Impact of Religious and Moral Beliefs & Confidentiality Flashcards
Examples of services potentially affected by religion, personal values and beliefs:
- Contraception including emergency hormonal contraception
- Sexual health
- Abortion
- Advanced decisions and end of life care
- Pharmacogenetics
Ethical basis for ‘conscience clause’
• Right to obtain contraception versus refusal to meet an obligation • Obligations as a pharmacist versus as a person who is a Catholic/Muslim/Jew • Patient – Autonomy – Beneficence • Healthcare professional: – Autonomy – Non-maleficence Provide person-centred care
Guidance for the pharmacy professional
- Pharmacy professionals have right to practise in line with religion, personal values or beliefs as long as act in accordance with equalities and human rights law and make sure that person-centred care is not compromised
- Think in advance about areas of practice which may be affected and make necessary arrangements, so are not in position where person’s care could be compromised.
- Referral to another health professional may be an appropriate option but may not be appropriate in every situation
Guidance on patient confidentiality
- Duty of confidentiality
- Protecting information
- Disclosing confidential information
• With consent
• Without consent
Justifications for keeping confidences
• Utilitarian argument
– Keeping confidences maximises happiness (utility)
• autonomy argument
– control over personal information
• privacy argument - ‘rights’- based argument
– Universal Declaration of Human Rights
– European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR)
• efficiency argument – public health-based
– healthcare system requires patients to be open and honest
• trust argument - fiduciary relationship
– nature of relationship out of which confidentiality arise
Duty of Confidentiality
- “Maintaining confidentiality is a vital part of the relationship between a pharmacy professional and a person under their care.
- A person may be reluctant to ask for advice, or give a pharmacy professional the information they need to provide proper care, if they believe that the pharmacy professional may not keep the information confidential. ”
- “Pharmacy professionals have a professional and legal duty to keep confidential the information they obtain during the course of their professional practice.”
Confidential information
- electronic and hard copy data
- personal details
- information about a person’s medication (prescribed and non-prescribed)
- other information about a person’s medical history, treatment or care that could identify them
- information that patients or the public share with you that is not strictly medical in nature but that they would expect you to keep confidential.
Data Protection Act 2018
Principles:
– Fairly and lawfully processed. – Processed for limited purposes. – Adequate, relevant and not excessive. – Accurate. – Not kept for longer than is necessary. – Processed in line with your rights. – Secure. – Not transferred to other countries without adequate protection.
Data Protection Act – Sensitive personal data
Includes:
– race – ethnic background – political opinions – religious beliefs – trade union membership – genetics – biometrics (where used for identification) – health – sex life or orientation
Data Protection Act – Rights of Data Subject
You have the right to:
– be informed about how your data is being used
– access personal data
– have incorrect data updated
– have data erased
– stop or restrict the processing of your data
– data portability (allowing you to get and reuse your data for different services)
– object to how your data is processed in certain circumstances
• You also have rights when an organisation is using your personal data for:
– automated decision-making processes (without human involvement)
– profiling, for example to predict your behaviour or interests
Protecting Information:
• It is essential that you take steps to protect the confidential information you are given in the course of your professional practice
– Store information securely
– Do not leave confidential information where it may be seen or accessed
– Do not discuss information that can identify patients where discussions can be overheard
– Do not disclose identifiable information on e.g. social media
Continue to protect a person’s confidentiality
The Caldicott Principles 2013
Refer to information handling in the NHS:
– Principle 1 - Justify the purpose(s) for using confidential information
– Principle 2 - Don’t use personal confidential data unless it is absolutely necessary
– Principle 3 - Use the minimum necessary personal confidential data
– Principle 4 - Access to personal confidential data should be on a strict need-to-know basis
– Principle 5 - Everyone with access to personal confidential data should be aware of their responsibilities
– Principle 6 - Comply with the law
– Principle 7 - The duty to share information can be as important as the duty to protect patient confidentiality
Disclosing information for individual care: Consent–>
• Explicit consent
• Implicit consent
– Consent to the use of confidential patient data for the purposes of delivering safe and effective care is implied by a consent given to care and treatment.
– Reasonable expectation of the person
• Patient can withdraw their consent for sharing data in general or specifically
There are three tests for establishing the conditions under which consent can be implied, all of which must be met :
– Is the person sharing the information a registered and regulated professional or one of their direct care team?
– Is the activity a type of direct care within the scope specified by the professional’s regulatory body?
– Does the professional have a legitimate relationship with the person or persons concerned?
» Information Governance Review 2013
If you decide to disclose confidential patient information you should:
– Use codes or make the information anonymous if you do not need to identify the patient
– Get the patient’s consent if possible
– Disclose the minimum amount of information
– Make sure the recipient knows it is confidential information
– Make records
– Be prepared to justify your actions
Disclosing information with consent:
• This is always the preferred option
• Make sure that it is informed consent
• Decide whether explicit or implied consent is appropriate
• If you are unsure if you have consent, ask
• If a patient with capacity refuses consent
– Respect their decision (unless required to disclose the information)
– Inform them of potential implications
Disclosing information without consent:
- Make every effort to get consent
- Be satisfied that you are required to by law
- Get the request in writing
- Disclose the minimum amount required
Disclosures of confidential information required by law. Examples include:
– The police
– A healthcare regulator – GPhC, GMC etc
– NHS counter fraud investigation officer
– Coroner, Judge, relevant court
• Do not have an automatic right to access all confidential information
• Require a legitimate reason for the request
Disclosures in the public interest
Examples of the public interest:
– To prevent a serious crime
– To prevent serious injury or damage to the health of the patient, third-party or public health
– For the protection of children or vulnerable adults
• Competing interests
– Maintaining confidentiality versus Public interest benefit in disclosing
– Harm by not disclosing versus Consequences of disclosing
Exceptional circumstances
• Children and young people
– with capacity – obligation of confidence
– without capacity – law requires ‘best interests’ approach
• Adults lacking capacity
– law requires ‘best interests’ approach
