The legal duty to protect patient confidentiality is common knowledge amongst healthcare professionals. However, what may not be widely known, is that this duty is not always absolute. In the United Kingdom, both the General Medical Council governing the practice of all doctors, as well as many other professional codes of practice recognise that, under certain circumstances, it may be appropriate to break confidentiality. This arises when there is a wider duty to protect the health of others, and when the risk of non-disclosure outweighs the potential harm from breaking confidentiality. We discuss this situation specifically in relation to genomic medicine where relatives in a family may have differing views on the sharing of familial genetic information. Overruling a patient’s wishes is predicated on balancing the duty of care towards the patient versus protecting their relative from serious harm. We discuss the practice implications of a pivotal legal case that concluded recently in the High Court of Justice in England and Wales, ABC v St Georges Healthcare NHS Trust & Ors. Professional guidance is already clear that genetic healthcare professionals must undertake a balancing exercise to weigh up contradictory duties of care. However, the judge has provided a new legal weighting to these professional duties: ‘The scope of the duty extends not only to conducting the necessary balancing exercise but also to acting in accordance with its outcome’ [1: 189]. In the context of genomic medicine, this has important consequences for clinical practice.

保护患者隐私的法律义务是医疗保健专业人员的常识。然而，可能并不广为人知的是，这项职责并不总是绝对的。在英国，管理所有医生执业的综合医学委员会以及许多其他专业执业守则都承认，在某些情况下，泄露机密可能是适当的。当保护他人健康的责任更广泛，并且不披露的风险超过破坏机密的潜在危害时，就会出现这种情况。我们专门讨论与基因组医学相关的这种情况，在这种情况下，家庭中的亲属可能对共享家族遗传信息有不同的看法。否决患者的意愿取决于平衡对患者的护理义务与保护其亲属免受严重伤害的责任。我们讨论了最近在英格兰和威尔士高等法院结束的一个关键法律案件的实践影响，ABC诉St Georges Healthcare NHS Trust & Ors。专业指导已经明确，遗传保健专业人员必须进行平衡练习，以权衡相互矛盾的护理职责。然而，法官为这些专业职责提供了新的法律权重：“职责范围不仅包括进行必要的平衡练习，还包括根据其结果行事”[1:189]。在基因组医学的背景下，这对临床实践具有重要意义。