confidentiality

Question 1

ethical reasons for keeping confidentiality *

Answer 1

Consequences
Autonomy
Duty

Question 2

consequence reasons for keeping confidentiality *

Answer 2

Patients are generally happy to disclose personal information because they trust doctors to keep their information confidential
It is essential that patients disclose personal information for doctors to treat them appropriately
If doctors frequently breached confidentiality, patients would lose trust.
As a consequence patients would be unwilling to disclose personal information

Question 3

problems with the consequentialist argument *

Answer 3

You may be wrong about the consequences - It won’t have any real impact on illegal immigration or the NHS finances
Ignores your duty to the patient
Permits doctors to breach confidentiality whenever - provided the patients don’t find out!

Question 4

describe the importance of autonomy *

Answer 4

Respecting autonomy should be seen as a fundamental principle in medical ethics. Therefore an action that does not respect autonomy is not morally acceptable whatever the outcome (unless there is a justifiable reason for limiting autonomy)

Question 5

confidentiality and autonomy *

Answer 5

Individuals consider it very important that they control who has access to their personal information
Therefore control over one’s personal information is an expression of autonomy
Therefore respecting autonomy requires us to keep personal information confidential unless we are given permission to disclose
However, it is permissible to override autonomy when there is serious and real harm to others

Question 6

problems with autonomy *

Answer 6

even people who don’t have autonomy - infants, adults with mental incapacity, dead patients’ should have their confidentiality respected

Question 7

describe duty *

Answer 7

Certain actions are morally required and others are morally impermissible whatever the outcome ie we have certain moral duties.

Question 8

describe confidentiality and duty *

Answer 8

When a doctor gains personal information about a patient there is an implied promise that this information will be kept confidential
There is a moral duty not to break promises
The duty is owed to ALL your patients
Therefore it is wrong to breach confidentiality unless we are given permission to disclose

Question 9

problems with duty and confidentiality *

Answer 9

you have to disclose some information and hence breach confidenitiality eg in suspected crime/abuse/to relatives of a dead patient

Question 10

how can you alter the duty argument so that you are allowed to breach confidentiality if there is a serious crime *

Answer 10

the pt has a duty as a public citizen to be law abiding

by committing crime they have broken their duty, so you can break yours

Question 11

how do you alter the duty argument for people without capacity *

Answer 11

implied promise to keep confidentiality is true for all patients
with children and adults lacking capacity the doctor has an overriding duty to act in their best interests
Therefore personal information can be disclosed when it is in the best interests of someone lacking autonomy
But it will usually be in the patient’s best interests to only disclose to those involved in the patients care

Question 12

when is it acceptable to break confidentiality *

Answer 12

when there is going to be harm to other people - only share the information necessary to prevent the harm
don’t give information to family members
don’t tell the police without patients consent unless risking harm to other people
acceptable when required by law
when have patients consent

Question 13

basic legal principle for confidentiality *

Answer 13

Information gleaned by a Health Care Professional should not be divulged to others

Question 14

describe implied consent in the MDT *

Answer 14

we assume that patients are happy for us to break confidentiality within the team by the fact that they are in the hospital
however - cannot share information that is beyond the team

Question 15

when do relatives have rights *

Answer 15

when they are a parent of a child without Gillick confidence
if pt lacks competence next of kin has rights to be consulted if practical

Question 16

when should you get express consent *

Answer 16

when sharing information out of the team

when in doubt about the nature of the information, or the form of the disclosure

Question 17

legal cases that require a breach of confidentiality *

Answer 17

Notification of Death
Notification of Termination
Treatment of Drug addict with specified drugs

consent is not required and the authority must be informed
Notifiable Infectious Disease

Question 18

when can you break confidentiality to assist the police *

Answer 18

Under a warrant from a circuit judge
To aid police request in identifying drivers suspected of offences
To aid police in all matters with suspected terrorist patient

Question 19

when do you breach confidentiality in children under 16*

Answer 19

based on best iterests

cant promise to keep secrets

Question 20

when do you breach confidence in children over 16 *

Answer 20

he/she is presumed competent and disclosure should only be made with their consent. But confidentiality can still be lawfully breached if it is in the child’s best interests up to the age of 18
HOWEVER, it will generally not be in the best interests of a competent child to override their competent refusal

Question 21

GMC guidance on personal beliefs and medical practice *

Answer 21

all patients must be treated with respect and not be unfairly discriminated against.
You must explain to patients if you have a conscientious objection to a particular procedure. You must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs.
You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.
You must not refuse or delay treatment because you believe that a patient’s actions or lifestyle have contributed to their condition.

Question 22

ethical grounds that conflict with people being able to practice in their beliefs *

Answer 22

duty - we have a duty to care and not be discriminatory
autonomy - people have the right to choose if they have a treatment or how they live their life so we shouldn’t treat them differently because of this
consequences - cant let people die/have distress because we don’t know how to treat them in some situations because of conscientious objection, cant led there be spread of STIs because religion mean you don’t want to learn about them

Question 23

GMC confidentiality for educational reasons *

Answer 23

should be anonymised
If you disclose identifiable information, you must be satisfied that there is a legal basis for breaching confidentiality - you should usually ask for the patient’s explicit consent before disclosing it to anyone who is not part of the team that is providing or supporting the patient’s direct care. You should make sure that the patient is under no pressure to consent.
. If doctors in training or medical or healthcare students are part of the team providing or supporting a patient’s direct care,3 they can have access to the patient’s personal information, just as other team members do, unless the patient objects

In some cases it might be necessary to disclose personal information, or it might not be practicable to anonymise it or to ask for a patient’s consent. In such cases you may disclose relevant personal information to medical students, doctors in training and other healthcare students and trainees, as long as you are satisfied that information has been made readily available to the patient about the disclosure and of their right to object, and they have not objected. You must also be satisfied that they understand that the information is given in confidence, which they must respect.

Question 24

GMC advice for confidentiality *

Answer 24

Use the minimum necessary personal information. Use anonymised information if it is practicable to do so and if it will serve the purpose.
Manage and protect information. Make sure any personal information you hold or control is effectively protected at all times against improper access, disclosure or loss.
Be aware of your responsibilities. Develop and maintain an understanding of information governance that is appropriate to your role.
Comply with the law. Be satisfied that you are handling personal information lawfully.
Share relevant information for direct care in line with the principles in this guidance unless the patient has objected.
Ask for explicit consent to disclose identifiable information about patients for purposes other than their care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest.
Tell patients about disclosures of personal information you make that they would not reasonably expect, or check they have received information about such disclosures, unless that is not practicable or would undermine the purpose of the disclosure. Keep a record of your decisions to disclose, or not to disclose, information.
Support patients to access their information. Respect, and help patients exercise, their legal rights to be informed about how their information will be used and to have access to, or copies of, their health records.
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