Confidentiality Flashcards
Explain the basic legal principle behind confidentialty
Apply the law governing confidentiality → Basic Legal Principle
Basic Principle – Information gleaned by a health professional should not be divulged to others.
This is well established in case law, but there is no statute.
Parliament has never passed a law requiring doctors to adhere to the rules of confidentiality.
Our understanding comes through cases that have come before the courts and been subject to judicial interpretation.
There is some statutory footing on confidentiality issues through the Data Protection Act.
Explain the Basic Ethical Principle behind confidentiality
Patients will say more if it remains a secret.
The patient has a right to privacy.
Be wary of breaching confidentiality in “corridor conversations”!
Descrobe the principles of the data protection act
Principles:
Personal data shall be processed fairly and lawfully.
Personal data shall be obtained only for one or more specified and lawful purposes, and shall not be further processed in a manner incompatible with that purpose or those purposes.
Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed.
Personal data shall be kept accurate and where necessary kept up-to-date.
Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes.
Personal data shall be processed in accordance with the rights of data subjects under this Act.
Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.
Personal data shall not be transferred to a country outside the EEA unless that country or territory ensure an adequate level of protection of the rights and freedoms of data subject in relation to the processing of personal data.
Explain ruling on confidentiality where children are involved
Children and confidentiality
The decision to maintain or breach confidentiality is based on best interests (this can happen without parental
consent if the child is suffering abuse).
If the child is under 16 and:
o Not Gillick competent: the doctor can breach confidentiality if it is in the child’s best interests (or with parental consent).
o Gillick competent: then he/she can give or refuse consent to disclosure.
o However, confidentiality can still be lawfully breached if it is in the child’s best interests.
Practice Point
As a medical student it is important that you do not enter into an agreement with a child whereby you agree to keep whatever they tell you a secret.
You may find that what they tell you compels you to inform someone and that would ruin the trust that the child has with you and future members of the team.
Explain the cicrumstances under which healthcare professionals may breach confidentiality
There are three circumstances in which healthcare professionals may breach confidentiality:
1) With consent
2) Require by law
3) In the wider public interest
Exception 1 – Implied Consent by presence: the multidisciplinary team (more than one person)
A very common practice but an unusual example of consent.
Rather than express consent (patient says ‘yes’ orally or in writing) we imply that the patient consents to us telling the wider team about their condition, through them being in hospital and realising that other people will be looking after them too.
Clarify who is and who is not part of the team (be careful about telling other medical students about a patient– if they are not part of the team they have no right to know).
Be careful about revealing the identity of patients in publications.
Exception 2 – With Express Consent
When breaching confidentiality to others who are not actively involved in the patient’s care, the patient must give their express consent.
Clarify how much information should be divulged and to whom.
Most relatives (parents) don’t have the right to know in most cases unless the child is not Gillick competent.
In situations of a patient who lacks competence to make a decision about healthcare, the next of kin now have a right to be consulted where practical to do so.
When in doubt about:
o The nature of the information (e.g. attendance at genitourinary clinic)
o The form of the disclosure (e.g. letter to GP, hospital notes, electronic record) o Or to whom (relative, carer)
Then get express consent!
Exception 3 – Required by Statute
Statutes are laws passed in Parliaments.
Examples requiring a breach include:
o Notification of Death
o Notification of Termination
o Treatment of a drug addict with specified drugs
o Notifiable infectious disease (there is a list for highly infectious diseases)
• In each case permission of the patient is not required and the Local Authority must be informed.
Exception 4 – Assisting the Police
The general principle remains the same.
Healthcare professionals are required to provide information (e.g. patient address) but not to gather
evidence.
You can breach confidentiality when:
o Under a warrant from circuit judge;
o To aid police request in identifying drivers suspected of offences; o To aid police in all matters with a suspected terrorist patient.
Exception 5 – Wider Public Interest
• The balance between duty to patient and duty to society, which may be challenged and you must justify your action (or inaction).
o Where there is uncertainty, consult a senior colleague
• For example, somebody about to commit a violent crime or continuing to drive with a medical condition.
A Case to Consider 2:
P comes into A&E smelling of alcohol following a Road Traffic Accident. He tells you he thinks he knocked over ‘some awful state’ on village green. A passer by took down P’s number plate. The receptionist has confirmed to the police that P is in A+E. The police wants confirmation of P’s address and whether he has been drinking alcohol. Can B, the A+E ST1 give the police this information without permission from S?
B may only give the address
o Under the 1988 Road Traffic Act, there is a statutory requirement to provide information to assist
the police in the identification of a person charged with a road traffic offence. However, under the Act, there is no statutory requirement to given any other personal information or to provide evidence unless you are directed to by the Court
W is a history lecturer who has been attending the diabetes outpatient clinic. He has diabetes 2° to alcoholic chronic pancreatitis. He is continuing to drive although he has hypoglycaemic unawareness from unpredictable episodes of severe hypoglycaemia. Debate between doctor and patient trying to obtain agreement of doctor not to inform DVLA otherwise he will lose the job. What should the doctor do?
E should write to DVLA about the driving and at the same time write to the patient telling him what he has done
o While there is no legal duty to inform in this situation, your professional guidance states that if you believe that your patient’s continued driving poses a serious risk of significant harm to toehrs and you have been unable to persuade the individual to disclose, then you have a professional responsibility to inform the DVLA and tell the patient what you are doing
o Only necessary information should be disclosed i.e. his hypoglycaemic unawareness, NOT his diagnosis of chronic alcoholic pancreatitis
o Similarly, while a breach of confidentiality is lawful in this situation, the breach should be the minimum necessary to prevent harm. Therefore only the DVLA should be informed and not W’s employer
A Case to Consider 4:
David, 15yo boy of normal intelligence and understand attends GUM clinic with his mother. He is diagnosed with syphilis. The treatment require IM injection of penicillin. Both David and his mother agree to the treatment. While the treatment, Dr E noticed that David has a variety of anal warts and signs of recent trauma. After he is dressed, Dr E tells David about his findings. David says that he is homosexual and in a relationship with another boy in his school. David says that his parents hate gays and he is not ready to discuss with them. What should Dr E do?
Dr E should ask David to come back to the clinic at a future time to discuss this further.
o Dr E should assess whether he has Gillick Competence → WRONG
o He is 15 yo minor and therefore almost certainly Gillick competent. His welfare is paramount.
o This is a delicate situation and his mother is waiting for him outside for a procedure that should only take a few minutes. You are likely to need time for quite a lengthy discussion with David (is the other boy the same age/coercion) and his warts require treatment
▪ Therefore it will be necessary for him to come back alone to address the issues appropriately
A legal duty of confidentiality is owed to all patients but does not continue after death.T/F
F
A legal duty of confidentiality is owed to all patients and continues after death.
The primary exception to the duty of confidentiality is the consent of the patient. T/F
T
Consent can never be lawfully breached T/F
F
Consent may be lawfully breached if there is a real risk of serious ham to others and that harm can be prevented by disclosure.
In adults lacking mental capacity and in children confidentiality may be lawfully breached provided it is in the individual’s best interests to do so. T/F
T
