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Introduction: 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.Objective: 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. Method: 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: 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. Conclusion: The importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context., Introduction : 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. Objectif : 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. Méthode : 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. Résultats : Les résultats ont montré que tous les facteurs ont influencé le jugement des participants mais que les “Troubles psychiatriques” avaient un impact plus faible. Cinq clusters ont été identifiés : « Favorable si collégialité » (n=23) ; « Favorable à la rupture du secret médical » (n=77) ; « Défavorable à la rupture du secret médical (n=26) ; « Sensible à tous les facteurs » (n=71) ; « Favorable si violence » (n=31), avec des moyennes respectives de 5.87, 8.42, 3.64, 6.30, et 7.16 sur une échelle d’acceptabilité allant de 0 à 10.Conclusion: L’importance que la grande majorité des participants attribue aux facteurs indique que ces derniers influencent leurs jugements dans ce contexte spécifique.

International audience

Introduction Confidentiality is essential for the establishment of trust between physicians and their patients. Objectives The circumstances under which it is acceptable to young Kuwaiti for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD) were examined. Method A sample of 263 young Kuwaiti indicated the acceptability of breaking confidentiality in 48 scenarios that were all possible combinations of five factors: disease severity, time taken by the physician to discuss with the patient, the patient's intent to inform the spouse about the disease, the patient's intent to adopt protective behaviors, and the decision to seek the advice of an expert in infectious diseases before breaking confidentiality. Results Through cluster analysis, four qualitatively different positions were found: Quite never acceptable (6% of the sample, mostly males), Depends on husband's willingness to inform (3%), Depends on husband's protective behavior (29%, mostly females), and Quite always acceptable (32%). The remaining participants did not express any clear view. Conclusion In Kuwait, students’ trust in the medical profession is, therefore, not likely to be seriously undermined if, from time to time, and in well-specified cases, individual physicians decide to break confidentiality when facing dilemmas of the kind examined in the current study.

Next-generation sequencing techniques enable unsolicited findings to be detected. This discovery raises ethical questions concerning the return of these findings. Our study aimed to highlight the views of the general public, patients under supervision and health professionals concerning the acceptability of disclosing unsolicited results to patients. In total, 449 participants assessed scenarios, consisted of all combinations of three factors (patient’s information and consent, prevention and treatment of the unsolicited disease and doctor’s decision). The response profiles were grouped into six clusters. The participants took ethical aspects into account, but health professionals also considered the medical aspects to a greater extent.

International audience; With progress in medical genetics, genome-sequencing techniques are becoming more and more efficient. However, these genetic tests may lead to the detection of unsolicited genetic findings, i.e. findings that are not the primary purpose of the screening. New ethical issues have emerged, in particular the question of whether to disclose these unsolicited findings to the patient or not. Forty-seven patients under supervision in a Medical Genetics service, 15 health professionals and 107 members of the French general population expressed their opinion regarding the appropriateness of disclosing an unsolicited high penetrance genetic finding in 36 scenarios containing three pieces of information on: a) patient information and consent;b) possibility of prevention and treatment of the detected genetic disease; and c) disclosure of the results by the physician (e.g., no disclosure of the unsolicited results). Four positions were found that were called Respect for patient’s autonomy, Beneficence to patient, Non-maleficence, and Always appropriate.; Con el progreso en medicina genética, las técnicas de secuencias de genomas están volviéndose más eficientes. Sin embargo, estos test genéticos pueden llevar a la detección de hallazgos no solicitados, e.g., hallazgos que no son el propósito primario del escaneo. Nuevos problemas éticos han surgido, en particular la pregunta de si revelar o no estos hallazgos no solicitados al paciente. 47 Pacientes bajo supervisión en un servicio de Medicina Genética, 15 profesionales de la salud y 107 miembros de la población general francesa, expresaron su opinión respecto a lo apropiado de revelar un hallazgo genético no solicitado de alto efecto en 36 escenarios con 3 piezas de información sobre: a) información del paciente y consentimiento, b) posibilidad de prevención y tratamiento de la enfermedad genética detectada, y c) revelación de los resultados por parte del médico (e.g., no revelar de los resultados no solicitados). Se encontraron cuatro posiciones que fueron llamadas Respeto por la autonomía del paciente, Beneficencia al paciente, No-maleficencia, y Siempre apropiado.

