Fidelity and dual loyalty
- Topic
Dual loyalty arises when a doctor serves the patient and, at the same time, a third party such as a company, an insurer, the army or a prison.
What it is
Fidelity is the duty to keep promises and not betray the patient's trust: the patient expects the doctor to act in their interest. Dual loyalty appears when the doctor has real obligations to someone else: the employer who hires them to assess workers, the insurer who pays for the examination, the sports team, the security forces, the prison system or a judge. That double role is not illegitimate in itself, but it demands transparency and limits: the patient must know whom the doctor works for, and there are things a doctor never does for a third party, such as taking part in torture. The WMA International Code of Medical Ethics (2022) sets out these duties in paragraphs 10, 22 and 23.
Key facts
- Occupational medicine: the company doctor tells the employer whether the worker is fit for the job, not the detailed diagnosis, unless the worker authorises it or a rule requires it.
- Insurance medicine: the examination for a policy does not create the same therapeutic relationship; even so, the doctor tells the person examined about serious findings.
- Sports medicine: the team doctor should not clear an injured athlete to return to play under pressure from the club or the results.
- Military and prison medicine: the doctor treats the person as a patient; their clinical information is not used to punish or interrogate.
- Expert witness: when the doctor acts for a judge or a prosecutor, they are not the treating doctor and must make that clear to the person examined.
- Health administration: incentives or orders from an organisation cannot change a sound clinical judgement (WMA, paragraph 6).
In clinical practice
- Pre-employment examination: «Your employer has requested this examination; I will tell them whether you are fit for the job, not the details of your health».
- A prisoner with injuries suggesting ill-treatment: the doctor documents the findings accurately even if the institution would prefer another version.
- An organisation pressures the doctor not to order an indicated test: professional autonomy protects the clinical decision, and the doctor records it with the reasons.
- When a serious conflict between the patient and the third party arises, the institution's ethics committee is consulted.
Legal framework in Colombia
- Statutory Law 1751 of 2015, art. 17: professionals' autonomy to decide on diagnosis and treatment is guaranteed; any coercion, pressure or restriction that undermines it is forbidden.
- Law 23 of 1981, art. 37: professional secrecy covers everything the doctor saw, heard or understood through the profession, except in the cases the law sets; working for a third party does not suspend it.
- Law 1581 of 2012, art. 6: health data are sensitive; the employer cannot demand the medical record without explicit authorisation or a legal mandate.
- Official texts checked on 2026-11-13 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
What is dual loyalty in medicine?
The situation in which the doctor has obligations both to the patient and to a third party, such as an employer, an insurer, the security forces, a prison or a court.
What does the WMA Code require of a doctor acting for a third party?
To inform the patient at the outset and during the interaction, explain the nature and extent of that commitment and obtain their consent (paragraph 23).
What information may an employer receive after a worker's medical examination?
Only what is needed for its purpose, such as fitness for the job; the detailed diagnosis requires the worker's authorisation or a rule that requires it.
Which Colombian rule protects doctors against pressure that undermines their clinical decisions?
Statutory Law 1751 of 2015, art. 17, which guarantees professional autonomy and forbids any coercion, pressure or restriction.
Elsewhere in DurgiPedia
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: WMA International Code of Medical Ethics (World Medical Association, 2022); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Función Pública, Gestor Normativo, 2015); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo, 1981); Ley Estatutaria 1581 de 2012, por la cual se dictan disposiciones generales para la protección de datos personales (Función Pública, Gestor Normativo, 2012).
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