What are the 4 ethical grounds for the importance of confidentiality?
- Respect for patient autonomy
- Person has right to decide who has access to their personal info
- Serious breach of confidentiality even if patient isn’t aware about breach
- However, autonomy-based justification does not see anything wrong w/ breaches in patients who lack capacity or awareness - Implied promise:
- Implied contract- patients generally expect doctors to treat info confidentially
- if doctor. breaks confidentiality, patient may feel doctor has broken implied promise - Virtue ethics:
- focuses on what makes a person virtuous, rather than what is the right thing to do in particular circumstances
- Virtuose doctor are trustworthy & respect patient’s confidences
- However, breach of confidentiality varies depending on the physician & role of other virtues- e.g. posting case online might be virtues for some due to sharing experiences & self-education for others. - Consequentialism
- the consequences of breach determine the seriousness of breach
- Serious consequences- patient angry/upset, looses trust in doctor, looses trust in healthcare- leads to poor health care
- However, under consequentialist view, only serious if consequences serious i.e. if patient finds out about breach
- If breach of confidentiality hits media- public loose trust in doctors or avoid disclosing important personal details- results in poor health & more untreated illness
- Positive consequences of breach- doctors learn & gain feedback from their own & other doctors clinical experience, avoids harm to patients or others.
Should doctors report or discuss case histories w/out patient consent?
Con- strict deontological view of confidentiality
- Patients & public expect doctors to respect their confidential info
- Doctors should seek patient consent to discuss w/ others who are not directly involved in patients medical care
- Patient consent should be sought even if patient unlikely to learn about discussion
- Patient consent should be sought regardless if doctor believes patient could identify themselves
Pro- minimal risk (cotsqeuentilist) approach:
- doctors benefit from discussion & publications of clinical cases & experience
- Reporting & discussing cases should minimise risk of self-identification, identification by others- seen as betrayal
- Doctors may report cases that are ‘self-identifiable’ but not ‘other-identifiable’ w/out patient consent if good reason to not obtain consent- however, preferable to avoid self-identification by patient
What are the key legal aspects of confidentiality?
Legal obligation for doctors to keep confidentially- but not absolute;
- some cases where breach of confidentiality is permitted- either if law obliges or law permits
- however, breach should only be to relevant authority or persons
Public interest for patients to be able to trust doctors to maintain confidentiality- important
GMC provides guilders on confidentiality- taken serious by courts
No breach of confidentiality has occurred if patient has given consent or if patient cannot be identified
- Sharing info w/ other members of healthcare team for purpose of best treamtnet not breach
Confidential info must be kept secure
What are the main GMC principles for confidentiality?
- Use minimum necessary personal info & use anonymised info to avoid breach
- Health professionals have duty to manage & protect info against improper access, disclose or loss
- doctors should be aware of their responsibilities in managing & protecting info
- Ensure handling personal info lawfully
- May share relevant info for direct medical care, unless patient has objected
- Explicity consent should be sought to disclose identifiable info about patients for purpose other than their care- consent not required if disclosure required by law or in public interest
- Doctors should, whenever possible, tell patients about disclosure of personal info that they would not expect- keep a record of decisions to or not to disclose
- Doctors should support patients to access their info e.g. by enabling access to health records
What does the Public health Act 1985 require?
Doctor must notify relevant local authority office if he suspects patient of having notifiable disease or food poisoning
Following info must be provided- name, age, sex, address, suspected disease, date of onset & date of admission to hospital
What is the Abortion Act 1967?
Doctor carrying out termination of pregnancy must notify relevant Chief Medical officer- including given name & address of women concerned.
What is the Road Traffic Act 1988?
All citizens must provide police, on request, w/ info that might identify driver alleged to have committed a traffic offence
What is the Human Fertilisation & Embryology Act 2008?
Regulates assisted reproduction & research on human embryos outside human body
Keeps a register recording names of all those provided w/ infertility treatments & all those born as a result of treatment.
Individuals aged over 18- allowed to find out if their on register, if register shows their parents are not their genetic parents & whether they are related to person they propose to marry.
Confidentiality of gamete donors is strictly protected.
- Even patients GP needs consent for info regarding patients infertility treatment,
What is the NHS Venereal Diseases Regulations 1974?
Requires health authorities to ensure info capable of identifying patients w/ STD’s is not disclosed, expect for purpose of treating diseases & preventing its spread.
Such disclosure can only be made to doctor & healthcare team involved in patient’s care- allows contact tracing
Does not allow genitourinary clinic to inform insurance company of patients STD, even w/ patients consent
What is the Children Act 1989?
