This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the New York University Grossman School of Medicine.
Dr Sean Conley faced a very tricky dilemma. As the White House physician, he was in a bind in terms of protecting the President's privacy. We've all just found out from a book written by Donald Trump's chief of staff, Mark Meadows, that the President, just prior to a debate with Joe Biden in Cleveland last September, had a positive COVID-19 test. We do know that, probably 6 or 7 days later, Trump went to Walter Reed and announced that he did have COVID-19.
The question that his White House doctor faced is that because he knew that Trump was positive, should he have warned anybody? Should he have tried to stop the debate? Who, if anyone, should he have told about the positive test prior to Trump going out and debating Biden?
Let's remember that Biden was 77 years old, so he was in a high-risk group. Let's remember that Trump maintained his schedule before the debate. He met with the American Gold Star Mothers and was around his staff without masking — remember, he refused to wear a mask. The doctor, Trump, and maybe his chief of staff all knew he had tested positive for COVID-19, but that he was wandering around and exposing people to the virus.
What is the standard when a doctor worries that a patient might be putting others at risk? In the White House, the standard is that the President is your patient, and the presumption is privacy. You're not going to talk about anything the President doesn't want you to talk about because the President, just like any other patient, has the right to keep medical information confidential. That is absolutely the presumption.
We could change the laws in this country if we wished and say that every year the President ought to undergo a physical by an independent panel of doctors that would be reported to the public. Or that the White House physician, in order to protect everybody in the White House, has to be able to disclose certain facts if there are dangers of risk posed by the President or the Vice President.
We've never done it. There's no duty that I'm aware of that the White House doctor has to report, nor is there a duty generally on the part of any doctor to report somebody's private medical information in a public forum.
The exception, however, is established in the case in psychiatry in the state of California in the 1970s, called Tarasoff. In that case, the psychiatrist really believed that a patient might be a danger to a former lover, and indeed, the patient went out and caused harm to that former lover. The psychiatrist, although pretty convinced that that danger was there, said nothing because of the obligation to respect privacy.
The California Supreme Court said that if you, as a doctor, believe that someone is a direct threat to an identifiable person, you have a duty to warn that person that they are at risk — if it's serious harm.
The question becomes: Is having COVID-19 and running around in front of people — Joe Biden, your staff, people who are coming in on the calendar to meet with you, get a handshake, or maybe an autograph, or otherwise interact with the Presiden — is that strong enough a risk to impose a duty that says you have to override privacy?
I'm not naive. If you override that privacy and tell people that President Trump is COVID-19–positive and start letting people know that they should stay away or never approach him without a mask, that's probably the last thing you're going to do as the White House physician. I don't think Trump, any President, or any staff would put up with it.
Nonetheless, I do believe that COVID-19 is a big enough threat, particularly to vulnerable people, such as older people, that at least you have the duty to say to the person who's running the schedule or organizing the debates, "We've got to take some precautions here because the President has tested positive." That does seem a significant threat that might rise, in my view, to the standard of the Tarasoff doctrine from that California case from many years ago.
In general, what we're seeing here is a pure ethics problem. Respect the President's privacy. The President might even say, "Respect executive privilege. Everything I do is hyper-protected in terms of privacy, including my health status."
If you're taking on that White House doctor's role, do you have an obligation to say, "Yes, but if you're a threat to others, I know who they are, and I can warn them, I must do so"? My answer is yes.
I'm Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.
Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
Medscape Business of Medicine © 2021 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Arthur L. Caplan. White House Doc Knew Trump Had COVID: What's His Duty to Warn? - Medscape - Dec 22, 2021.
Comments