Medical Ethics and Professionalism – Extended Notes – Confidentiality in Medical Practice

Medical Ethics and Professionalism – Extended Notes – Confidentiality in Medical Practice

• Confidentiality in Medical
• Practice

Learning Objectives

• Define confidentiality
• Explain the principles of confidentiality in medical practice
• Describe the importance of confidentiality in medical practice
• Identify limitations of confidentiality in medical practice
• Definition of Terms
• What is confidentiality?
• Confidentiality: The ethical principle that requires non-disclosure of
• private or secret information with which one is entrusted.
• In research, confidentiality refers to the researcher’s assurance to
• participants that information provided will not be made public or
• available to anyone other than those involved in the research process
• without participants consent.
• The obligation to respect confidentiality applies when a person has
• information in confidence.
• Principle of Confidentiality in Medical
• Practice
• The medical practitioner’s duty to keep patient information
• confidential has been a cornerstone of medical ethics since the time
• of Hippocrates.
• Hippocratic Oath states: ‘What I may see or hear in the course of
• treatment or even outside of the treatment in regard of life of men,
• which in no account one must spread abroad, I will keep to myself
• holding such things shamefully to be spoken about’.
• The World Medical Association International Code of Medical Ethics
• requires that: ‘A physician shall preserve absolute confidentiality on
• all he knows about his patient even after the patient has died’.
• However, other codes reject this absolutist approach to
• confidentiality.
• The high value that is placed on confidentiality has three sources:
• autonomy, respect for others and trust.
• Autonomy relates to confidentiality in that personal information about an
• individual belongs to him or her and should not be known to others without
• his or her consent.
• When an individual reveals personal information to another, a medical
• practitioner or nurse for example, or when information comes to light
• through a medical test, those who have access to the information are bound
• to keep it confidential unless authorized to divulge it
• concerned.
• Confidentiality is also important because human beings deserve respect. One
• important way of showing them respect is by preserving their privacy.
• In addition, the basis of trust between the patient and healthcare
• professionals is the ethical and legal standard of confidentiality that
• healthcare professionals are expected to uphold.
• Without an understanding that their disclosures will be kept secret, the
• patient might withhold personal information.
• This will hinder medical providers in their efforts to provide effective

interventions or to obtain public health goals.

Case Study

• A medical practitioner was playing pool with his colleague, while in
• the process they were discussing about the seriousness of a tumour
• of one school teacher. This conversation was overheard
• of the patient and the patient was informed.
• Questions
• Was the practitioner right to discuss this issue at that location?
• Do you think the patient will prefer again being attended by this
• doctor? Why?

The Importance of Confidentiality in

Medical Practice

• A confidential relationship arises whenever one person entrusts
• confidential information of another person.
• Confidential information is known as secrets.
• Where the person to whom the information has been entrusted or
• conveyed is a medical practitioner, the patient has the right to believe
• that this confidential information will not be conveyed to others
• without the patient’s consent and that it will only be used for the
• purpose for which it has been given.
• The Importance of Confidentiality in
• Medical Practice cntd
• The trust which the patient places in the medical practitioner can be
• viewed as the basis of a healthy practitioner-patient relationship.
• Two important aspects of confidentiality are identified:
• To limit access to information
• To make provision for communication on intimate and other sensitive,
• personal matters
• Vulnerable patients, and in this instance particularly the dying
• patient, would be more willing to reveal personal information and
• secrets and personal information of the patient should not be shared
• unnecessarily.
• The Importance of Confidentiality in
• Medical Practice cntd
• Confidentiality should be viewed as the basis of a confidential
• relationship in which the practitioner is accountable for her/his
• practice.
• In the execution of this professional accountability she/he will not
• disclose any information which is obtained during the care of the
• patient, except with the consent of the patient or a person who may
• make decisions on behalf of the patient, or if the court requires such
• a disclosure.
• The Importance of Confidentiality in
• Medical Practice cntd
• Professional Pledge of Service for medical professional states in as
• follows; ‘I will hold in confidence all personal matters coming to my
• knowledge’.
• Dispute Relating to Confidentiality
• Health care personnel are obliged both legally and ethically to
• maintain strict confidentiality in respect of the patient.
• If this obligation is not met, it may be viewed as a serious ethical
• offence and disciplinary actions may be taken.
• Most institutions lay down strict policy measures in respect of the
• confidentiality of patient information
• It is the practitioner’s duty to acquaint him or herself with these
• measures to prevent being held accountable for the disclosure of
• confidential information.
• Anyone who feels that the disclosure of confidential information in
• certain instances is morally justifiable or even obligatory bears a
• burden of proof which cannot be denied.
• Limitations/Challenges to the
• Requirement to Maintain
• Confidentiality
• Routine breaches of confidentiality occur frequently in most
• healthcare institutions, for example:
• Many individuals, i.e. doctors, nurses, laboratory technicians, and students,
• require access to patient’s health in order to provide adequate care to that
• person and, for students to learn how to practice medicine.
• When patients speak a different language than their caregivers, there is a
• need for interpreters to facilitate communication.
• In cases of patients who are not competent to make their own medical
• decisions, other individuals have to be given information about them in order
• to make decisions on their behalf and to care for them.
• Medical practitioners routinely inform family members of deceased persons
• about the cause of death.
• These breaches of confidentiality are usually justified, but they
• should be kept to a minimum and those who gain access to
• confidential information should be made aware of the need not to
• spread it any further than is necessary for the patient’s benefit.
• Another generally acceptable reason for breaching confidentiality is to
• comply with legal requirements. For example, there is a law for mandatory
• reporting of patients who suffer from designated (notifiable) diseases such
• as cholera.
• In addition to those breaches of confidentiality that are required by law,
• medical practitioner may have ethical duty to impart confidential
• information to others who could be at risk of harm from the patient. There
• are two situations in which this can occur:
• When a patient tells a psychiatrist that he intends to harm another person
• When a physician is convinced that an HIV-positive patient is going to continue to

