“Did You Take Care of Tsarnaev?”

I am affiliated with the institution where Dzhokhar Tsarnaev is currently hospitalized.  I am friends with people who have treated him.  I’m trying to stay away from those people; I would be unable to help asking them about him.  They might be unable to help talking about him.    There has been a flurry of emails and red-letter warnings cautioning people here not to talk about Mr. Tsarnaev or look him up on the EMR (Electronic Medical Record) system.  Despite this there have been leaks of information and photos from various sources.  It is virtually impossible to keep people from asking about him and talking about him.  Curiosity is human nature.  When human nature comes up against morals and laws, human nature will win a good percentage of the time.  The question is:  given what he has done, does this 19-year-old still have his right to privacy?

The answer, of course, is yes.  The American Medical Association includes patient confidentiality in it’s ethical guidelines:

“…the purpose of a physicians ethical duty to maintain patient confidentiality is to allow the patient to feel free to make a full and frank disclosure of information…with the knowledge that the physician will protect the confidential nature of the information disclosed.”

Threre are legal guidelines as well, most notably with the Health Insurance Portability and Accountability Act, or HIPAA.  This law was originally passed in 1996 to improve the efficiency and effectiveness of the health care system, allow people to switch jobs without losing their health insurance, and impose some rules on electronic medical information. Congress incorporated into HIPAA provisions that mandate the adoption of  the Federal privacy protections for health information.  The “simplified” administrative document for the privacy and security portions of HIPAA is 80 pages long.  Basically your health information cannot be shared with ANYONE. Of course, there are exceptions to HIPAA. They include:

1. Certain wounds and injuries to law enforcement officials.

2. The information could be subpoenaed in an investigation.

3. There are limited exceptions for the victim of a crime for law enforcement.

4. Victims of abuse, neglect, or domestic violence can be reported to law enforcement.

5. Threat to health or safety of patient or others.

6. Limited access to the information of prisoners by law enforcement.

7. Child abuse and neglect may be reported to law enforcement and social service providers.

8. Certain contagious diseases, although individual patients are not named.

Notice that most of the HIPAA exceptions are for law enforcement folks.  Mr. Tsarnaev’s personal health information is definitely being released to the police under these HIPAA exceptions.  Does he present a threat to society?  Well, he DID, that’s for sure.  Is he a prisoner? Most definitely.  Is the information relevant to an investigation?  Probably.  Does the public have a right to know this information?  Nope.  Doesn’t matter what he did or is alleged to have done.

But here we run up against that pesky nature of humans.  Aristotle, in his Poetics, talks about “…enjoy[ing] contemplating the most precise images whose sight is painful to us.”  Curiosity, according to Wikipedia, is an instinct, an innate basic emotion.  One model of curiosity holds that experience that are novel create a sensation of uncertainty that is unpleasant.  Curiosity is a means to dispel this uncertainty.  Neurobiologists note that the act of wanting or obtaining new information is associated with brain chemicals associated with pleasure or reward, such as dopamine and opiates.  There is also the sort of social grooming aspect of rumor and gossip; the holder or giver of information acquires temporary popularity by having acquired information.  This releases endorphins in the person with the information, a chemical also associated with pleasure.

The online Urban Dictionary defines “morbid curiosity” this way: “When curiosity and common sense collide”, which I think is a fabulous way of describing the conflict between doing what is right and doing what is human. I will not be talking to my friends about suspect #2, and I will not be looking him up on EMR.  But I would sure like to.

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at medicine for real, where this post originally appeared.

6 replies »

  1. Thanks for a compelling reminder of everyone’s legal and professional responsibilities.
    I, too, am impressed with all I have read about BIDMC.

  2. I was struck from the beginning by the professional and measured communication from your hospital. I suppose it was too much to hope that in the heightened emotions of the event fed by the instantaneous rumours of our times that the communication would be heard in the same light. There was a young man who appears to have been likable showing some promise. He was a stranger as he had been for all his life. He had a brother even more disturbed but who was perhaps an important reminder of family loyalties. They did a dreadful thing but even here people who are charged with the care of damaged humans are at their best if they follow their principles. “First do no harm”. And if our society is the beacon of humane standards we say it is we must believe that all just process will follow. Not simple..

  3. Given how high emotions are running in Boston on this one – I wonder if anybody refused to treat. I’m not sure I would have been able to.