Medical confidentiality has long been recognized as one of the fundamental principles of professional ethics and health law, playing a crucial role in maintaining patient trust and protecting privacy. However, in critical situations such as contagious diseases, life-threatening risks arising from a patient’s psychological condition, or serious threats to public health, physicians face a conflict between the principle of confidentiality and the duty to inform—a situation that places them in sensitive decision-making contexts with significant legal, ethical, and jurisprudential challenges. This study, adopting an analytical–comparative approach and drawing upon sources of Imami jurisprudence, domestic legislation, and international regulations, explores the dimensions of this conflict. The findings reveal that although the Iranian legal system emphasizes confidentiality, it lacks clear executive guidelines regarding physicians’ obligation to inform third parties. In contrast, legal systems such as those of the United States, the United Kingdom, and the European Union have established explicit regulations for exceptions to medical confidentiality. Jurisprudential analysis, based on the principle of “la Zarar” (no harm) and the obligation to preserve life, also justifies disclosure of information in emergency situations. The overall conclusion indicates that enacting clear regulations, revising existing laws, developing executive guidelines, and designing supervisory mechanisms can establish a balance between protecting patients’ privacy and physicians’ responsibility toward public health. This innovation not only paves the way for reforming medical law in Iran but also strengthens public trust in the healthcare system and enhances its efficiency.