The child’s welfare is paramount
The child is a person, not object
Children should be brought up by aprons w/out interference of state, unless placed at risk
Family links should be maintained if child is placed out of home
Welfare checklist- following should be taken into account in court:
- wishes & feelings of child
- child’s physical, emotional & educational needs
- any harm the child has suffered or is at risk of suffering
What is the Terrorism Act 2000 & 2006, & Counter-Terroism & Security Act 2015?
Imposes duty on health professionals to report their suspicions that a person has been involved in terrorist activities.
- Even if doctor has not even asked for info
What is the Human Rights Act 1998? What impact has it had on confidentiality?
States everyone has the right to respect for his private life.
Has had little impact on medical confidentiality- public interest in medical confidentiality is considered strong-
- Has had more impact in other settings e.g. confidentiality & media
Is it okay to break confidentiality for public interests?
A breach is justified if the public interest in breaching confidentiality outweighs the public interest in maintaining confidentiality
Breach for public interest in problematic- as there is little guidance from courts as to the meaning of public interest.
Court concludes that in order for breach to be justified- risk must be real, immediate & serious
Only the minimum info necessary to protect public should be disclosed.
Is it oaky to breach confidentiality for genetic diagnosis?
For genetic diagnoses that may imply other family members are at risk of significant illness
- most patients will agree to share info w/ family members.
- patient should be encouraged to share relevant info & their consent should be sought before sharing w/ family
- If patient refuses, still might be justified to disclose info in ‘public interest’ if risk fo death or serious harm
Is it okay to breach confidentiality for STD’s?
Diagnosis of STD’s can have implications for others
GMC recommends doctors seek consent of patient to inform contacts
Doctors should encourage patient to inform partner, as they may also have it & would benefit from early diagnosis & treatment
If patient refuses consent, doctor can inform partner to prevent serious harm to them
It is okay to breach confidentiality to police?
Doctors should not disclose personal info to solicitors or police officer w/out consent (except in circumstances to prevent harm to another person)
Staff are permitted to disclose info to prevent & support detection, investigation & punishment of serious crime &/or to prevent abuse or harm to others.
- if disclosure benefits public disclosure
Serious crime:
- rape
- murder
- manslaughter
- treason
- kidnapping
- child abuse
Does not include theft, fraud or damage to property.
For knife or gunshot wound- doctor should promptly inform police that patient has been. admitted to ED
- Patient should be encouraged to speak to police
- if patient refuses, disclosure of some confidential info may be justified for public interest.
Drivers have legal duty to inform DVLA if their condition affects they safety
- Doctors should ensure patients understand if their medical condition may impair ability to drive & explain that patient should inform DVLA
- If patient continues to drive, doctors should persuade them to stop
- If continues to drive, & their is serious risk of death or harm to others, doctor should disclose info immediately to DVLA
- Before disclosing info, doctors should inform patient of their decision to do so.
Is it okay too breach confidentiality if patient lacks capacity?
Patient lacking capacity cannot five consent for info to be passed onto someone else
Doctors should act in patient’s best interest
- Sharing info about diagnosis, treatment & prognosis w/ close relative would be in patient’s best interest
A patient who lacks capacity has same legal protection from breaches of confidentiality as competent patient.
Confidentiality & children?
Child aged 16y & above is assumed to have capacity to make decisions (unless disability)
- thus, doctor must seek child’s permission in order to discuss case w/ parents
- Also the case for children under 16 who are Gillick competent
If child under 16 who is not Gillick competent- doctor is allowed to discuss medical treatment w/ parents & consent not necessary.
Whether child has capacity or not, breach of confidentiality is permitted is child is at risk of death & serious harm.
Is showing medical records in court proceedings a breach?
Doctors may be asked to show medical records as evidence in court proceedings
- records can be released but w/ permission of patient
Police can not inspect a person’s medical records
If coroner asks to see medical records of dead patient- must be complied w/
If life insurance company requests medical records of dead patient- should only be complied w/ the consent of personal representative of dead persons estate.
When should doctors not breach confidentiality (unless w/ consent of patient)?
Casual breaches e.g. carelessly
To satisfy another persons curiosity
To prevent minor crime or to help conviction of minor crime
to prevent minor harm to someone else
Doctors working in genitourinary clinic- no info that might identify patient for STD should be provided to 3rd party
When can doctors breach confidentiality (to specific authorities only)?
Notifiable diseases
Termination of pregnancy
Births
Deaths
To police, on request for driver of vehicle who is guilty of crime
Under court orders
What is the role of GDPR? Principles
General data Protection Regulations- important component of EU privacy law & of human rights law
Outlines clear roles & responsibilities for the entities involved in the collection, storage & processing of personal data
7 principles;
- Lawfulness, fairness & transparency
- Purpose limitation
- data minimisation
- accuracy
- storage limitation
- Integrity & confidentiality
- Accountability
