Excerpt From Medical Ethics: Real-World Application By Afshin Nasser

Confidentiality

The term ‘confidentiality’ refers to the protection of sensitive information. Health care providers respect confidentiality by protecting personal health information to others who have no right to the information and by safeguarding patient information from those without authorization. Providers can violate this duty both intentionally and unintentionally. An unethical physician might intentionally breach confidentiality by selling information about a celebrity patient to a journalist. A nurse might inadvertently violate confidentiality by discussing a patient’s condition with a co-worker in a public area where it may be overheard by other patients or visitors.

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The term ‘confidentiality’ refers to the protection of sensitive information. Health care providers respect confidentiality by protecting personal health information to others who have no right to the information and by safeguarding patient information from those without authorization. Providers can violate this duty both intentionally and unintentionally. An unethical physician might intentionally breach confidentiality by selling information about a celebrity patient to a journalist. A nurse might inadvertently violate confidentiality by discussing a patient’s condition with a co-worker in a public area where it may be overheard by other patients or visitors.

Most prominent federal regulations implemented under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The foundation for these regulations was a perceived threat to patient confidentiality posed by electronic transmission of medical records, the HIPAA privacy regulations require health care providers to protect the confidentiality of personal health information (PHI) recorded or transmitted in any form, including electronic, written, and oral communication. Under these regulations, providers must obtain the patient’s written authorization to use or disclose PHI. There are, however, notable exceptions to this requirement; providers may use and disclose PHI without patient authorization for “treatment, payment, and health care operations” activities, and for twelve “national priority purposes,” including public health and abuse and neglect reporting requirements, law enforcement purposes, and organ donation. Violations of HIPAA privacy regulations may subject health care providers to civil and criminal penalties.

According to the Medical Patients’ Rights Act, a law passed by Congress in 1996, all patients have the right to have their personal privacy respected and their medical records handled with confidentiality. Test results, patient histories, and even the confirmation that the person is a patient, cannot be passed on to another person without the patient’s consent. No information can be given over the telephone without the patient’s permission. No patient records can be given to another person or physician without the patient’s written permission, unless the court has subpoenaed it.

Sharing health information amongst physicians at the time of a referral is common practice. However, the patient must consent for his/her information to be transferred to another physician by signing a release form.

The AMA appeals to an implied duty to obey the law which may override the duty to protect patient confidentiality. Some jurisdictions require health care professionals to report certain

personal health information, including diagnoses of serious communicable diseases, abuse or neglect of children or older adults, gunshot and knife wounds, and poisonings, and so on. These laws require reporting to public health, social services, or law enforcement officers. Enforcing of these reporting practices reflects a social choice that protection of the public’s health and prosecution of serious crimes should override patient confidentiality. Information takes variety of forms. A neurologist providing medical care for a patient with a newly diagnosed seizure disorder and the likelihood of harm to public as a motor vehicle operator. The neurologist may report his assessment to appropriate state agency to suspend the patient’s driver’s license. Other examples are notifying authorities of a psychiatric patient’s intention to harm self or others. Informing the wife of a patient diagnosed with HIV is another difficult yet necessary act.

Q6 An 82-year-old female with multiple comorbidities is diagnosed with lung cancer. She declines surgery, chemotherapy, or radiation therapy. She states that she has lived a good life and is too old for interventions. She lives with her older daughter and she also has a son. She requests that her condition to remain confidential. You determine that she is mentally competent to make that decision. She signs a do-not-resuscitate order and advance directives stating that she does not want to be kept alive by artificial means.

Both the son and daughter call requesting information about their mother’s medical condition.

Who would you discuss the patient’s condition with?

A- Neither daughter nor son
B- Both daughter and son
C- The daughter
D- The son

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State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

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Boundary Violation

Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.

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Medical Ethics: Real-World Application By Afshin Nasser

You may have acquired this book as a result of conflicts with peers, administrators, patients, or State Medical Boards, where the outcomes of those interactions have left you wondering, “…what if I had done things differently?”

In that case, I hope that this book answers some of your questions and guides you with regards to any future quandaries you may encounter.


If you are a healthcare worker seeking to understand the subject of medical ethics, then I hope this book helps you acquire the clarity you seek.
If you are an individual simply curious about medical ethics, then I raise my hat to you for your pursuit of knowledge.