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Confidentiality and Its Limits
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Multiple sclerosis is believed to be an autoimmune disease of the central nervous system. However, according to Italian physician Paolo Zamboni, it is related to cerebrospinal vascular insufficiency. Zamboni claims that MS can be treated by remedying this condition with venous angioplasty. This surgery is offered as treatment for MS in various countries—Poland, Bulgaria, and Costa Rica, for example. But the Medical Board of Quebec, Canada, does not allow its members to perform the surgery and strongly advises patients against seeking it elsewhere. This opposition is based on the lack of evidence to support the procedure and the serious risks associated with it (including venous thrombosis, stroke, and pulmonary embolism). As a result, many Canadian MS patients have traveled to other countries to receive the surgery. Quebec physicians have been reluctant to provide surgical follow-up for patients who undergo the surgery in other countries due to the lack of information regarding the procedure. No alternative treatments are effective to partially or completely cure MS, and so the treatments available in Canada aim only to manage its symptoms.

Jade is a forty-year-old Canadian woman with MS. She is on long-term disability leave, complains of growing fatigue and muscle stiffness, and has painful sensations in her limbs. She has been followed by an interdisciplinary team in a specialized hospital in Quebec for the past twenty years, since she was diagnosed. At her last appointment, Jade told her physical therapist that she recently underwent the experimental Zamboni surgery in Poland, despite her physician’s strong recommendation not to. Jade fears her physician’s reaction, so she asks the physical therapist to keep this information from the rest of her medical team.

Jade is shy and tends to distrust health care professionals. It took many years for her physical therapist to gain her trust and to develop a positive therapeutic relationship with her. However, the physical therapist knows that serious complications can occur in patients who have had Zamboni’s surgery. Not telling Jade’s physician about the surgery could result in harm; Jade could have complications that are not recognized. Providing the information to the rest of the team would allow them to adjust her treatment to respond to the surgery and give her information and postoperative education that she will need. Moreover, keeping this secret could threaten team cohesion and trust if they find out about it later.

Jade decided to undergo a risky surgery against her doctor’s advice in the hope of improving her quality of life. This was her autonomous choice. How should the physical therapist respond?


Commentary by Maude Laliberte.


Commentary by John D. Lantos and Sonia Gowda.

Copyright © 2011 The Hastings Center
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"Confidentiality and Its Limits." Hastings Center Report 41.6 (2011): 12-12. Project MUSE. Web. 26 Jan. 2013. <http://muse.jhu.edu/>.
(2011). Confidentiality and Its Limits. Hastings Center Report 41(6), 12. The Hastings Center. Retrieved January 26, 2013, from Project MUSE database.
"Confidentiality and Its Limits." Hastings Center Report 41, no. 6 (2011): 12-12. http://muse.jhu.edu/ (accessed January 26, 2013).
T1 - Confidentiality and Its Limits
JF - Hastings Center Report
VL - 41
IS - 6
SP - 12
EP - 12
PY - 2011
PB - The Hastings Center
SN - 1552-146X
UR - http://muse.jhu.edu/journals/hastings_center_report/v041/41.6.article01.html
N1 - Volume 41, Number 6, November-December 2011
ER -


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