I am a physician. Years ago, I saw a young patient with headaches, who disclosed — reluctantly — that he had committed a serious crime and that somebody else took the fall for it. I believe he was telling me the truth (his headaches soon resolved after the confession). Before his admission, I assured him that whatever he told me would not leave the room. Later, without giving specifics, I consulted our hospital lawyer, who told me that we were under no obligation to report the incident, because the patient wasn’t in danger of hurting himself or others. But the future of an innocent man hinges on two people’s consciences, my patient’s and my own. I feel like a coward, hiding behind the Hippocratic oath, doing nothing. NAME WITHHELD

I’m (obviously) not a doctor, and I assume some doctors will vehemently disagree with what I’m about to write. But I feel that the first thing we need to recognize is that the Hippocratic oath represents the ideals of a person who died in the historical vicinity of 370 B.C. Now, this doesn’t make it valueless or inherently flawed. It’s a good oath. But we’re dealing with a modern problem, so I would separate the conditions of that concept from this discussion. And even if you refuse to do that — even if you feel your commitment to this symbolic oath supersedes all other things — keep in mind that one of its cornerstones is to “do no harm.” Are you latently doing harm by allowing someone to be penalized for a crime he did not commit? This is not exactly a medical issue, but your relationship to the problem is still an extension of your position as a physician.

Here is the root of the problem: You promised a man that you would keep his secret in confidence, only to have him tell you something you now view as too important to remain unspoken. The stakes are pretty high; the possibility of someone’s being convicted of a crime that he did not commit is awful. But you’ve painted yourself into a corner. You should not tell someone “Whatever you tell me will never leave this room” if that promise only applies to anecdotes you deem as tolerable. It doesn’t matter if you’re a physician or anyone else. The deeper question, of course, is whether breaking this commitment is ethically worse than allowing someone to go to jail for no valid reason. On balance, I have to say it is not.