OPINION
BOOCHEVER, Chief Justice.
Like many other states,
Alaska has recently enacted legislation requiring disclosure of the financial interests of public officials and candidates for office. In this case, we consider the applicability and constitutionality of certain provisions of that law, AS 39.50.010,
et seq.,
which has been entitled the Alaska Conflict of Interest law.
Dr. Falcon has appealed from a decision on summary judgment that, as a member of the Kodiak Island School Board, he is required by statute to disclose the names of all patients from or on behalf of whom his professional corporation has received over $100.00 in income during calendar year 1974. He raises three issues:
1. Does AS 39.50.200(8), which defines “source of income” as the
clients
or
customers
of a professional corporation, require disclosure of the names of individual patients of physicians employed by and holding an interest in such corporations?
2. Is a physician exempted from compliance with AS 39.50 on the grounds that disclosure of a patient’s identity violates the legal privilege between physician and patient or is barred by the ethical considerations attendant on the physician-patient relationship?
3. Does the disclosure of the names of individual patients unconstitutionally invade each patient’s right to privacy?
Like the superior court, we find that the statute does require disclosure in the in
stant situation and that such disclosure is not barred by a legal privilege or ethical mandate. We conclude, however, that in the absence of applicable regulations designed to protect certain classes of patients, the Conflict of Interest law impermissibly infringes on a constitutionally-protected zone of privacy.
The central facts of the case are not disputed. Spencer Falcon is a physician licensed under the laws of Alaska to practice medicine. He is actively engaged in practice and maintains an office in Kodiak, Alaska.
During the calendar year 1974, Dr. Falcon was a one-third owner of the Kodiak Island Medical Center, a professional corporation organized under the laws of Alaska. During this time, he derived no income from the practice of medicine except from his interest in the Kodiak Island Medical Center. Payment is made to the Center for services by its physicians.
Dr. Falcon’s practice consists primarily of general medicine. Approximately three to five percent of his time and income relates to psychiatric counselling; approximately two to four percent is concerned with treatment of all varieties of venereal disease and approximately twenty percent of the practice of the corporation involves contraception.
On November 24, 1975, Dr. Falcon was duly appointed a member of the Kodiak Island School Board to fill the unexpired term of a resigning member. As a result of this appointment, he submitted a “Conflict of Interest Statement for Public Official or Candidate” to the Alaska Public Offices Commission (APOC) on a form prescribed by APOC. Although disclosing various data required by the provisions of the Alaska Conflict of Interest law, AS 39.50,
Dr. Falcon did not reveal the names of individual patients from whom the Kodiak Island Medical Center had received over $100.00 in income during the 1974 calendar year.
On December 26, 1975, acting under color of the Conflict of Interest law, the APOC notified the Borough Clerk of the Kodiak Island Borough that Dr. Falcon’s statement was deficient under AS 39.50.030(b)(1) and AS 39.50.200(8).
Dr. Falcon refused to make the disclosures. The Attorney General agreed not to prosecute for nondisclosure if Dr. Falcon would initiate a test case with reasonable diligence.
A suit for declaratory judgment was commenced in February 1976. As there were no disputed issues of material fact, both parties moved for summary judgment on the issues of the applicability and constitutionality of AS 39.50.
After oral argument, the trial court ruled in favor of the APOC. It found that “physicians are no less prone to have possible conflicts of interest than are businessmen .,” and that they are clearly included within the class that must report the names of clients. The court further found no stat
utory or common law privilege sufficient to excuse a physician from revealing the names of his patients. Finally, having determined that Dr. Falcon had standing to raise the argument that disclosure of his patients’ names would unlawfully invade their rights to privacy, the trial court concluded that the statute mandating intrusion into the patients’ privacy constituted a “close and substantial means of accomplishing the over-all purpose of the statute” and was therefore constitutional.
This appeal followed.
I
We first address Dr. Falcon’s contention that the patients of a physician are not “clients” or “customers” and therefore do not fall within the scope of the statute. AS 39.50.030 requires that public officials and candidates reveal, among other data, “the source of all income over $100.” “Source of income” is defined in AS 39.50.200(8) as:
. [T]he entity for which service is performed or which is otherwise the origin of payment; if the person is self-employed by means of . . .a professional corporation . . ., the
“source” is the client or customer of the corporation . .
