WEEK1 - Ethics: Confidentiality in clinical practice

Question 1

What is the hippocratic oath on confidentiality?

Answer 1

And about whatever I may see or hear in treatment, or even without treatment, in the life of human beings – things that should not ever be blurted out outside – I will remain silent, holding such things to be unutterable

Question 2

Why is confidentiality important from an ethical perspective?

Answer 2

• Trust depends upon it
• Common law duty to keep confidences (not just contractual)
• GMC emphasis on confidentiality
  .- autonomy
• right to privacy
• enhances compliance
• patients might reveal more information about themselves

Question 3

What is the legal basis of confidentiality?

Answer 3

• common law (BY JUDGES)
• statute law (MADE IN PARLIAMENT)

.

Question 4

What is said in the common law about confidentiality?

Answer 4

1. Contract.
   - only in private health not NHS
   - if breached court case
2. Tort (harm)
   - which involves negligence (of breach of confidentiality).
3. Equity:
   - need to respect private information
   - have to respect privacy regardless of context
   - Not much compensation available for breach of confidentiality, but you can request an injunction before disclosure happens.

Question 5

What does the statute law state about confidentiality?

Answer 5

1. Data Protection act 1998 = governs the collection, storage and processing of information.
2. Human Rights act 1998= right to respect private and family life.
   - Not absolute
   - can be overriden e.g. nationan/public safety
3. Human fertilization and embryology act 1992
4. National health service regulations 1974 on STI’s
   - health clinic doctors not allowed to pass info on)

Question 6

When must a doctor disclose information?

Answer 6

• if required by law e.g. communicable disease
  = tell patient if need to disclose, no consent needed
• if ordered by judge (doctor can object if want to)

Question 7

What does the common law keep a balance in?

Answer 7

Public interest in doctors keeping confidences

vs

Public interest in protecting society or individuals from harm

Question 8

What does the statute law keep balance in?

Answer 8

Right to respect for private and family life

vs

Right to life & right to freedom of expression

Question 9

When can you breach confidentiality?

Answer 9

• Patient consents
• Best interest of patient (lack capacity)
• Legal requirement
• Public interest (protect society, individuals from harm)
• Detect and prosecute real crime

Question 10

If you need to break confidentiality to protect individuals of society, what do you need to consider?

Answer 10

• Public interest should only be in the most compelling circumstances= SHOULD real and serious risk of physical harm to an identifiable individual or individuals.
• Balance (weighing up) of public interest in doctors keeping confidences vs public interest in protecting society or individuals from harm.
• Need to balance the right to respect for private and family life against other rights e.g. freedom of expression.

Question 11

What things are legally required to disclose?

Answer 11

• notification of deaths
• notification of births
• fertility treatment
• communicable disease e.g. cholera (to health authorities not to like wife lol)
• doctors have no discretion or control

Question 12

How can breaching confidentiality be bad?

Answer 12

• Breaching confidentiality in:

= lifts/canteens
= A&E departments and wards
= computers/faxes/printers
= trains 
= parties.  

• Taking notes out of hospital (66% of hospital staff) for purpose of research/audit.
• Social media sites.
• Trivial information is more complicated .e.g. patient plays golf, but GMC say “patient have a right to expect that information about them will be held in confidence by their doctor”

Question 13

What about death and confidentiality?

Answer 13

GMC:
- ethical duty same after death

LEGAL:

• confidentiality dies with patient
• e.g. public nature of death certificates