER THE HOUSES BY THE DOORS THEREOF,

and that he spied on the man though Allah says,

AND ESPY NOT.

And Amir Al-Mu'mineen, i.e. the Commander of the Faithful, could not but obey the Islamic Sharia! Fourteen centuries ago Islam taught us that the end does not justify the means, thus surpassing the continuous development and modern progress in the law science, until it reached the concept of the "Blemished Evidence" and that it is invalid and so any resultant consequence is invalid since the evidence itself is not obtained through sound legal procedure.

It is no wonder that in the light of these "general" teachings of Islam, that the "specific" teachings governing the medical profession are firmer and stricter.

If Allah's dispensation and justice has willed and ordained Muslims to lag behind and lose leadership of the world because they have not lived up to the specifications and provisions that Allah made their victory conditional upon; still, it is equally true that Europe emerged from the dark Middle Ages to the Renaissance thanks to the Islamic civilization which was duly received by the Europeans though disregarded by the original owners; and amidst the ever-growing complexities of life, confidentiality in the medical profession was not left to customs, conventions and traditions but was provided for in the text of the Law. Pioneering in this respect was the French Law which considered violation of professional secrecy a misdemeanour punishable by imprisonment and fine. All countries followed the same path, including Kuwait by virtue of Law No. 23 of 1960 (article No. 22), later followed by Law No. 25 of 1981 in which the sixth article reads: "The doctor shall not divulge a private, secret obtained through professional practice, whether, such secret is confided to him by the patient, self-deducted or heard of except by virtue of court order for purposes of Justice administration. However a secret may be divulged in the situations hereafter enumerated:

1. If divulgence is to the interest of husband or wife, provided that such is made to both in person.
2. If it is a precautionary measure to prevent a crime. Divulgence of secret in this case shall be confined to the competent official authority.
3. If made by way of reporting a contagious disease as stipulated in current laws. Divulgence in such cases shall be confined to authorities specified by the Ministry of Public Health.
4. If the person entrusting the doctor with the secret approves divulgence to other bodies which he specifies. These then are the cases permissible as enumerated by law and as governed by this provision. Not adhering to this enumeration is per sea violation of the law.

It is obvious that as law commits the doctor to this, the whole of the medical profession and medical services in general are likewise commited, for not only doctors deal with the patient but also assistants in nursing, laboratories, support services, record and file keeping, etc. The administration of medical services is obliged to take whatever measures needed to ensure that confidentiality is fully observed since any patient's information is nothing but a deposit in trust (though not monetary) and such a deposit must be kept in a container that would not leak, filter or effuse.

Some may imagine that a secret worth keeping is only one that involves infamous, humiliating or shameful information of the patient. This is quite wrong, even-though it is common, for confidentiality of patient records is an absolute value that is observed for its own sake. It is not at all necessary for a patient to request of his doctor to withhold the information, for it is naturally and professionally a secret, though the patient may not request considering it so. In his valuable research on "Medical Secrecy", published by "Law and Sharia" Journal, second issue of fifth year, P. 60. Professor Dr. Abdulsalam Al-Termanini reported how a French newspaper, when reporting on the death of a famous French painter, attributed his death to complications of a shameful disease. Since what the paper claimed was mere fabrication which caused grave harm to the reputation of the dead painter, his treating physician, out of doing justice to the man and in defence of the reputation of an innocent man no longer able to defend himself, published an article showing the falsehood of the newspaper report and the true disease that caused the painter's death. This act, in the general convention, is charitable and a commended effort, to establish what is right, but medical wise it stands in contravention of the strict legal perimeter established by the Law by virtue of the Text on the sanctity of professional confidentiality. The Physician's act was not included in any of the Law enumerated cases allowing divulgence of secret, so an action was brought against the doctor who was found guilty of medical secret divulgence, an appeal was filed but the ruling was ratified. For a secret is a secret in itself and must not be divulged regardless of what harm the divulgence may cause or avert, except by virtue of a legal provision or court ruling.

As a doctor writing on a medical topic as viewed from a medical perspective, I would like to assure all fellow doctors that the uncontroversial principle and the rule of all time is "Keep the Secret". Secret divulgence should not be based on the doctor's judgement, and when considering it one should not consult one's feelings or resort to one's own discretion under certain circumstances, but the text of Law is to be followed to the letter.

It is regrettable, and even embarrassing, that health authorities sometimes issue, to doctors and other personnel, administrative orders not evoking that text of Law and are consequently nonvalid. Whether they initiate such orders or give them to conform with the directives of the authorities of the Ministry of Interior, like the order to report cases of pregnancy out of wedlock (i.e. illegitimate) to the police, administrative orders do not repeal the legal provisions nor constitutional rights.

These authorities are thus violating both Sharia and conventional law.

The one and only right path for the authorities is to take the legitimate channels for an amendment of the law to accommodate the needs and interests of the society, not to violate the standing Laws or act with a complete disregard to legal provisions. The severest detriment afflicted upon many countries of our Pan-Arab World is the desire for reform that thought commitment to Law an impediment that prolongs procedures and delays justice. With such desires in mind and out of faithfulness the authorities go beyond the limits prescribed by Law disregarding it completely or putting it aside, and forging ahead their own way.

Sanctity of professional confidentiality is a "value" and Law is a "value", and to the maintenance of these values we call; for in them lies all the good, durable and perpetual, even if not immediately expedient. Adherence to these values ensures the establishment of security, stability and peacefulness in the long run, even if otherwise mirrored in the short run.