Doctor-patient confidentiality vs. reporting obligation

Medical confidentiality is one of the most important pillars of trust between patients and healthcare professionals. It is protected by law not only during the patient's lifetime, but also after their death. Violating this duty can have serious legal consequences, ranging from disciplinary action to criminal liability. However, it is not absolute. There are situations defined by law where confidentiality gives way to the public interest – for example, when reporting particularly serious crimes. When is a doctor obliged to protect the confidentiality of information, and when must they act against the patient's wishes?

Author of the article: ARROWS (Mgr. Dita Zbožínková, LL.M., office@arws.cz, +420 245 007 740)

Medical confidentiality

Medical confidentiality is one of the fundamental duties of healthcare professionals. Sensitive information about a patient's health or personal life must remain secure. Confidentiality is not limited in time – it continues even after the patient's death and even after the doctor has ceased providing healthcare services. Violation of this duty may result in disciplinary action by the Czech Medical Chamber and, under certain circumstances, criminal consequences (unauthorized handling of personal data pursuant to Section 180 of the Criminal Code).

The essence of the criminal offense of unauthorized handling of personal data is a breach of the confidentiality obligation established by law, even through negligence. This refers to situations where you unlawfully disclose, publish, or make personal data available to third parties, thereby causing serious harm to the person to whom the data relates.

Request for cooperation from the Czech Police

In practice, law enforcement authorities sometimes request information for the purposes of criminal proceedings. They may only request such information about health data from a healthcare facility with the prior consent of a judge, see Constitutional Court ruling ref. no. II. ÚS 2050/14.

When does confidentiality not apply absolutely?

The Czech legal system provides for situations where the public interest or the protection of life outweighs the privacy of the patient. There are legal exceptions where a doctor may or must disclose confidential information without breaching confidentiality. These exceptions include, in particular (Section 51(2) of the Health Services Act):

• Patient consent: If the patient (or their legal representative) gives their consent, the doctor may disclose specific information.
• Legal obligations in proceedings: For example, the obligation to testify in court or provide documentation in accordance with procedural rules.
• Reporting obligation under special laws: The most important is the obligation to report or prevent selected criminal offenses under the Criminal Code. It is this legal obligation that “breaks” the doctor's confidentiality in cases of the most serious crimes.

Reporting obligation: When must a doctor report a crime

The Criminal Code imposes an obligation on every citizen to report selected serious crimes. This reporting obligation means that a person must immediately inform the public prosecutor or the police if they learn in a credible manner that a serious crime has been committed. This includes only the listed crimes, typically the most serious crimes: for example, murder, grievous bodily harm, torture, human trafficking, child abuse for the purpose of pornography, abuse of a person in custody, but also some particularly serious property or economic crimes, terrorist acts, etc. The complete list is provided by law (Section 368 of the Criminal Code) and includes only particularly dangerous offenses.

Exceptions to the reporting obligation are limited. The law provides for cases where reporting the perpetrator would expose the reporter or a close person to serious danger (threat to life, health, or, for example, risk of criminal prosecution of the reporter). Furthermore, lawyers and their trainees are not required to report information they have obtained in the course of their legal practice. Similarly, clergy of registered churches are not required to reveal the secrets of the confessional. However, doctors do not have any general exemption – if a doctor in the course of their professional duties learns that one of the serious crimes listed above has been committed, they have a legal obligation to report it (typically to the police). What is more, this obligation applies even despite medical confidentiality.

If a doctor fulfills their reporting obligation and reports a serious crime, this does not constitute an unauthorized disclosure of protected information – in such a situation, the law breaks confidentiality. The doctor therefore does not have to worry that they are violating confidentiality regulations. On the contrary, failure to comply with the reporting obligation could result in criminal prosecution.

Please note: the list of crimes subject to the reporting obligation does not include most crimes against human dignity in the sexual sphere (typically rape, sexual abuse, or sexual intercourse between relatives). Therefore, if an adult has been raped, the doctor does not have to report this to the Czech Police.

In the case of minors, the provisions of the law on social and legal protection of children apply. Healthcare providers are required to report to the municipal authority with extended powers any facts that indicate that a crime has been committed against a child that threatens their life, health, freedom, human dignity, moral development, or property.

Duty to prevent a crime: The active role of doctors in prevention

In addition to reporting crimes that have already been committed, doctors (like other citizens) also have a duty to prevent serious crimes that are being planned or committed. If a doctor reliably learns that someone is planning or committing any of the above-mentioned crimes (e.g., planning murder or grievous bodily harm), they must take active steps to prevent the crime from being committed. Prevention can be achieved through personal intervention, but in practice, timely notification of the Czech Police or the public prosecutor is usually sufficient. By doing so, the doctor fulfills their duty and the responsibility for preventing the crime passes to the criminal justice authorities.

The exhaustive list of crimes subject to the duty to prevent is much broader than that subject to the duty to report and includes, among other things, rape and sexual abuse.

There are also limited exempting circumstances for preventing a crime. If the doctor could not prevent the crime without considerable difficulty or risk to themselves or their loved ones (e.g., there is a real threat that the perpetrator would take revenge), inaction is not punishable. However, situations where reporting would endanger the doctor's safety are rather exceptional. In practice, therefore, as soon as a doctor learns of a serious crime being planned, they have a duty to act immediately—typically by informing the police—and thus prevent the crime from being committed.

