Ethics: Confidentiality in Clinical Practice Flashcards
Why is confidentiality important from an ethical perspective?
- autonomy
- rights to privacy / common law duty
- welfare/beneficence
- trust depends on it
- general utility concerns
What type of law governs the general basis of confidentiality issues?
- confusing + complex
- primarily “common law” rather than statute law
What is the difference between common and statute law?
- common - occurs in the courts
- statute - queen passes the law + cannot be overruled
Give 2 examples of general statute law
- Data Protection Act 1998
- Human Rights Act 1998
Give 2 examples of specific statute law
- Human Fertilisation & Embryology (Disclosure of info) Act 1992
- National Health Service (Venereal Disease) Regulations 1974, SI 1974/29
What does Article 8 of the Human Rights Act 1998 suggest?
- right to respect for private + family life
- invoked by a case in Finland (disclosure of HIV status in partner)
- Z v Finland (1998) 25 EHRR 371:
- “the protection of personal data…is of fundamental importance to..right for respect for private + family life”
Can the Human Rights Act 1998 be overriden?
- Yes, it’s not absolute - may be overriden
- national security, public safety, crime
- “health and morals”
- “rights and freedoms” etc
What are the 4 rules of acceptable breaches of confidentiality?
- patient consents
- best interests of patient lacking capacity
- public (+private?) interests
- legal requirement
What two things must be balanced in the common law?
- public interest in doctors keeping confidences
- vs
- public interest in protecting society or individuals from harm
What does public interest mean?
- only the ‘most compelling circumstances’ justify a doctor breaching confidentiality (W v Egdell)
- there must be a real + serious risk (not simply a ‘fanciful’ possibility) of physical harm to an identifiable individual or individuals
- disclosure must be made only to those who are in vital need of the info
What are statutory requirements to breach confidentiality?
- notification of birth (inc stillbirths) + deaths
- fertility treatment
- communicable diseases
- termination of pregnancy
- drug addicts
- poisonings + serious work accidents
- terrorism
- court orders under the PCA 1984
When are common places medical professionals accidentally discuss confidential info?
- lifts + canteens
- A&E depts + wards
- computers, faxes, printers
- trains, parties
What did the Audit Commission in 1995 find?
found that ~ 65% of hospital staff took notes out of hosp for purpose of research/audit. often taken home + left in car. 1 doctor sold his car w notes still in the boot!
Issue: genes
Mr Patel has recently been diagnosed with Huntington’s Disease at the age of 45. You have advised him that the condition is “autosomal dominant” and that his 15 and 20 year old children may have inherited the mutated genes. Mr Patel does not want his children to know about his condition or the risks to their health.
What are the ethical/legal issues here? What do you do?
- breach of confidentiality harms Mr Patel + undermines his trust in med profession
- informing children may harm them
- what benefit is there when there is little treatment for huntington’s?
- does family share genetic information in some way?
- informing kids increases their autonomy
This is a case of “breach allowed but not required” - can disclosure avoid or reduce harm, maybe not in this case..
Your patient, Sandra Kazelnicks, was diagnosed with epilepsy a few months ago. You advised her to contact the DVLA in order to determine whether she could continue driving. She agreed to do so. A few months later you see her driving into the hospital car park before you appointment with her. You ask her about this and she admits that she did not get in contact with the DVLA…
What do you do?
- It is the licence holder’s duty to inform the DVLA of any medical condition which may affect driving, and also their insurance company.
The GMC has clear guidelines:
DVLA is legally responsible in deciding if someone is fit to drive. As the patients doctor-it is our responsibility that the patient understands that their condition may impair their ability to drive. If a patient cannot make this decision based on competence, e.g. dementia - then you should inform the DVLA. If a patient refuses to accept a diagnosis or its effect on their ability to drive you can:
- a) seek a second opinion
- b) make every effort to persuade them to stop
- c) IF still continue to drive despite contrary advice-tell the DVLA and tell the patient you have done so in writing.
