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SDLS 2008 Confidentiality
SDLS 2008 Confidentiality
SDLS 2008
Medicine for the intoxicated
Subject: Bioethics Lecture Date: July 15, 2005
Topic: Confidentiality Transcriber(s): JC Oca & Karen
Lecturer: Melchor Frias M.D. No. of pages: 5
CONFIDENTIALITY
Secret
knowledge which a person has the right to conceal
if revealed will affect the one who revealed the secret, the one who has the secret or it will affect others
obligation to keep secrets arises from the fact that harm will follow if the particular knowledge is revealed unless
there are reasons not to conceal it
in one way or another, secrets are concealed for some reason and will cause harm if kept
there are secrets we are obliged to keep
Obligatory Secret
the obligation to keep a secret arises from the fact harm will follow if a particular knowledge is revealed
Three types:
• Natural secret
o not always medical in nature
• Promised secret
• Professional secret
NATURAL SECRET
Avoid harm
a universal rule in medical practice
as medical practitioners it is our duty not to harm our patients
Example
• to keep our patients diagnosis confidential
if harm follows after the revelation of the secret
• then it must be kept instead
once a patient enters the hospital, confidentiality is considered part of the consent
if reported, secret should be kept between you and your preceptor
obligation exists no matter how a person gets information
Examples
• private peculiarities of the person
• hospitalization name of the patient
• consultation diagnosis
Principles:
an obligation to avoid harming others unless there is proportionate reason for risking or permitting the harm
• use proportionality to justify revelation of secrets
• proportionality should be applied in breaking confidentiality
sometimes harm which comes from keeping natural secret outweighs harm caused when secret is revealed
• patient with AIDS who attempt to give blood
o there is a stigma involved when this is revealed
• persons with infectious disease
• if concealing equals harm, then reveal the secret
the form of treatment the patient yet to receive, and anything under the confinement and charts should be kept
confidential
Promised Secret
when broken, the harm caused is more than that of its natural state
Principles:
generally the promise has been exacted because the matter is also a natural secret
• in this case the nature of the secret makes it stricter
the evil of revealing promised secrets arises from the harmful effects of breaking promises
• breaks down communication and social relationship
the promised secret may be revealed if the good to be attained affects the evil that results from the
broken promise as well as, from the nature of the information
• consequences are much worst than natural promises when you break it
• use proportionality principle – would you risk breaking a promise about sensitive information
Proportionality principle
justifies revelation of both natural and promised secrets
weighing out the good and the bad
if the harm from concealing a secret outweighs the harm from revealing the secret, revelation of the
secret can be justified
• weigh the good and bad effects, if it is good, you can reveal it
Professional Secret
knowledge which, if revealed, will harm only the professional’s client, but will do serious harm to the
profession and to the society which depends on the profession for important services
in many cases, this is recognized by law so that a professional would not have to reveal “privileged
communication” even in court
• Statutory Immunity
o protects physicians from testifying
o we may not testify treatment of patient in court due to the:
nature of secret
implied promise
good of profession patients may not trust you
most seriously deal with secret because of (yes, eto nanaman po ):
2
• nature of knowledge
• implied promise
• good of profession and society
recognized by the law so that a professional would not reveal “privileged communication” even in the court
• a physician cannot just disclose information to anyone regarding his patient’s chart, unless he gets the
consent/permission of his patient
• interns/clerks/residents have no right to look into the patient’s chart, unless there is a “need to know”
o people who are allowed to look at the patient’s chart are those:
permitted by the patient
directly involved in diagnosis and treatment
Principles:
importance of this secret in health care is best seen by contemplating the consequences : should patient lose
their faith in the confidentiality of their dealings with health care system
• yung STD case sa U.S….nawalan ng trust yung mga teenagers sa mga physician
because of a law na nag-rerequire sa kanila to report STD cases to their parents…
• patient loses faith in doctors patient will not consult to any doctor anymore
o STD cases are legal exemptions to confidentiality
the condition of the patient’s body is private and is shared only with those he/she
chooses to help him/her, but not with anyone else
• when a patient chooses you to touch his body then he is giving you his trust
EXCEPTIONS OF CONFIDENTIALITY
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• in industrial and military companies pre-employment physical exam, the physician is required to
report any abnormalities of the employee that are work related
o M.D. should be loyal both to the patient and the employer
but loyalty is first provided to the patient
***As long as the patient understands that he is not fully protected by confidentiality, no serious ethical problems may
arise
Patient doctor employer or officer
o consider a public good that must be at stake before revealing the information; if general public at
state justify revelation of information
o one is not allowed to reveal the diagnosis regarding illness of the patient without the permission
of the patient
o in general the physician is not allowed to tell the spouse about the illness of the patient without
the patient’s consent
patient with AIDS – if patient refuses to tell his/her parents, the physician should
tell the patient that he will be the one to the parents
it you tell then patient-physician and husband-wife relationship will be broken
Family
if a patient is incompetent and family asks for the information
• M.D. can reveal some
revealing a certain information of the patient does not establish trust and destroys patient-doctor relationship
always ask a competent patient first before revealing any information
information should be revealed to families if patient is incompetent
• competent patient always assumes that there is promise of confidentiality
o revealing information does not promote trust
physician should always consider the patient first
example: if patient is diagnosed to have cancer
physician should reveal the information to the patient first, but if and when the doctor
thinks that the patient may not take the information, withhold the information first
• relatives can act as surrogate to purposes of getting informed consent for the physician to be able
to reveal information
Media
media personalities and/or public figures still retain their rights for privacy
in such cases, under public pressures and/or demands, the involved patient (personality) should be sought for
revelation and not the health care providers
M.D. can attend press conferences and can reveal information but it should be summarized and not detailed
information can only be divulged if permission is granted by the patient
• politicians and actors
Hospital records
any records regarding patient’s information should be kept confidential
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• 3rd year students required to submit chart review
• for clerks and residents, implicitly can get information for research
use only summarized data (mean, media, mode) without identification
number of people who will be looking at the chart should be kept at minimum (in short, yung may kinalaman
lang sa case ng patient)
done retrospectively
• patient has already been treated and no longer stays in the hospital
a summary data with no identification should be used in publishing a research
Health Insurance
weakens confidentiality and may result to harmful consequences
confidentiality and 3rd party payers refer to involvement with company health insurance (policies are involved
wherein information are revealed)
computerization of health care information represents a potential for the harm of the patients
information can be used against the patient (socio-political impact)
Public good
depends on the legislation necessary for revelation
society needs to speak through specific legislation
examples:
• SARS patients are asked to quarantine themselves, but if they don’t follow…the public should be
warned regarding the case
• AIDS patients – public wants to reveal patients with AIDS because they want to protect themselves
there are no laws of breaking confidentiality about AIDS because most patient are quarantined (except Magic
Johnson)
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Sori guys kung ngayon ko lang ito nailabas… Anyway, goodluck sa lahat ng evals… Ganbatte!!!!
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