Keep it Confidential
Medical confidentiality, since Hippocratic times, was part of a doctor's code of ethics. Similarly the "oath according to Hippocrates in so far as a Christian may swear it," includes the oath of medical confidentiality. "Whatsoever in the course of practice I see or hear (or outside my practice in social intercourse) that ought not to be published abroad, I will not divulge, but consider such things to be holy secrets."1
The purpose of the code of confidentiality is to help patients to trust their physician that information revealed to him will not be passed on to others. This bond of trust between patient and physician is important both in the diagnostic process and in the treatment phase, which often turns out to depend not only on surgery and medications but also on the patient's confidence in the doctor.
However, medical confidentiality, as patients and doctors have traditionally understood it, in some sense no longer exists. There are often quite a few health professionals and hospital personnel who are involved in providing healthcare services and as such have access to the medical records. That is understandable. In the modern hospital there are often several attending physicians (surgical, intensive-care unit, and "covering" house staff), a considerable number of nursing personnel (on three shifts), therapists, nutritionists, clinical pharmacists, students, unit secretaries, hospital financial officers, chart reviewers, various technical and support services, etc. What is important is that a distinction is made between information about the patient that will be kept confidential regardless of the interest of third parties and information that will be exchanged among members of the health-care team in order to provide care for the patient.
There are many angles to professional confidentiality and many confidentiality dilemmas in professional ethics. Should a physician warn the spouse or lover of an HIV-positive patient? Should a psychiatrist keep confidential a patient's threat to kill someone?
In various new forms for the ordination of elders and deacons, the third question put to the brethren contains the question:
"Do you promise ... keep the required secrecy with regard to what is confidentially brought to your attention in the discharge of your office?"2
This goes not only for elders and deacons but also for pastors. Prof. C. Trimp correctly applies that to family visiting reports and pastoral reports. To be sure, we are to report on our visiting. The members of the congregation will know that as well. However, that does not mean that we are to report to council everything that comes up in family visiting or in a pastoral visit. That which they share with us and which we discuss explicitly in a confidential way is to remain confidential. Even if afterwards we feel the need to talk about it with a fellow-officebearer, of whom we know that he is also under oath of confidentiality, we may not do so, except with permission from those members. They must be able to count on our keeping things confidential. If need be, we can discuss with them to what extent they agree that we report to council. We should clearly agree on this with them. They may never feel that we betrayed them.
In reporting on our visits, we deacons, elders and pastors need to be to the point and keep back confidential information. Our contact with the members of the congregation is to be marked by love and patience, by hoping and hiding, by covering (1 Corinthians 13:7), even if for a lengthy period of time we need to admonish and urgently counsel them. Only in that way there continues to be an open relationship with the members, and the Word of God is given room to bring about healing. To be sure, that changes when the member of the congregation himself makes his sin to be a public sin, or we as officebearers have become convinced that we slowly but surely are drawn into a dirty scheme against God and His people.3Lynn R. Buzzard and Dan Hall quote Ecclesiastes 3:7 in their subtitle: "A time to be Silent, and a Time to Speak."4
The premises supporting confidentiality ... cannot support practices of secrecy ... that undermine and contradict the very respect for persons and for human bonds that confidentiality was meant to protect.
With regard to the latter, Jeanette Hofstee, Milgrom and Gary R. Schoener tell of a teenager who told her pastor of her father sexually abusing her. She asked him not to tell anyone else. The pastor talked with her for a long time and finally she began to understand that the pastor was not to keep this information confidential; she agreed to contact children's protection service, etc.5
Confidentiality at council
In practice it turns out to be difficult as members of church council to keep things confidential. You will know the old story that once at a council meeting there was a lengthy discussion of a very weighty matter. At the close of the discussion the chairman reminded the brothers of the confidentiality of the discussion. He stated it explicitly: "That is to say, brothers, you are not to speak about this matter with anyone." One of the brothers asked in response: "But chairman, what then can we tell our wives when we get home?"
You will get the point of the story. (Some) husbands have difficulty keeping silent about things and (some) wives tend to be overly inquisitive.
As a result we sometimes hear members in the congregation say: "No, I'm not going to tell my ward elder, for then his wife finds out as well, and then in no time the whole congregation will know." Sometimes elders hear members in their district say: "No, I'm not going to tell the pastor, for then his wife finds out as well, and then in no time the whole congregation will know."
It is necessary for us to keep confidential things confidential. We may not tell our wives any of it. When we become officebearers, we need to discuss this matter of confidentiality with our wives, and our wives need to honour this obligation to keep confidential things confidential. Even though our wives are more aware than other members in the congregation of various aspects of our work as officebearers, by their very attitude they are to convey that their husbands honour confidentiality.
May we not talk at all with our wives about our work as officebearers?
Are there not some aspects of our work as officebearers that we may talk about with our wives? I repeat that we definitely may not talk with our wives about those things that are clearly to be kept confidential. But it maybe that there are some aspects, for example, of a family visit that we can share, such as sickness in the family or other needs that our wives may well know about, but then that should concern "things" that are clearly public knowledge or should be public knowledge, and the very best will be to ask the family if you may tell your wife.
Prof. W. H. Velema suggests that each officebearer needs to know whether his wife is able to keep silent or not. If your wife is the type to readily talk with others about all she does know, then you can discuss with her less than someone whose wife is able to keep things silent.6
It is also needful to pastors to keep confidential things confidential over against their colleagues. Sometimes we pastors in "very difficult cases" feel the need to ask for advice from colleagues who have been in the ministry longer than we have. At times we even feel the need to ask our wives for advice. This, however, is to be done only after we have asked for and received permission from those who are involved.
Prof. Trimp reminds us that we are not in council in order to satisfy our curiosity neither simply 'to pass on the latest.'
Every officebearer ought to so love the members who have been entrusted to his care that he in his contacts shows forth the form of Christ and for that reason knows how to restrain himself in his talking about these members of the congregation.7
We need to gain confidence
The matter of confidentiality is a matter of confidence. If there is this confidence, if in practice we as officebearers have shown that we know how to shepherd those who are in special need, then this confidence will be given to us. It is not a matter simply of secrecy, of having to keep silent. Even if we are given the strictest rules for confidentiality, that as such does not encourage the members to come to us and share things that are to be kept confidential. The question is: Do we as officebearers have the wisdom to understand and are we able to lead in love those who are entrusted to our care? If that is missing, the most important thing is missing. It's important for us in our labours as officebearers to be not merely theologians who reason but rather under-shepherds who love and lead the sheep.