Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

Confidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence. This study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization. A total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data. Results showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n=23); “Favorable to breach confidentiality” (n=77); “Unfavorable to breach confidentiality” (n=26); “Sensitive to all factors” (n=71); “Favorable if violence” (n=31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10. The importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context. Le secret médical est crucial pour établir une solide relation patient-médecin. Toutefois, certaines situations peuvent créer un dilemme pour le médecin qui doit alors choisir entre le respect du secret médical ou la protection de tiers face à un risque sérieux de violence. Cette étude visait à observer comment des personnes issues du grand public et des professionnels de santé évaluaient l’acceptabilité de la rupture du secret médical lorsqu’un médecin est confronté à un patient présentant des signes de radicalisation terroriste. Un total de 228 participants (174 issus du grand public et 54 professionnels de santé) devaient évaluer l’acceptabilité de 54 scénarios construits grâce à la combinaison orthogonale de 4 facteurs fréquemment mentionnés dans la littérature: présence d’un « Trouble psychiatrique »; « Signes de radicalisation »; « Projets de violence »; « Collégialité ». Des analyses de variance et de cluster ont été effectuées sur l’ensemble des données. Les ré