In more severe cases, when the doctor is convinced that the patient is
incapable of controlling himself or does not wish to, or that he has
already committed crimes, he should act as follows: He must explain to
the patient that it is impossible for him to take the responsibility
and that he must be immediately sent to an asylum, in default of which
information will be given against him. We must make him understand
that he is a danger to society and goes beyond the limits of what is
licit, but that if he voluntarily submits to rational treatment,
offering all requisite guarantees on both sides, he (the doctor) is
disposed to avoid any legal action.

The duty of medical secrecy ought never to go so far as to render the
medical man an accomplice of dangerous individuals or criminals. The
lunatic asylum in such cases is the natural refuge for the patient, as
the lazaret is for cases of smallpox or cholera. These cases, however,
require public asylums which are not too large, well organized, with
divisions for different cases, and provided with a sufficient medical
staff.

I have chosen as the first example one of the worst kind of cases
which endanger the public safety. But there are other cases such as
that depicted by Brieux in "_Les Avaries_." A syphilitic subject
wishes to marry before he is cured, and consults his doctor. Does the
whole duty of the doctor consist in dissuading the patient from
marriage? Has he actually the right to be silent when the patient will
not listen to him, and thus allow an innocent young woman to be
contaminated, through respect--or rather idolatry--for medical
secrecy? Is it not rather his duty to say to the patient: "Beware! If
you do not promise to obey me, I will immediately denounce you to your
_fiancee_ and her parents, and will tell them the state of affairs."
It seems to me that this is his duty. In this case the doctor does not
denounce the patient without his knowledge; he threatens him face to
face, and may speak to him as follows: "You have confided in me. I am,
it is true, under the obligation of medical secrecy toward you, so
long as you do no harm to any one. But if, in spite of all my
explanations and warnings, you attempt to marry in your present state,
rendering yourself guilty of infamous deceit toward a family and an
unfortunate young woman whose health you will ruin, trusting in the
obligation of secrecy which ties my tongue, I must inform you that I
have a much high