ABC v St George's Healthcare NHS Trust & Ors

A doctor’s duty to preserve a patient’s medical confidentiality is qualified, but that qualification does not ordinarily create a duty of care to relatives or other third parties to disclose confidential information. A proposed duty requiring disclosure of a patient’s genetic diagnosis without consent is a radical, rather than incremental, development of negligence law. In deciding whether such a novel duty is fair, just and reasonable, the court may consider its wider effects on confidentiality, clinical judgment and conflicting duties. Article 8 does not require disclosure where the balance between the relative’s interest in receiving genetic information and the patient’s confidentiality weighs decisively against it.

The claimant alleged that three NHS trusts negligently failed to tell her that her father had Huntington’s disease, despite the associated genetic risk and her pregnancy. She claimed that, had she known, she would have undergone testing and terminated the pregnancy. She also alleged breaches of Article 8 of the European Convention on Human Rights.

The defendants applied to strike out the claim as disclosing no reasonable cause of action. The central issues were whether the pleaded facts disclosed an arguable duty of care to disclose the father’s confidential diagnosis, and whether Article 8 required or justified such disclosure.

1. Negligence. The defendants’ starting obligation was to respect the father’s medical confidentiality. His detention and conviction did not establish that he lacked capacity to consent to, or refuse, disclosure. Under the Mental Capacity Act 2005, capacity was presumed, was issue-specific, and could not be inferred merely because a decision appeared unwise.
2. The claimant’s participation in family therapy did not convert the complaint into negligent performance of that therapy. The substance of the claim remained an omission: failure to disclose information held confidentially for another patient. There was no relevant assumption of responsibility or special relationship in respect of that disclosure.
3. The proposed duty was entirely novel. It was not an incremental extension of the ordinary doctor-patient duty, and would represent a radical departure from established negligence principles. The wider consequences were relevant, including the risk of conflicting duties, reduced candour by patients, pressure to consent to disclosure, uncertainty about whether third parties wished to receive the information, and the burden on clinicians.
4. The pleaded facts therefore disclosed no reasonably arguable duty of care. The negligence claim was bound to fail and was struck out.
5. Human rights claim. The relevant balance was between the claimant’s interest in knowing the genetic risk and the father’s Article 8 right to medical confidentiality. For the same reasons identified in the common-law analysis, that balance came decisively against disclosure. Article 8 did not assist the claimant.
6. The court also granted an anonymity order for the claimant, her father and her daughter. The order was justified by the daughter’s private-life interests and the serious consequences of learning through publicity about the genetic condition and associated risk.

First-instance decision. The judgment records no prior appellate determination.