. . (emphasis added)
The Conflict of Interest law was enacted in 1974 by popular initiative. There is therefore a relative dearth of legislative history to aid in determining the meaning of the statutory language.
In the past, this court has eschewed speculation on the intent of the voters who approved a particular ballot measure;
and, in any event, there appear to be no published arguments made in connection with the vote
which would give some indication of the precise meaning of the chosen language.
Nevertheless, we have little difficulty concluding that a patient of a physician is a client for medical services and falls within the scope of the statute. Our view is supported by the definitions in Webster’s Second International Dictionary,
and these and similar definitions have been relied upon by a number of courts in somewhat different contexts.
It may be true that in the past the terminology ordinarily associated with the medical profession on one hand and business on the other has been distinct. With the burgeoning of “professional corporations,” however, medicine has taken on more of the attributes of the business world, and the language of business has followed. Indeed, in a letter to Dr. Falcon, the director of the Kodiak Island Medical Center refers to the Center’s patients as “clients” and “clientele.”
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OPINION
BOOCHEVER, Chief Justice.
Like many other states,
Alaska has recently enacted legislation requiring disclosure of the financial interests of public officials and candidates for office. In this case, we consider the applicability and constitutionality of certain provisions of that law, AS 39.50.010,
et seq.,
which has been entitled the Alaska Conflict of Interest law.
Dr. Falcon has appealed from a decision on summary judgment that, as a member of the Kodiak Island School Board, he is required by statute to disclose the names of all patients from or on behalf of whom his professional corporation has received over $100.00 in income during calendar year 1974. He raises three issues:
1. Does AS 39.50.200(8), which defines “source of income” as the
clients
or
customers
of a professional corporation, require disclosure of the names of individual patients of physicians employed by and holding an interest in such corporations?
2. Is a physician exempted from compliance with AS 39.50 on the grounds that disclosure of a patient’s identity violates the legal privilege between physician and patient or is barred by the ethical considerations attendant on the physician-patient relationship?
3. Does the disclosure of the names of individual patients unconstitutionally invade each patient’s right to privacy?
Like the superior court, we find that the statute does require disclosure in the in
stant situation and that such disclosure is not barred by a legal privilege or ethical mandate. We conclude, however, that in the absence of applicable regulations designed to protect certain classes of patients, the Conflict of Interest law impermissibly infringes on a constitutionally-protected zone of privacy.
The central facts of the case are not disputed. Spencer Falcon is a physician licensed under the laws of Alaska to practice medicine. He is actively engaged in practice and maintains an office in Kodiak, Alaska.
During the calendar year 1974, Dr. Falcon was a one-third owner of the Kodiak Island Medical Center, a professional corporation organized under the laws of Alaska. During this time, he derived no income from the practice of medicine except from his interest in the Kodiak Island Medical Center. Payment is made to the Center for services by its physicians.
Dr. Falcon’s practice consists primarily of general medicine. Approximately three to five percent of his time and income relates to psychiatric counselling; approximately two to four percent is concerned with treatment of all varieties of venereal disease and approximately twenty percent of the practice of the corporation involves contraception.
On November 24, 1975, Dr. Falcon was duly appointed a member of the Kodiak Island School Board to fill the unexpired term of a resigning member. As a result of this appointment, he submitted a “Conflict of Interest Statement for Public Official or Candidate” to the Alaska Public Offices Commission (APOC) on a form prescribed by APOC. Although disclosing various data required by the provisions of the Alaska Conflict of Interest law, AS 39.50,
Dr. Falcon did not reveal the names of individual patients from whom the Kodiak Island Medical Center had received over $100.00 in income during the 1974 calendar year.
On December 26, 1975, acting under color of the Conflict of Interest law, the APOC notified the Borough Clerk of the Kodiak Island Borough that Dr. Falcon’s statement was deficient under AS 39.50.030(b)(1) and AS 39.50.200(8).
Dr. Falcon refused to make the disclosures. The Attorney General agreed not to prosecute for nondisclosure if Dr. Falcon would initiate a test case with reasonable diligence.
