In most countries doctors have the right to withhold information without being required to tell the patient they have done so. Medical records are inaccessible even to the patients themselves. The confidentiality with which physicians, other health workers and institutions may treat the medical history, present health and health-related conditions of patients and ex-patients, may be a serious obstacle to preventing crises in the lives of the individuals and families concerned. It may also prevent effective action against socially undesirable behaviour and individual and public health hazards. In some cases it is an obstacle in legal proceedings and may interfere with the ends of justice.
Adolescent pregnancy concealed from parents by health or social workers, who may be excluded from exercising their legal responsibilities over a minor, presents a moral, medical and legal challenge to the community. Similarly among the young, detected venereal disease and drug and alcohol addiction may not be disclosed to the parents or legal guardians. Among the mature, health workers may keep secret a serious heart condition although it may be known to them that the patient is in high-stress employment. Secrecy may apply to diagnosed mental illness or brain-function impairment; and increased stress in an already stressful situation may be caused when a person dying of cancer, for example, is not told, even though his family may have been informed. Patients may request deletion from their records of conditions which future medical treatments may be affected by; they may also refrain from authorizing release of their records even when medical research could benefit.