Professions, Confidentiality, and Moral Uncertainty:

Abstract

Professional obligations of confidentiality frequently conflict with duties to protect third parties from harm, creating dilemmas characterized by deep moral uncertainty. When competing ethical frameworks yield contradictory prescriptions—such as prima facie duties mandating third-party warnings versus rule-utilitarian principles favoring confidentiality to safeguard public health cooperation—rational action requires formal decision-making under moral uncertainty. Analogous to maximizing expected utility under empirical uncertainty, agents facing conflicting duties should choose actions that maximize the probability of being morally permissible. Applying this decision-theoretic model to biomedical ethics—specifically whether a physician should disclose a patient’s positive HIV status to an endangered partner against the patient’s wishes—demonstrates how probabilistic reasoning can resolve seemingly intractable moral disagreements. Whether evaluated through cardinal probability assessments, parameter bounds, or ordinal inequalities, calculating the expected moral rightness reveals that maintaining confidentiality frequently retains a higher aggregate probability of moral permissibility than breaching it, even under assumptions initially weighted toward third-party protection. Formal decision theory thus provides a rigorous, quantifiable method for guiding professional conduct when basic ethical principles cannot be definitively established. – AI-generated abstract.