A suit for declaratory judgment was commenced in February 1976. As there were no disputed issues of material fact, both parties moved for summary judgment on the issues of the applicability and constitutionality of AS 39.50.
After oral argument, the trial court ruled in favor of the APOC. It found that “physicians are no less prone to have possible conflicts of interest than are businessmen .,” and that they are clearly included within the class that must report the names of clients. The court further found no stat
utory or common law privilege sufficient to excuse a physician from revealing the names of his patients. Finally, having determined that Dr. Falcon had standing to raise the argument that disclosure of his patients’ names would unlawfully invade their rights to privacy, the trial court concluded that the statute mandating intrusion into the patients’ privacy constituted a “close and substantial means of accomplishing the over-all purpose of the statute” and was therefore constitutional.
This appeal followed.
I
We first address Dr. Falcon’s contention that the patients of a physician are not “clients” or “customers” and therefore do not fall within the scope of the statute. AS 39.50.030 requires that public officials and candidates reveal, among other data, “the source of all income over $100.” “Source of income” is defined in AS 39.50.200(8) as:
. [T]he entity for which service is performed or which is otherwise the origin of payment; if the person is self-employed by means of . . .a professional corporation . . ., the
“source” is the client or customer of the corporation . .
. . (emphasis added)
The Conflict of Interest law was enacted in 1974 by popular initiative. There is therefore a relative dearth of legislative history to aid in determining the meaning of the statutory language.
In the past, this court has eschewed speculation on the intent of the voters who approved a particular ballot measure;
and, in any event, there appear to be no published arguments made in connection with the vote
which would give some indication of the precise meaning of the chosen language.
Nevertheless, we have little difficulty concluding that a patient of a physician is a client for medical services and falls within the scope of the statute. Our view is supported by the definitions in Webster’s Second International Dictionary,
and these and similar definitions have been relied upon by a number of courts in somewhat different contexts.
It may be true that in the past the terminology ordinarily associated with the medical profession on one hand and business on the other has been distinct. With the burgeoning of “professional corporations,” however, medicine has taken on more of the attributes of the business world, and the language of business has followed. Indeed, in a letter to Dr. Falcon, the director of the Kodiak Island Medical Center refers to the Center’s patients as “clients” and “clientele.”
This construction of AS 39.50.200(8) comports with the stated statutory policy. Although the relationship between physicians and their patients ordinarily presents less danger of a conflict of interest than the connection between businessperson and client, the purpose of the statute is to bring to light all conflicts — actual and potential. AS 39.50.010 states:
Findings and purpose,
(a) It is declared by the people of the State of Alaska that the purposes of this chapter are:
(1) to discourage public officials from acting upon a private or business interest in the performance of a public duty;
(2) to assure that public officials in their official acts are free of the influence of undisclosed private or business interests;
(3) to develop public confidence in persons seeking or holding public office, enhance the dignity of the offices and make them attractive to citizens who are motivated to public service; and
(4) to develop accountability in government by permitting public access to information necessary to judge the credentials and performance of those who seek and hold public office.
Once all sources of income are revealed, the public may ascertain whether, in fact, a conflict is “spurious” or significant. A judgment as to the types of conflicts which ought to evoke concern is neither within the province of the courts
nor the public officials whose conduct is monitored for the purpose of maintaining public confidence in the democratic process.
II
Having determined that the statute encompasses individual patients as sources of income, we next consider whether disclosure is barred in this situation because of a legal privilege or ethical obligation. AS 39.50.035 states:
No person subject to-this chapter is exempt from any of its provisions
except to the extent state courts determine that legally privileged professional relationships preclude complete compliance,
(emphasis added)
We have defined the physician-patient privilege in Civil Rule 43(h)(4) as follows:
Physician-Patient Privilege.
A physician or surgeon shall not, against the objection of his patient, be examined in a civil action or proceeding as to any information acquired in attending the patient which was necessary to enable him to prescribe or act for the patient.
Thus, under the rule, the privilege applies only to information acquired by the physician which is necessary for him to act for the patient.
Conceding that the evidentiary privilege does not ordinarily protect the identity of the patient,
Dr. Falcon argues that statutory provisions subjecting him to discipline for unethical conduct creates a legal privilege barring disclosure in this situation.