International audience

International audience; We examined the extent to which lay people and health professionals are able to assess occurrence risks for multifactorial diseases. We asked 341 participants to assess the risk of developing lung cancer, coronary artery disease or rheumatoid arthritis in 16 scenarios, each featuring a combination of four factors (family history, daily alcohol intake, daily tobacco consumption and genetic test results). Participants considered all factors. However, they accorded more weight to tobacco and genetic test results. Moreover, it appears that where one of the factors (e.g. the presence of the incriminated gene) exerted a strong influence, the influence of the other factor(s) was correspondingly weaker. The health risk judgements of health professionals were more dependent on the specific disease and were also influenced to a greater degree by genetic information than lay people.

Objective: To determine under what conditions lay people and health professionals find it acceptable for a physician to breach confidentiality to protect the wife of a patient with a sexually transmitted disease (STD). Methods: In a study in France, breaching confidentiality in 48 scenarios were accepted by 144 lay people, 10 psychologists and 7 physicians. The scenarios were all possible combinations of five factors: severity of the disease (severe, lethal); time taken to discuss this with (little time, much time); intent to inform the spouse about the disease (none, one of these days, immediately); intent to adopt protective behaviours (no intent, intent); and decision to consult an expert in STDs (yes, no), 2×2×3×2×2. The importance and interactions of each factor were determined, at the group level, by performing analyses of variance and constructing graphs. Results: The concept of breaching confidentiality to protect a wife from her husband’s STD was favoured much more by lay people and psychologists than by physicians (mean ratings 11.76, 9.28 and 2.90, respectively, on a scale of 0–22). The patient’s stated intentions to protect his wife and to inform her of the disease had the greatest impact on acceptability. A cluster analysis showed groups of lay participants who found breaching confidentiality “always acceptable” (n = 14), “depending on the many circumstances” (n = 87), requiring “consultation with an expert” (n = 30) and “never acceptable (n = 13)”. Conclusions: Most people in France are influenced by situational factors when deciding if a physician should breach confidentiality to protect the spouse of a patient infected with STD.

Objectives: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient. Design: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness). Participants: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France. Main measurements: Mean acceptability ratings for each scenario for each group. Results: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide. Conclusions: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.

International audience; We present, in a synthetic way, the main findings from a series of ten studies in the domain of health psychology. All of these studies have inventoried motives to perform or not perform a given health-related behavior (e.g., consulting a physician) without postulating any a priori motivational structure. As a result, the whole set of studies allowed testing the capacity of reversal theory's model of four domains of experience to account for motivational data gathered in different settings but on the common ground of health-related behavior. From five to ten factors were found in each study, and all these factors were classifiable in one or other of the twelve categories offered by the structure of four domains of experience when transactions and relationships were considered in combination. All factors posited by reversal theory were found except one; the only factor that was not found at least once was of the pro-autic kind. In some cases, two factors of motives had to be classified under the same rubric, which led to the suggestion that the relationship domain may perhaps be extended. Overall, our findings suggest that the four-domain model, and its associated ten mental states, encompass and surpass previous theories of human motivation.

Purpose To understand how lay people and health professionals in France judge the acceptability of hospitalizing a psychiatric patient against his will. Methods 123 lay people, 20 nurses, 5 psychologists, and 6 physicians judged the acceptability of involuntary hospitalization in each of 36 scenarios consisting of all combination of 4 factors: patient's adherence to treatment (agrees to take his medications or not); risk of suicide (none, immediate, multiple past attempts); risk of harming others (none, immediate, history of violence against others); attitude of patient's family (favorable to involuntary hospitalization or not). The judgment data were subjected to cluster analysis and subsequently to analysis of variance. Results 4 clusters were identified and labeled according to the factors that affected judgments: Never Favorable (7 participants, with mean acceptability judgment of 1.30 on a scale of 0–10); Threat to Others (35, with mean judgment of 8.68 when risk high, 2.94 when risk low), Threat to Others or Self and Adherence (88, with mean judgment of 6.89), and Always Favorable (24, with mean judgment of 8.41). Conclusions 95% of participants agreed that involuntary hospitalization is acceptable under certain conditions, especially – in accordance with French law – when the patient presents a risk to others.

