It is generally agreed that confidentiality as a vital part of the professional code in the fields of medicine and mental health. What a patient reveals to the doctor is, therefore, considered as protected information which should not be shared with anyone no matter how revealing it is. Professional bodies stipulate patient confidentiality as an ethical responsibility but in some cases allows breaches on patient confidentiality. Routinely, patients share personal information with their care providers. This paper aims at discussing the opposite views on patient confidentiality drawing a line between circumstances under which patient confidentiality is helpful and when it is not.
Argument for Patient Confidentiality
Encourages patients to speak truthfully and frankly
The proponents of patient confidentiality argue that confidentiality is important because it makes patients to speak frankly and freely having it mind that what they say will not be disclosed to anyone. For this reason, patients would speak the truth and this helps in giving appropriate diagnosis and treatment to the patient (Cohen & Caswell, 2017). Lack of patient confidentiality may cause non-presentation, which may subsequently lead to misdiagnosis and no treatment. If this was the situation, treatment would not have any meaning since it would not have been helpful. The justification of patient confidentiality is based on the behavior of patients when exposed to a different level of confidentiality. There is empirical evidence from different research which proves that patients' behaviors are altered by disclosure practices.
Helps in enhancing patient Autonomy
Another argument for patient confidentiality is the fact that it helps in enhancing autonomy because it gives the patient the power to control personal information. This is part of property rights meaning that the information belongs to the patient and, therefore, it is only the patient who has the right to control personal information. The information may only be released by the doctor upon an agreement with the patient.
Protection of the patient from Stigma
The doctor's decision on confidentiality with an aim of reducing risk to the third party is another strong justification of patient confidentiality. Legal precedents and professional guidance are often justified because in some situations patients’ confidentiality would result in a greater good. For example, in a case where the guardian or parent of a patient has a record of high blood pressure or history of heart diseases, it may be harmful to reveal that a patient is having certain infections. Also, in cases of rape, it is important to maintain patient confidentiality to avoid stigma by the members of the public (Cohen & Caswell, 2017). Fidelity based theory suggests that the doctors are obliged to protect the information shared with them in their medical role and in their practice. In certain cases, like that of rape, the patients are victims and revealing the information may prolong the suffering of the patient as it may add psychological trauma because of stigma from the public. In this case, a patient is a vulnerable party who should be protected.
Physicians are patients’ representatives and therefore should maintain loyalty
It is generally agreed that doctors are representatives of patients and should, therefore, expected to be loyal to their patients at any given time and should not reveal any information of a patient unless with the consent of the patient. This argument is largely accepted by the public who support a standard level of confidentiality.
Even with the importance of patient's confidentiality, there are certain moments when the patient confidentiality may be breached. For example, parents may need to have medical information about their children. This argument is supported by the fact that children may not be capable of managing their health conditions by themselves. There are other cases when patient confidentiality may be waivered.
Patient confidentiality may be waivered when the concerns of public health outweigh an individual right to privacy. This is mostly seen in cases of communicable diseases. Many states have put up laws which require the health experts to disclose certain diseases such as sexually transmitted diseases, HIV/ AIDS and other contagious diseases such as tuberculosis (Wong, Lavoie, Browne, MacLeod & Chongo, 2015). Such laws require disclosure of communicable diseases to specific risk individuals and to the public health agencies. For that reason, disclosure may not only be allowed to public health authorities and care providers but also to the family members. Revealing genetic information is also one of the concerns in public health. While the genetic traits may not be always passed to the children, they cannot be transmitted in the same way that the other contagious diseases can and thus it is not always an issue of importance in the public health debate. Even so, because sometimes a patient may be having a gene for a disease like cancer, sometimes it may be useful to reveal genetic information to the immediate family members of the patient. This is similar to postmortem cases where genetic information may be of great use to predict certain healthcare needs and thus there may be strong arguments in favor of disclosure.
Protecting the vulnerable
Circumstances that involve protection of vulnerable persons such as children are widely accepted as reasons that would justify waiving of patient confidentiality. Disclosing patient's information may be appropriate if the patient is likely to harm the vulnerable like children or if it's a case being treated as a result of sexual abuse. In that case, it may be appropriate for the doctor to disclose the information to help in the investigation or protection of the vulnerable parties (Gibson, 2018). Many states have reposting statutes for child abuse. For example, in the State of Missouri, physicians are required to report the minors who are drug dependent on the department of health (Gibson, 2018). Additionally, certain states have statutes which require the physicians to report any form of abuse ranging from domestic violence, elder abuse, spousal abuse, and rape.
State Registries and Research Purposes
Apart from reporting for the purposes of safeguarding public health and safety, patient confidentiality may also be waivered for purposes of research or information keeping for the registries. When patient information is disclosed to the federal or state agencies, it usually does not reach the public and thus is not seen as breaching the patient confidentiality (Levine, 2017). The information is useful since it allows the officials at the registries to use the data presented for purposes of keeping track of certain statistics on health such as cancer rates. Additionally, the data is used to keep track of developmental disabilities. Sharing medical information for purposes of research may be controversial since the patients who reveal information in confidence can be traced should it be considered necessary. Whereas it is generally agreed that patients should consent before getting into a research study, certain state laws give exceptions to restrictions on patient confidentiality allowing access to the records for purposes of research (Levine, 2017). Since research enables the development of better treatments, it is reasonable that the disclosure of certain medical information may provide a greater good.
Society is concerned with both obtaining information and the right to privacy. While patient confidentiality is important for purposes of proper treatment, there are other situations which may require disclosure of patient confidentiality for the sake of the public, the patient or the third party. Confidentiality laws dealing with medical information are currently undergoing several changes to ensure the right of patient privacy is taken care of and at the same time matters of public interest and the common good are also looked into. As already discussed above, the reasons for breaching patient confidentiality include safeguarding public health and safety and as well as protecting the vulnerable parties such as children.
Cohen, C. E., & Caswell, R. J. (2017). Patient confidentiality and autonomy: how do we account for coercive control?. Sex Transm Infect , sextrans-2017.
Gibson, J. C. (2018). Confidentiality has limits in domestic abuse cases. bmj , 363 , k4950.
Levine, H. (2017). Psychoanalytic Professional Ethics and Patient Confidentiality. Psychoanalytic Discourse/Discours Psychanalytique (PSYAD) .
Wong, S. T., Lavoie, J. G., Browne, A. J., MacLeod, M. L., & Chongo, M. (2015). Patient confidentiality within the context of group medical visits: is there cause for concern?. Health Expectations , 18 (5), 727-739.