The ethical responsibilities of a physician to his patient, like those of a lawyer to his client, are indeed broader than the limited evidentiary privilege;
and the
legislature, in providing for discipline, has delegated the formulation of those responsibilities to the profession.
Thus, as a physician, Dr. Falcon may be subject to loss of license, censure or reprimand for violating the State Medical Association declaration that publication of patients’ names by board members in complying with AS 39.50 is unethical.
However, the possibility of professional discipline for unethical behavior is irrelevant to the instant case. The statutory exemption applies only to legal privileges, not ethical mandates. Moreover, to equate ethical directives with legal privilege for purposes of AS 39.50, particularly where, as here, a relevant professional standard has been enacted subsequent to the passage of the Conflict of Interest law, would effectively allow an elite professional group to amend the law by declaring itself exempt. We conclude, therefore, that there is no legal privilege which precludes compliance with the Conflict of Interest law.
Ill
The final and most significant issue in this appeal is whether AS 39.50 impermissi-bly infringes on the right to privacy of the individual patients of a physician.
Since Dr. Falcon concedes that but for the interests of his patients, the public would be entitled to know of any information which could reveal possible conflicts of interest in the performance of his official duties, he has to that extent waived his right to privacy by “voluntarily entering the public arena.”
As he claims an invasion of privacy only on behalf of his patients, we must initially consider his standing to assert the constitutional rights of third parties.
The question of standing involves a determination that there exists the “adversity which is fundamental to judicial proceedings” and is necessary for a fair resolution of the case before us.
Standing is a component
of
justiciability which, under the federal constitution, acts as a limitation on federal court jurisdiction, and is grounded in the “case or controversy” requirement of art. III.
Flast v. Cohen,
392 U.S. 83, 88 S.Ct. 1942, 20 L.Ed.2d 947 (1968). Under
Flast,
the federal constitutional standards of “case or controversy” require adversity and concreteness in order to ensure than “the dispute sought to be adjudicated will be presented in an adversary context and in a form historically viewed as capable of judicial resolution.”
Since the requirement of adversity is neither federally mandated nor required by the Alaska Constitution, the court’s requirement of adversity as a component of standing is essentially a judicial rule of self-restraint.
The court in
Wagstaff v. Superior Court, Family Division,
535 P.2d 1220, 1225 (Alaska 1975), adopted the “injury-in-fact” test to determine the requisite adversity.
Although one United States District Court has denied a physician standing under analogous circumstances,
we conclude that Dr. Falcon may challenge the constitutionality of the Conflict of Interest law on behalf of his patients. There are two reasons for this determination. First is our conclusion that Dr. Falcon’s patients, in attempting to vindicate their rights, would forfeit the very privacy they seek to protect.
See Carey v. Population Services International,
431 U.S. 678, 684 n.
i;
97 S.Ct. 2010, 52 L.Ed.2d 675 (1977). In
NAACP v. Alabama,
357 U.S. 449, 78 S.Ct. 1163, 2 L.Ed.2d 1488 (1958), the standing to raise members’ rights of association was granted to the NAACP in part because the members’ rights could not be effectively vindicated if the members were required to step forward and litigate.
The second basis for our determination that Dr. Falcon may challenge the constitutionality of the law on behalf of his patients is our finding of adversity on the part of Dr. Falcon.
In
Carey,
the United States Supreme Court considered the standing of a corporation, Population Planning Associates, Inc. [PPA], making mail order sales of nonmedical contraceptives and advertising its products in periodicals to challenge a New York statute prohibiting such distribution and advertising to persons under sixteen. Relying on
Craig v. Boren,
429 U.S. 190,192-97, 97 S.Ct. 451, 50 L.Ed.2d 397 (1976),
and a
number of other recent cases,
it held that PPA is among the:
vendors and those in like positions [who] have been uniformly permitted to resist efforts at restricting their operations by acting as advocates for the rights of third parties who seek access to their market or function. 429 U.S. at 195, 97 S.Ct. at 456.
The court found that PPA had standing to challenge the law not only on its own right but on behalf of its potential customers. The corporation had a choice of obeying the statute, with a resultant economic injury, or of disobeying the statutory command and suffering legal sanctions.