Who can you contact:

Practical situations: when to remain silent and when to report

Difficult dilemmas can arise in everyday medical practice. Below are several model situations and how to approach them from a legal perspective:

• Child abuse: A pediatrician or other doctor treating a child may notice suspicious multiple bruises in various stages of healing, signs of malnutrition, or indications of sexual abuse. Abuse of a person in one's care is one of the acts that a doctor is required to report. If they fail to do so and the suspicion is confirmed, they are liable to prosecution for failure to report a crime. At the same time, continued silence may lead to further harm to the child. In practice, it is advisable not to delay – inform the police or OSPOD (social and legal protection of children) and resolve the situation in accordance with the law.
• Domestic violence and serious bodily harm: An emergency room doctor treating an adult victim of repeated fractures or head injuries may have reasonable suspicion of serious bodily harm in the context of domestic violence. If they find that the injuries were caused by a partner and that the attacks were serious (e.g., strangulation, use of a weapon, etc.), this falls under the reporting obligation. Serious bodily harm (Section 145 of the Criminal Code) is a criminal offense that must be reported by a doctor. Conversely, if the injuries are minor and the doctor is unsure of the circumstances (e.g., the patient is concealing the real reason), it is necessary to proceed with sensitivity—confidentiality may only be breached if there is certainty of a serious offense. If the doctor is unsure, they may consult (see below) or monitor the situation so that they can act in a timely manner if the violence escalates.
• A patient threatening violence or terrorism: A psychiatrist or general practitioner may hear disturbing statements from a patient such as “I'm going to kill that person” or a description of a plan of attack. If this is not idle talk and the doctor has reason to take the threat seriously, there is an obligation to prevent the crime. If the patient is actually preparing, for example, murder or a terrorist attack, the doctor must do everything in their power to prevent the crime—typically by immediately informing the police. It is understandable that such a step is sensitive (especially in psychiatry, where delusions may be involved), but the law is clear: protecting lives takes precedence over confidentiality. In addition to calling the police, hospitalization of the patient may be considered (if their condition allows it), but reporting cannot be omitted, otherwise the doctor would be guilty of failure to prevent a crime.
• Serious injuries associated with criminal activity: Certain injuries should immediately arouse the doctor's suspicion that a crime has been committed. An example is gunshot wounds (except for clearly documented accidents during sports, etc.) – gunshot wounds in a civilian environment are often related to a crime (attempted murder, robbery, etc.). Similarly, stab or cut wounds may indicate involvement in a violent conflict. Although doctors do not have a general obligation to report every injury to the police, if the circumstances indicate that a serious crime has been committed, the doctor responsible should report the matter. For example, a gunshot wound under unknown circumstances definitely justifies the obligation to inform the Czech Police.
• Illegal but unreported facts: Not everything that is illegal falls within the scope of the reporting obligation. For example, if a doctor discovers that their patient is a foreigner residing in the Czech Republic illegally, or discovers another offense unrelated to the serious crimes mentioned above, they are still bound by confidentiality. Illegal immigration is not a crime whose non-reporting would be punishable in itself, and doctors do not have the right to report such information to the immigration police at their own discretion. Similarly, if a patient only admits to a minor offense that is not included in the legal list (e.g., experimenting with soft drugs for personal use), the doctor must maintain confidentiality. The reporting obligation applies only to crimes specified by law – any other disclosure of information would be an unjustified breach of trust.

Practical advice: The doctor should carefully assess each suspicious situation. They are caught between two conflicting obligations – on the one hand, to maintain the confidentiality of patient information, and on the other, to fulfill their legal reporting (or prevention) obligation in the case of serious crimes. Violation of either of these obligations is punishable – failure to report a crime or prevent it is a criminal offense punishable by up to three years' imprisonment, while unauthorized disclosure of information may lead to disciplinary proceedings or criminal prosecution for breach of confidentiality.

Responsible conduct and legal certainty for physicians

In situations where these obligations conflict, it is advisable to consult a lawyer. The doctor may request a consultation with the hospital's legal department or an external law firm specializing in medical law. Preventive legal consultation will help assess how to proceed in a specific case and provide certainty that the doctor is acting in accordance with the law

and ethics. This will not only avoid legal problems, but above all ensure the best possible protection for patients and society at large.

Conclusion: Confidentiality and reporting obligations do not have to be in conflict – with a proper understanding of the law, doctors know when to remain silent and when to speak up. If you are unsure, do not hesitate to consult with experts as a preventive measure. Responsible and legally safe conduct is the best way to protect your patients, yourself, and the good name of the medical profession.

Key points to remember:

• Medical confidentiality obliges doctors to keep all information about their patients confidential; breaches of confidentiality may be punished.
• The Criminal Code establishes an obligation to report certain serious crimes (murder, grievous bodily harm, etc.) and to prevent crimes that are being planned.
• By fulfilling their reporting or prevention obligations, doctors do not breach confidentiality – in such cases, the law automatically releases doctors from their confidentiality obligations.
• Failure to comply with the reporting/prevention obligation is a criminal offense punishable by up to three years in prison.
• Unauthorized disclosure of confidential information outside of legal exceptions may also have legal consequences (fines, lawsuits, prosecution).
• In any doubtful situation, it is advisable to immediately assess the seriousness and, if there is reasonable suspicion of a serious crime, contact the Czech Police. If the doctor is unsure, it is advisable to consult a lawyer immediately. Preventive advice from an expert will help you act correctly and protect both the patient and yourself.