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Privacy and confidentiality

Protecting patient information

Sharing information

Open circle of careConsent for release:
  • implied
  • express

Implied consent

Much of a health professional's work is done on the basis of consent which is implied either by the words or the behaviour of the patient or by the circumstances under which treatment is given.

Express consent

Express consent may be in oral or written form.

When there is doubt, it is preferable that the consent be expressed.

A patient might ask for a note excusing her from work. Handing the note to the patient allows her to control its distribution. Alternatively, providing the note directly to the patient's employer can be done on the basis of implied consent.

Express consent, usually in writing, should be obtained for most personal health information sent directly from the doctor to a third party (insurance company, an employer, etc.). If the information is sensitive, or the patient may not be aware of the contents, the doctor may wish to confirm that the patient understands what information will be divulged.

Public Safety

Arising from the decision by the Supreme Court of Canada in the landmark case Smith v. Jones, physicians are permitted to disclose confidential information to the relevant authorities in the interest of public safety if all of the following conditions are present:
  • There is a clear risk to an identifiable person or group of persons.
  • The risk is one of serious bodily harm or death.
  • The danger is imminent.

Physicians are encouraged to seek specific advice and legal counsel in individual situations concerning the appropriateness and scope of disclosure of information relevant to public safety.

Learn more about Smith v. Jones — a landmark Canadian legal case
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Case: Threat of harm
Silhouette of angry man


A patient tells you he was fired unfairly. As he talks to you, he becomes more and more agitated, finally declaring "I'm going to make my boss wish he'd never seen me."  

You ask the patient to elaborate and he tells you he's going to make a car bomb and set it off at the workplace during working hours. He convinces you he knows how to make a bomb and bolts from the office.

Think about it

What would you do next?
Silhouette of female physician on phone


This would appear to be an imminent, credible risk of serious bodily harm to a recognized group of individuals. Canadian law permits you to take steps to warn the potential victims (e.g. the plant manager) or the police. Only the facts relevant to the warning should be divulged.  You should seek legal advice on how to proceed if you believe time permits.