[Dr. Kluge responds:]
I thank Robert Robson for likening my proposal to Swiss cheese, which is a classic that has stood the test of time, the holes notwithstanding. If my proposal attains similar status, I shall be well pleased.
Jokes aside, his letter raises 2 interesting and important points: that it is up to the medical profession and "research scientists" to decide what information about physicians is appropriate or useful for patients to know before they select a doctor, and that the CMPA is the appropriate agency to provide such information.
Regarding the former, it strikes me as odd that Robson, a risk-management consultant, should have missed the point of my ethical analysis and the significance of the lesson provided in Reibl v. Hughes1 and McInerney v. MacDonald.2 In these cases the courts stated very clearly that it is not up to the medical profession to decide what should be revealed and what may be withheld from a patient. Arguing the very ethics of informed consent that I sketched in my article, the court stated that the standard of disclosure should be what the objective, reasonable person in the patient's position would want to know. Therefore, both the ethics and case law make it very clear that it is not up to the medical profession (or research scientists) to decide what should and what should not be revealed. It also bears emphasizing that these decisions were not "some recent lower court decisions" but rulings by the Supreme Court of Canada.
As for the second point, I think the CMPA would be the last agency one would turn to for the information Robson mentions. The CMPA's mandate is to provide legal assistance to physicians, so its perspective is litigious and physician oriented. How would this organization address the ethics of patients' demands for information on physicians? Further, the CMPA's mandate is not to do longitudinal follow-up studies of the practice patterns of physicians who have been subjected to legal or disciplinary action. Consequently, the CMPA database could not possibly yield the information that Robson suggests is relevant. Databases of the licensing authorities could do this, a fact I did not mention in my article because of space limitations.
In the end, I believe that the court findings in Reibl v. Hughes and McInerney v. MacDonald - as well as in Malette v. Shulman3 - speak for themselves.