Dr. Falcon had a similar choice although . his economic injury is not as direct. We believe that if disclosure is required in all cases, potential patients may be deterred from seeking the services of a physician involved in state or local government. Moreover, although the economic injury to Dr. Falcon may not be as direct as that involved in the above-cited cases as a result of his ethical obligation, he and those similarly situated may be forced to choose between governmental service and professional pursuits.
We turn next to an analysis of the merits of the privacy claim.
While the federal right of privacy derives from a broad reading of the due process clause of the fourteenth amendment
or from “emanations” from other constitutional provisions,
the right to privacy in Alaska is guaranteed by an explicit constitutional provision — art. I, sec. 22 of the Alaska Constitution which states in part:
The right of the people to privacy is recognized and shall not be infringed.
Neither the state nor the federal right to privacy is absolute, but it is part of the judicial function to ensure that governmental infringements of this right are supported by sufficient justification. Under the language of the federal cases, it must be found that the privacy invasion is necessary to a compelling state interest, that the governmental regulation does not sweep too broadly.
Under the Alaska Constitution, the required level of justification turns on the precise nature of the privacy interest involved. We have stated that, like interference with rights of privacy within the home, interference with certain relationships such as the doctor-patient relationship ordinarily mandates a very high level of justification.
There must be a “fair and substantial relation” between the statutory means and a legitimate governmental purpose.
Thus, to determine the validity of the disclosure provisions of the Conflict of Interest law, we must consider both the nature and the extent of the privacy invasion and the strength of the state interest requiring disclosure.
The purposes of Alaska’s Conflict of Interest law as set forth in AS 39.50.010 have been generally regarded as legitimate goals as have similar provisions in other
states.
We agree with those courts and commentators which have found that financial disclosure laws have the purpose of promoting efficient, ethical government and preserving the integrity and fairness of the political process both in fact and in appearance.
One court which considered the constitutionality of a state conflict of interest law found the state’s interest to be compelling but noted that “[e]ven when motivated by a compelling reason, the abridgment of such rights must be accompanied by the least intrusive method.”
While other courts have also found this interest to be “compelling,” outweighing claims of invasion of privacy of a public official or candidate and his family,
none has specifically considered the question presented here.
We, therefore, must determine whether the interest in disclosure to prevent conflicts of interest outweighs claims of privacy by the client of the public
official, as distinguished from claims of privacy by the official.
The decisions of both this court
and the United States Supreme Court
clearly establish that certain types of information communicated in the context of the physician-patient relationship fall within a constitutionally-protected zone of privacy. The nature and weight of a privacy interest in an individual’s identity as a patient or client, however, presents a more difficult issue.
Although some courts have held that the right to privacy does not encompass an individual’s identity in situations in which disclosure is not related to other constitutionally-protected activities such as speech or association,
there is federal authority to the contrary.
In
Roe v. Ingraham,
403 F.Supp. 931 (S.D.N.Y.1975), a three-judge court
considered the constitutionality of legislation requiring a physician to disclose the names of patients who had received prescriptions for particular drugs having a high potential for abuse. Without addressing the identity of the patient as a distinct issue, it held that the federal constitution protected the doctor-patient relationship. The court stated:
[W]e read
Roe v. Wade
as holding implicitly and
Doe v. Bolton
as holding explicitly that the doctor-patient relationship is one of the zones of privacy accorded constitutional protection. . . . While the doctor-patient relationship involved in
Roe
and
Doe
concerned the most intimate personal relationships, sexual relations and “whether to bear or beget a child,” and the right of privacy has primarily focused on home and family, it would be too restricted a reading of precedent for us to hold that the physician-patient relationship here is not constitutionally protected merely because it does not concern medical advice or professional judgments concerning child bearing, (citations omitted) 403 F.Supp. at 936.
An individual’s physical ills and disabilities and the medication he takes, the frequency of his medical consultation are among the most sensitive of personal and psychological sensibilities. There is fear that the adults or children will be stigmatized if their use of the drug becomes known. 403 F.Supp. at 937.
It concluded that since revealing the names of the patients did not further the purpose of controlling over-prescription and inhibiting trafficking, the legislation was over-broad and constitutionally invalid.
