Confidentiality

Question 1

Define Confidentiality within a medical context.

Answer 1

Confidentiality involves a set of rules or a promise usually executed through confidentiality agreements that limits access or places restrictions on certain types of information.

Question 2

Give 5 examples of how to view Confidentiality within a medical ethics framework

Answer 2

Four quadrants: Autonomy + Beneficence

Human Rights: Privacy

Virtue Ethics: (Hippocratic, keep secrets)

Consequentialist justifications

Builds trust and relationship with patients

Question 3

Outline the two main aspects of one’s professional duty of confidentiality:

Answer 3

A physician:

• Must disclose if required by law (e.g. known or suspected communicable disease). Tell patient if practicable, but no consent required.
• Must disclose if ordered by a judge (but can object if you feel information wanted is not relevant)

Question 4

Both in statute and common law, physicians have a requiremernt to balance two opposing sides of confidentiality. Outline these:

Answer 4

Common Law

Public interest in doctors keeping confidences

vs

Public interest in protecting society or individuals from harm

Statute Law

Human right to respect for private and family life

vs

Human right to freedom of expression (e.g. public interest/newspapers)

NB See also: Data Protection Act 1998

Question 5

What are 3 key points in deciding whether information can be released under the pretence of public interest:

Answer 5

1. Only the ‘most compelling circumstances’ justify a doctor breaching confidentiality

(per Lord Bingham in W v Egdell at 378)

2. There must be a real and serious risk (not simply a ‘fanciful’ possibility) of physical harm to an identifiable individual or individuals
3. Disclosure must be made only to those who are in vital need of the information

Question 6

Name four instances in which one “could” - along with a claim of public interest - argue that a disclosure without consent is justifiable:

Answer 6

1. The patient is not competent to consent
2. Obtaining consent would put others at risk
3. Obtaining consent would undermine the purpose
4. Time is of the essence.

Question 7

Name 8 scenarios in which there is a statutory provision for disclosure:

Answer 7

1. Notifications of deaths and births
   
   • Ethical duty of confidentiality remains same after death – GMC states
   • HOWEVER, legally the duty seems to die with the patient
2. Fertility treatment
3. Notifiable diseases
4. Terminations of pregnancy
5. Poisonings and serious work accidents
6. Addiction to drugs
7. Terrorism
8. Court orders under the PCA 1984

Question 8

Name 5 locations/methods of accidental confidentialy disclosure (or overhearing thereof)

Answer 8

1. Lifts & canteens & corridors – practical issues, discussing info can leak
2. A&E departments & wards – open departments, not private enough
3. Computers & faxes & printers
4. Family & friends – recipients of medical histories are part of decompression as we come home from work
5. Emails & social media

Question 9

Name 7 particularly tricky areas in which confidentiality can cause ethical dilemmas:

Answer 9

1. Genetic diseases
2. Diseases that affect driving
3. Sexually Transmitted Infections
4. Domestic abuse and child abuse
5. Sexually active children
6. Crimes
7. Immigration issues