Ethics & Law

Question 1

When may a doctor breach patient confidentiality?

Answer 1

• Disclosure required by statute law e.g. Notifiable Diseases
• Disclosure in court to judges in connection with litigation (NB: not to solicitors or police unless required by law)
• Disclosures in public interest e.g. to prevent serious harm or disease to public
• Disclosures of patients who lack capacity regarding neglect or abuse
• Disclosure after death if required by law or coroner, death certificate, parents inquring to childs death, family asking about adults death if no reason to believe patient would want to withold such information

Question 2

What is the difference between common law and statue law?

Answer 2

Common law is law developed through court cases

Statue law is law created by parliament, statue law overrides previous common law.

Question 3

What is the statue law relevant to confidentiality?

Answer 3

Public health (Control of disease act) 1984

• doctors have a duty to inform their local authority about notifiable infections
• HIV is not a notifiable infection

Question 4

Describe W v Egdell, and its role in breaching confidentiality in public interest.

Answer 4

Case law that established a public interest defence for breach of confidentiality.

Doctors are not compelled to breach confidentially in public interest but they have a potential legal defence for doing so as long as:

Ensure there is a risk o serious harm
Gain consent if possible
Warn patient disclosure will be made
Disclose only to those who need to know 
Keep disclosures to the minimum necessary 
Anonymise information if possible.

Question 5

What ways is confidentiality preserved in practise?

Answer 5

No unauthorised access to records
Only view your own patients records
Password protection
No personal information/medical notes taken outside of the hospital
Unofficial confidential information shredded
No conversation about patient in public places.

Question 6

Describe negligence and the relevance of Bolitho and Bolam test.

Answer 6

To win a claim for clinical negligence the claimant must prove that:

• a duty of care existed
• that duty was breached
• harm was caused by the breach

There is no Good Samaritan law in the UK, but professionally doctors are bound to help those in need. A GP has a duty of care to all persons on its list, and any person who need help in its practise area, a hospital have a duty of care to all patients treated by their employees, doctors have a legal duty to anyone they offer help.

Bolam test establishes the legal standard of care, a doctor is not negligent if he/she acts in accordance with a practise accepted as proper by a responsible body of medical opinion.

Bolitho states it is not enough for the doctor to find a body of opinion that supported their actions but the court has the right to decide that actions are not defensible if they were illogical

Question 7

Describe Burke vs GMC (2005) and its impact to patients rights to request treatment.

Answer 7

Doctors are under no obligation to agree to a patient’s request for treatment if they consider it not to be overall benefit to the patient.

Question 8

Describe the Sidaway case and Montgomery Case and their effects on consenting for risky procedures.

Answer 8

Sidaway established that a doctor has to provide enough information to enable the patient to reach a balanced judgement

Montgomery established that risk communication is based on informing patients of risks that a reasonable patient would want to know, not just the most common risks.

Question 9

How might one help patients reach maximum capacity?

Answer 9

Avoid jargon
Using pictures
Treating concurrent pain
Allowing time for patient to process information
Asking questions at the best time of day for patient
Having a relative/friend present
Ensure a quiet comfortable setting.