14-10-21 - Confidentiality

Question 1

What is the definition of confidentiality?

Answer 1

• When one person discloses information to another, and the person whom the information is disclosed to pledges not to divulge that information to a third part without the confider’s permission.

Question 2

What are 4 reasons why confidentiality is important in medicine?

Answer 2

• Respect for patient autonomy
• Implied promise
• Virtue ethics
• Consequentialism (morality of action judged solely by its consequences)

Question 3

What does common law (from GMC 2017) say regarding confidentiality?

What does the European Convention on Human Rights Article 8 state?

Answer 3

• Common law has established the principle that information given or obtained in confidence should not be used or disclosed further, except in certain circumstances
• European Convention on Human Rights Article 8 states everyone has the right to respect for his private and family life
• There shall be no interference from public authority to exercise this right, unless it is in accordance with law and is necessary for national and public safety, and the freedom and wellbeing of others.

Question 4

What are the 4 common law justifications for breaking confidentiality?

Answer 4

• With the patients consent
• Unable to seeks the patients consent, but is in the patients’ best interests (overall benefit to the patient)
• It is required by law
• It is in the best interest of the public

Question 5

What occurred in the case of W vs Edgell?

Answer 5

• Mentally ill patient convicted of killing 5 people puts in an application to a mental health tribunal to be transferred to a regional unit
• Independent psychiatrist Dr Edgell was asked by Ws legal advisors to provide a confidential expert opinion to show W was no longer a public threat
• Dr Edgell found that he was indeed still dangerous
• Ws application was withdrawn, but Dr Edgell sent a copy of the report to the medical director of the hospital and the home office, as he knew the report would not be included in patient notes.
• W brought an action for breach of confidence; the court ruled the breach was justified in the name of public interest
• However, the court said the risk must be real, immediate, and serious.

Question 6

When is there a duty to warn?

Answer 6

• Doctors have a duty to warn in the name of public interest if the threat is real, immediate, and serious

Question 7

What occurred in the case of X vs Y

Answer 7

• Health authority sought injunction to prevent a newspaper posting an article about 2 practising doctors receiving aids treatments.
• Court balanced public interest in freedom of press against public interest in maintaining hospital records confidentiality
• Court ruled the lack of public information was of little significance
• Disclosure of info was only made to relevant parties, there was no blanket disclosure.

Question 8

List the 4 criteria that define “the public interest” in terms of justifying disclosure of confidential information

Answer 8

• Risk must be real and serious
• Risk must be of physical harm
• Identifiable individual(s)
• Disclosure must only be on need to know basic

Question 9

What are 9 statutory (by law) requirements for disclosure of confidential information?

Answer 9

• Criminal cases
• Public health reasons
• Abortions (in minors-to-minors parents – surgical abortion but perhaps not medical abortion)
• Births & Deaths
• Road traffic offences
• Fertility treatment
• Venereal diseases (limited) (STI)
• Suspicion of child abuse
• Terrorism

Question 10

What are the GMCs professional guidance on disclosure?

When might they be useful?

Answer 10

• Public interest
• Risk of harm to patients or others
• Driving against medical advice
• Crime
• HIV/AIDS – need to disclose info to GP and partner
• Particularly useful when there’s discretion (freedom to decided what should be done in a particular situation) when law allows

Question 11

What is the GMC: 8 key ethical and legal duties of confidentiality for doctors?

Answer 11

• Use the minimum necessary personal information
• Manage and protect information
• Be aware of your responsibilities
• Comply with the law
• Share relevant information for direct care
• Ask for explicit consent
• Tell patients
• Support patients to access their information

Question 12

What are the problems that arise around genetics and confidentiality?

Answer 12

• If one sibling wants their genome sequenced, and the other doesn’t, reactions from the sibling who wanted their genome may reflect the results of the genome sequencing
• There is no way to keep it private.
• Ex BRAC1 gene of breast cancer