The duty to maintain confidentiality is an ancient and weighty obligation and has many beneficial consequences for patients and society generally. interest in disclosure outweighs both the individual’s right to confidentiality, and the public interest in a confidential health service, information can be disclosed without consent, and even in the face of a competent refusal. Lucassen, A., & Parker, M. (2004). While the American Society for Reproductive Medicine guidelines may support disclosure over the objections of the surrogate, the authors argue that such disclosure is a violation of the surrogate’s rights and the physician’s ethical and professional duties. Mrs. B's refusal to share her test results with her daughter places Dr. T in a dilemma. Public Health. Similarly, paragraph (b)(3) recognizes the overriding value of life and physical integrity and permits disclosure reasonably necessary to prevent reasonably certain death or substantial bodily harm. The obvious harm to the patient in this case was his loss of life, but failing to provide needed care can cause substantial harm short of death. Note. 7 ThePresident’sCommissionfortheStudy of Ethical Problems in Medicine and Biomedical and Be- Similarly, the duty of care towards a patien … Confidentiality and fitness to drive: Professional, ethical, and legal duties in the case of the diabetic bus driver S Afr Med J. A study indicated that 72% of Americans believed “the doctor's obligation to treat all sick people” in 1991. A conflict of duties. In the course of duty and relationship with patients the physician must adhere to certain principles of medical ethics (autonomy, non-maleficence, beneficence and justice), rules (fidelity, confidentiality, privacy and veracity) and virtues (compassion, kindness, respect, etc). Patient-physician confidentiality is a fundamental tenet of medical ethics. In Wenden v Trikha, a duty to protect a third party or parties was indicated if a requisite proximity of relationship existed12. duties, as is the case with the physician-patient relationship. These include: Protecting the patient . Likewise, potential harm also is thought to override confidentiality duties on the basis of the familial nature of genetic information. CONFLICTS AND RESOLUTIONS Between a rock and a hard place: AIDS and the conflicting physician’s duties of preventing disease transmission and safeguarding confidentiality. Health Insurance Portability and Accountability Act. The ethical category of Non-Malfeasance represents the doctor’s attempt to avoid any act or treatment plan that would harm the patient or violate the patient’s trust, and has been popularized in the phrase “first, do no harm.” Non-Malfeasance is supported through Confidentiality and Prevention. For instance, an impaired parent should not be allowed to drive. The Supreme Court recognized that physicians may disclose confidential patient information in the limited and exceptional circumstances in which they have reason to believe there is an imminent risk of serious bodily harm or death to an identifiable person or group. The failure of a physician to warn the patient or a third party of a foreseeable risk is a separate and distinct negligent act. This will usually be where disclosure is required to prevent or mitigate a risk of serious harm to others. opiates given to relieve a terminally ill patient’s pain may suppress respirations and hasten death. Thus, although doing no harm should be one's first consideration, it must not prevent the clinician from avoiding all treatments which have some risk attached. Several factors ethically support both a breach of confidentiality and the physician’s duty to warn and protect the third party: the emerging professional consensus that confidentiality is not absolute; the known identity of a third party who stands in harm’s way; the risk to unknown and unidentified sexual partners of the third party; and the deadliness of AIDS. In particular, should a physician be able to breach confidentiality when public health or safety is threatened? CrossRef Google Scholar A conflict of duties Mrs. B’s refusal to share her test results with her daughter places Dr. T in a dilemma. When providing care, consider the risks and benefits and, where significant, discuss these with the patient and record the discussion in the notes. If there is reason to believe that the parent's impaired judgment substantially risks harming the patient or others, the pediatrician should attempt to decrease that risk by the least restrictive means. victim may be insufficient action to prevent harm in certain circumstances. The physician’s European Journal of Human Genetics, 12, 93–97. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is … It is less clear how to deal with the physician’s responsibility to prevent harm to the public. Confidentiality. and legal duties of confidentiality in medicine, the physician’s obligation should be to maintain confidentiality . One day Mr. Richards, a teacher from the school, visits the physician for . prevent a highly likely and foreseeable harm to an identi- fiedindividual. Balancing the competing duties of maintaining privacy in the doctor-patient relationship with minimising potential harm caused by non-disclosure of HIV status is not always easy, says Tak Kwong Chan The theoretical reasons for breaching patient confidentiality to protect a third party from risk of HIV infection are straightforward. The Duty to Preserve Confidentiality . 112 Common Ethics Issues in Rural Communities a check-up. Physician's Duties: Patient's Expectations . Therapeutic nihilism is as unethical as negligent practice. I engage on the concept of “harm” to discuss the moral scope of the duty to warn an involved third party and when it is justified to breach confidentiality of the patient. Medicine has an obligation to protect the well-being of the community. He is also a member of his town’s school board. While reports to CPS do violate ethical duties of confidentiality, one might argue that it is acceptable to breach confidentiality to prevent serious, imminent harm to identifiable individuals.21 A famous US court case, Tarasoff Principle IV of the American Medical Association's Code of Medical Ethicsstates, “[a] physician shall safeguard patient confidences and privacy within the constraints of the law” [1]. The Nigerian National Health Act (passed by both legislative Houses and awaiting the President’s signature) forbids disclosure of medical information save in the following circumstances, namely, the patient consents in writing, the disclosure was made pursuant to a court order or legal requirement, or to prevent a serious threat to public health. In Canada, several cases have provided some guidance since Tarasoff and before Smith v Jones. Current legal and ethical debates highlight duties of the physician that are relevant to the issue of driving. The physician's decision to reveal confidential information in order to prevent harm to the patient or others should be based on the probability of harm, the magnitude of the expected harm, and the possibility of alternative methods for avoiding harm that do not require infringement of confidentiality. A surrogate’s confidentiality must be maintained as it is an essential element of the physician–patient relationship. Concerning the first argument, as noted earlier, most confidentiality laws allow reporting of abuse or neglect. 5 A physician's duty of care includes the duty to identify reasonably foreseeable harm resulting from treatment and, if possible, to prevent it. Such an obligation had been first established more than 140 years earlier than 1991. Some—privacy, confidentiality, continuity of care, and reasonable prudence—are well known and much discussed. case 6.3 | Breaching patient confidentiality to prevent possible harm Andy Cox is a nurse in a physician’s office some 30 miles from his hometown. Two problems attend the question of civil liability for the unprivileged disclosure of medical secrets: First, there is the very basic question of what remedies the law affords to the disgruntled patient. For instance, Sandroff, R (5) and Alistair Kent (6) 3 insist the health professional should ignore the concerned person's right to privacy whenever breach of confidentiality can prevent harm. You may only disclose confidential information in the public interest without the patient's consent, or if consent has been withheld, where the benefits to an individual or society of disclosing outweigh the public and patient's interest in keeping the information confidential. 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