have unprotected sexual intercourse with his spouse or other partners

Case Study

• You are a passenger in a public bus. Upon boarding a bus from Kibaha
• to Dar es Salaam, Dr. X realized that the driver is a person who is
• attending epileptic clinic at his hospital. Alarmed
• accident if the drive gets an attack, Dr. X stood up and loudly
• announced to all passengers that your life is in danger as the driver is
• epileptic, and any time he can get an accident, then he disembarked
• from the bus.
• Question
• Was the action taken by Dr. X proper?
• Conditions for breaching confidentiality when not required by law
• are:
• The expected harm is believed to be imminent
• Serious (and irreversible)
• Unavoidable except
• Greater than the harm likely to result from the disclosure
• In determining the proportionality of these respective harms, the
• medical practitioner needs to assess and compare the seriousness of
• the harm and the likelihood of their occurrence.
• In case of doubt, it would be wise to seek expert advice.
• When a medical practitioner has determined that the duty to warn justifies
• an unauthorised disclosure, two further decisions must be made.
• Whom should the medical practitioner tell?
• How much to tell?
• The disclosure should contain only that information necessary to prevent the
• anticipated harm and should be directed only to those who need the
• information in order to prevent the harm.
• In case of HIV-positive patient, disclosure to a spouse or current sexual
• partner may not be unethical and, indeed, may be justified when the patient
• is unwilling to inform the person at risk. Such disclosure should require that
• all of the following conditions are met:
• The partner is at risk of infection of HIV and has no other reasonable means of knowing
• the risk
• The patient has refused to inform his or her sexual partner
• The patient has refused an offer of assistance by the physician to do so on the patient’s

behalf

• The healthcare provider has informed the patient of his or her intention to disclose the
• information to the partner
• In medical care of suspected and convicted criminals, healthcare provider
• should safeguard confidentiality by not revealing details of the patient’s
• medical conditions to prison authorities without first obtaining the patients

consent.

Key Points

• Confidentiality is the ethical principle that requires non-disclosure of
• private or secret information with which one is entrusted.
• A confidential relationship arises whenever one person entrusts
• confidential information of another person.
• Professional Pledge of Service for medical professional states in as follows;
• ‘I will hold in confidence all personal matters coming to my knowledge’.
• Health care personnel are obliged both legally and ethically to maintain
• strict confidentiality in respect of the patient.
• There are few exceptions whereby the health care practitioner is obliged to
• reveal some of the patient’s information relevant authority/persons only.
• 277 Assignment
• Apply knowledge of medical laws in disclosing health information
• a) Define the term confidentiality and patient’s privacy
• b) Define disclosure of health information in relation to medical practice
• c) Describe health information to be disclosed
• d) Describe health information to be protected
• e) Describe authorized users of health information
• f) Disclose health information according to medical laws