[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › [Confidentiality and truth-telling](https://durgical.com/en/medical-ethics/areas/communication/) › Fidelity and dual loyalty # 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. Updated Nov 13, 2026 ## Key points - Fidelity: the patient's interest is the first consideration and their trust is not betrayed. - Dual loyalty: simultaneous obligations to the patient and to a third party (employer, insurer, State, court). - Transparency rule (WMA, paragraph 23): tell the patient at the outset whom the doctor works for and obtain their consent. - Absolute limit (WMA, paragraph 10): never take part in torture or in cruel, inhuman or degrading practices. - The third party is told only what is needed for its legitimate purpose, not the whole record. - Colombia: Law 1751 of 2015, art. 17, forbids pressure on or restriction of professional autonomy. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/medical-ethics/fidelity-and-dual-loyalty/) ## Elsewhere in DurgiPedia - [The doctor as expert witness (perito) under Law 906 of 2004](https://durgical.com/en/forensic-medicine/the-doctor-as-expert-witness-under-law-906-of-2004/) ## Connections ## Related 5 - [Conflicts of interest and relations with industry](https://durgical.com/en/medical-ethics/conflicts-of-interest-and-relations-with-industry/) - [The WMA International Code of Medical Ethics](https://durgical.com/en/medical-ethics/the-wma-international-code-of-medical-ethics/) - [Professional secrecy and confidentiality](https://durgical.com/en/medical-ethics/professional-secrecy-and-confidentiality/) - [Honesty with third parties: insurers, certificates and billing](https://durgical.com/en/medical-ethics/honesty-with-third-parties-insurers-certificates-and-billing/) - [When the doctor is also the investigator](https://durgical.com/en/medical-ethics/when-the-doctor-is-also-the-investigator/) [← All of medical ethics](https://durgical.com/en/medical-ethics/) 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](https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/) (World Medical Association, 2022); [Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=60733) (Función Pública, Gestor Normativo, 2015); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=68760) (Función Pública, Gestor Normativo, 1981); [Ley Estatutaria 1581 de 2012, por la cual se dictan disposiciones generales para la protección de datos personales](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=49981) (Función Pública, Gestor Normativo, 2012). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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