International audience; Two studies examined the motives that lay behind patients' acceptance or reluctance at donating organs after death. They also examined the way these motives were related to demographic characteristics, personality, and signing a donor card. Six separable motives for donation were found: Financial Incentive, Humanistic or Religious Duty, Positive Consideration from Others, Living on Through a Receiver, Gift of Life, and Close Others. Five motives for not donating were found: Preserving the Absolute Integrity of the Corpus, Strict Individualism, Lack of Control over the Use of the Organs, Anonymity of the Procedure, and Respecting Family Wishes. These motives were linked to personality factors in a meaningful way. Willingness to sign was higher among female participants and among participants with lower scores on Integrity of the Corpus and higher scores on Duty and Gift of Life. When Integrity of the Corpus scored highly, however, the effect of the other factors was practically eliminated. In other words, Integrity of the Corpus acted as a protected value: Trying to change people's belief that the integrity of the corpus at death is a sacrosanct issue would come with its own ethical issues.

International audience; To examine the conditions under which lay people and health professionals living in Chile and France find it acceptable for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD), 207 lay persons and healthcare professionals indicated the acceptability of breaking confidentiality in 48 scenarios combining five factors: disease severity, time taken to discuss this with the patient, patient's intent to inform his spouse about the disease, patient's intent to adopt protective behaviors, and physician's decision to consult an STD expert. A cluster analysis revealed groups that found breaking confidentiality "always acceptable", requiring "consultation with an expert", "depending on the many circumstances", and "never acceptable" (11%)". Despite differences in legislation and ethics codes, Chilean and French lay people showed similar personal convictions regarding the circumstances in which breaking patient confidentiality is acceptable. In contrast, Chilean physicians were much less supportive than French physicians of complete respect of patient confidentiality in all cases.; Para examinar las condiciones bajo las cuales una muestra de participantes del público general y de profesionales de la salud chilenos considera aceptable que un médico rompa la confidencialidad para proteger al cónyuge de un paciente que padece una enfermedad de transmisión sexual (ETS), doscientos siete participantes (personas del público general y profesionales de la salud), evaluaron la aceptabilidad de dicha ruptura en 48 escenarios, que consistieron en todas las posibles combinaciones de 5 factores (gravedad de la enfermedad, tiempo que se toma conversar sobre la enfermedad conel paciente, intento del paciente por informar a su cónyuge sobre su enfermedad, intento del paciente por adoptar una conducta de protección hacia su cónyuge, y decisión del médico de consultar a un especialista en ETS). Un análisis de racimos reveló grupos de participantes que encontraron la ruptura de la confidencialidad oscilando entre “siempre aceptable” y “nunca aceptable”. A pesar de las diferencias de legislación y códigos de ética, las muestras de público general no difirieron mucho en sus convicciones personales respecto a las circunstancias de protección o ruptura de la confidencialidad del paciente. En contraste, los médicos chilenos apoyaron menos que los franceses mantener un completo respeto a la confidencialidad del paciente en todos los casos.

International audience; Study question: When is it acceptable for a psychiatrist to break confidentiality to protect the wife of a potentially violent patient?Methods: 153 lay persons, 13 nursing personnel, 10 physicians, and 10 psychologists in France indicated this acceptability in 48 scenarios. The scenarios were all combinations of 5 factors: gravity of threat (death or beating), certainty of mental illness (certain or not), time spent talking with patient (considerable or little), his attitude toward psychotherapy (rejection, indecision, or acceptance), and whether the physician consulted an expert.Results: Lay people favored breaking confidentiality more than did nursing personnel or psychologists. Consulting an expert had greatest impact. Lay participants were composed of groups that found breaking confidentiality “always acceptable” (22 participants), “depending on many circumstances” (106), requiring “consultation with an expert” (31), and “never acceptable” (27).Conclusion: Lay people in France are influenced by situational factors when deciding if a psychiatrist should break confidentiality to protect a patient's wife.