On appeal, the United States Supreme Court reversed, finding that the New York program, on its face, did not pose “a sufficiently grievous threat” to the patients’ interests in either the nondisclosure of significant information or in making important decisions independently.
Whalen v. Roe,
429 U.S. 589, 597-598, 97 S.Ct. 869, 51 L.Ed.2d 64 (1977). Pointing to the “security” provisions in the statute, the Court noted that public disclosure of patient identity and information was unlikely:
There is no support in the record, or in the experience of the two States that New York has emulated, for an assumption that the security provisions of the statute will be administered improperly. And the remote possibility that judicial supervision of the evidentiary use of particular items of stored information will provide inadequate protection against unwarranted disclosures is surely not a sufficient reason for invalidating the entire patient identification program, (footnotes omitted) 429 U.S. at 601-602, 97 S.Ct. at 877-78.
We do not read the decision in
Whalen v. Roe
as a rejection of the district court’s conclusion that where the identity of the patient may be linked with stigmatizing personal information, full public disclosure even for legitimate governmental purposes may invade a protected right of privacy. Rather, we regard the opinion as a recognition that where applicable rules or regulations insure that such information will be available only to authorized personnel in the context of a valid governmental program, no constitutional violation has occurred.
Against the background of these state and federal cases, we turn to the facts of the instant controversy and to the mandates of the Alaska Constitution. Initially, we note that, ordinarily, disclosure of the names of persons who have paid more than $100.00 to a physician during a calendar year involves only a minimal invasion of privacy. In the general case, such disclosure indicates to the public only that these persons have seen a doctor. In contrast to the situation presented in
Whalen v. Roe,
it does not suggest the nature of their concern or their treatment.
In particular situations, however, as the state admits, disclosure of the mere fact that an individual has visited a certain physician may have the effect of making public certain confidential or sensitive information.
According to one commentator:
[sensitive information is that which a person desires to keep private and which, if disseminated, would tend to cause substantial concern, anxiety or embarrassment to a reasonable person.
As an example, the commentator suggests:
the decision to have an abortion [is one] which many people would be reluctant to discuss even with their closest friends, (footnotes omitted)
Where an individual visits a physician who specializes in contraceptive matters or whose primary practice is known to be giving abortions and the fact of a visit or rendering of services becomes public information, private and sensitive information has, in our view, been revealed.
Even
visits to a general practitioner may cause particular embarrassment or opprobrium where the patient is a married person who seeks treatment without the spouse’s knowledge or a minor who does so without parental intelligence.
Similar situations would be presented where, because of a specialized practice, the disclosure of the patient’s identity also reveals the nature of the treatment, and the particular type of treatment is one which patients would normally seek to keep private. Some examples would include the patients of a psychiatrist, psychologist or of a physician who specialized in treating sexual problems or venereal disease.
In these situations, at least, we find that the extent to which the governmental interest in promoting fair and honest government would be impeded, does not outweigh the individual’s privacy interest in protecting sensitive personal information from public disclosure. In emphasizing these examples, we reiterate that situations involving specialized practice of psychiatry or venereal disease present the exception rather than the general rule and that, ordinarily, identification as a patient of a general practitioner who also engages in some of these functions does not infringe a significant privacy interest.
Neither the Conflict of Interest law nor any applicable regulations provide a method for exempting certain classes of patients or physicians from the disclosure requirement or for determining whether certain patients fall within special or sensitive classes. The state has suggested that all privacy claims should be resolved on a case-by-ease basis. In our view, however, a case-by-case determination would be excessively burdensome for the doctor, the patient and for the courts.
AS 39.50.050 requires the Alaska Public Offices Commission to promulgate regulations to implement and interpret the provisions of the law. Determination and designation of exempted classes of patients or physicians may best be accomplished by means of regulations enacted with the safeguards and opportunity for public participation provided by Alaska’s Administrative Procedures Act (AS 44.62).
To prevent invasion of the right to privacy guaranteed by art. I, sec. 22 of the Constitution of the State of Alaska, we hold that until appropriate regulations are promulgated, the Conflict of Interest law may not be applied so as to require reporting the names of individual patients of a physician. In addition, the Commission may well wish to promulgate regulations which apply to relationships other than that of physician-patient.
REVERSED IN PART.