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Confidentiality has long been a core value in medical ethics, but the parameters of this value have rapidly evolved. The principle is now best understood in the context of competing loyalties: Physicians owe patients a broad duty to protect confidences, but that duty is limited—in specific circumstances—by a competing obligation to protect the health of others and the general public welfare. The trend is increasingly toward more disclosure. The author examines three areas in which rules governing confidentiality have rapidly evolved in recent decades—the development of a duty to warn or protect potential third-party victims in the wake of the seminal California case of Tarasoff v. Regents; the establishment of a psychotherapist-patient privilege for the federal courts in Jaffee v. Redmond; and the codification of protections for health information under HIPAA—and how these rules have been implemented. The author …