Confidentiality - Medical Ethics

Confidentiality

·        Hippocratic Oath: “Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart there from, which ought not to be noticed abroad, I will keep silence thereon, counting such things to be as sacred secrets”

·        NZMA code of ethics:

o   Protects patients secrets even after death

o   Maintain confidence unless patient consents or required by law

·        Benefits:

o   Access to information for the patient‟s benefit

o   Autonomy: patient control over information about them, respect for patient‟s choice

o   Dignity

o   Consequences: positive reinforcement of trust

·        Legal requirements:

o  Health Information Privacy Code 

§  Rule 10 (1): information obtained for one purpose cannot use that information for any other purpose

§  Rule 11(1): An agency must not disclose information unless… 

o  Code of Health and Disability Service Consumer‟s Rights: Every consumer has the right to have his or her privacy respected

·        Legal exceptions:

o  With patient‟s consent

o  Within the team of doctors caring for the patient.  Not disclosed to students unless anonymised

o  Statutory e.g. Notifiable diseases, Land Transport Safety Authority (Driver‟s licence)

o  Disclosure in the public interest: Health Information Privacy Code allows disclose to prevent a

o   „serious and imminent threat‟

o  Common Law: e.g. Tarasoff v Regents of the University of California case, Duncan v Medical

o   Practitioners‟ Disciplinary Committee

·        Special cases:

o  Children: does the child have the understanding and maturity to form a relationship of confidence 

o  Incompetent adults: duty of confidentiality remains. The Health Information Privacy Code allows a representative of the patient to authorise disclosure

o  The dead: Patient‟s representative must authorise disclosure of information.

·        Collection of health information discusses (Privacy code?):

o  Purpose e.g. necessary for a lawful purpose

o  Source: usually individual concerned 

o  Collection: reasonable steps to ensure individuals aware of purposes, recipients and rights of access & correction

o  Manner: e.g. overly intrusive

o  Storage and security

o  Rights of access

o  Right for correction

o  Reasonable steps to ensure accuracy

o  Retention: not kept longer than required

o  Use limited to purpose for which it was collected

o  Limits on disclosure – breaching confidentiality:

§  Necessary to prevent/lessen serious and imminent threat to life/safety

§  Disclosure will lessen or prevent risk

§  Minimal information released compatible with preventing harm

§  Patient must be identified to reduce this risk

§  There is no better alternative

§  Recipient of the information can do something about it